Pediatric Coding Alert

Attention Deficit Hyperactivity Disorder (ADHD) can take a lot of time, both up-front and in follow up. There are effective ways to code for these appointments, depending on the situation. We talked to Judith Wise, CPC, department manager of pediatrics at West Virginia University Hospital in Morgantown, WV. Here are her recommendations for optimal ADHD coding.

1. Prolonged services for initial workups. Because the workups can take three, four, or five hours, Wise uses the prolonged services codes. For the time the pediatrician spends with the child, she uses 99354 for the first hour, and 99355 for each additional 30 minutes. Much of the time may be spent with a social worker, however, and for that time Wise uses 99358 for the first hour, and 99359 for each additional 30 minutes. Whether the codes are for face-to-face patient contact (99354 and 99355) or without direct patient contact (99358 and 99359), Wise bills under the pediatricians name because he is always there, supervising.

Note: The 99358 and 99359 codes cant be used unless the pediatrician has had some face-to-face contact with the patient, either before or after the social worker (or both before and after).

2. Prolonged services for extensive review of records. A new approach to getting reimbursed for evaluating a childs medical records, which can take 1 to 1 1/2 hours, is to use the prolonged services without face-to-face contact codes (99358 and 99359), explains Wise. We conduct an extensive review of medical records before we do anything else, she says. We spend this extra time with every ADHD child, and we havent been able to get reimbursed for it. So were trying something new by utilizing these prolonged services codes. Although the initial response is promising, its too early for definite results. But if youre not being reimbursed at all, trying this cant hurt.

3. Testing codes. For following up on ADHD patients, Wise usually utilizes the codes for central nervous system assessments. The ones she uses depend on what was done. Here are the four main codes that Wises practice submits for ADHD follow-ups.

Note: All but 96110 are coded per hour, and all require extensive documentation and reports to be placed in the child's chart.

96100 - Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, e.g. WAIS-R, Rorschach, MMPI) with interpretation and report, per hour.

96110 - Developmental testing; limited (e.g. Developmental Screening Test II, Early Language Milestone Screen), with interpretation and report.

Note: 96110 coding is not determined by time spent with a patient but by what is done during the exam.

CPT 96111 - Developmental testing; extended (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments) with [...]