Pediatric Coding Alert

BC/BS UHC, tell coder to halt 96110-59 denials with 96110-79.

If you're ready to bill 96110 and 96110-59, think again. One pediatric office was billing 96110 (Developmental testing Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report) with modifier 59 (Distinct procedural service). BlueCross/BlueShield (BC/BS), UnitedHealthcare (UHC), and other insurers were denying the 96110-59s. "I called BC/BS on 8-19-2010 and was told that we should be using a 76 (Repeat procedure or service by the same physician) modifier instead," reports Bonnie Palmer, with Lawrenceville Pediatrics in Georgia. "I also called UHC and was told the same thing." 96110 x 2 or 96110-59 Is Technically Correct Modifier 59 rather than 76 more appropriately describes two distinct 96110s. When you're reporting two 96110s, you're doing so to represent two different tests, not a repeat second test as modifier 76 represents. That being said, the American Academy of Pediatrics prefers that you report multiple 96110s using units rather than any modifier.

Two 96110s indicate that the second developmental test is a separate test. Staff administered -- or the parent completed -- two different tests, such as the Ages and Stages Questionnaire (ASQ) and the Modified Checklist for Autism in Toddlers (MCHAT) -- and that the physician interpreted and documented the tests' interpretation.

Before Using Repeat Method, Obtain Proof

Modifier 76 instead indicates that the second test was repeated. The modifier appropriately describes cases in which staff has to readminister the same test and the physician has to reinterpret the results.

In practice, the old adage is best to follow: Get the policy in writing. If you obtain a modifier directive from an insurer to use modifier 76 for multiple 96110s -- either from the payer's Web site or an email confirmation, save the documentation -- and then adhere to the payers' policies. Just be prepared that you have the supporting documentation to prove why you billed this way.