Pediatric Coding Alert

Question: Can you explain the difference between 96127 and 96110? Which assessment instruments go with which code?

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Answer: Though they function in similar ways, and some of the assessment tools they use share similarities, 96110 (Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument) and 96127 (Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument) assess different developmental milestones and behavioral conditions.

Think of 96110 as a developmental assessment and 96127 as a behavioral and emotional assessment. This means that the two codes are best suited to the following commonly used instruments, according to a recent factsheet authored by the American Association of Pediatrics (AAP).

96110

• Ages and Stages Questionnaire - Third Edition (ASQ)
• Modified Checklist for Autism in Toddlers (M-CHAT)
• Parents' Evaluation of Developmental Status (Developmental Milestones) (PEDS/PEDS-DM)

96127

• Ages and Stages Questionnaire: Social-Emotional (ASQ:SE)
• Australian Scale for Asperger's Syndrome (ASAS)
• Beck Youth Inventories- Second Edition(BYI-II)
• Behavior Assessment Scale for Children-Second Edition (BASC-2)
• Behavioral Rating Inventory of Executive Function (BRIEF)
• Connor's Rating Scale 
• Patient Health Questionnaire (PHQ-2 or PHQ-9)
• Parents' Evaluation of Developmental Status (Developmental Milestones) (PEDS/PEDS-DM)
• Pediatric Symptom Checklist (PSC/PSC-Y)
• Screen for Child Anxiety Related Disorders (SCARED)
• Vanderbilt Rating Scales

(For the full list, go to https://www.aap.org/en-us/Documents/coding_factsheet_developmentalscreening­testingandEmotionalBehvioraassessment.pdf)

Coding alert: Both codes require use of standardized tools, such as the ones listed above, that can be administered by clinical staff rather than a qualified health care professional. Also, assessment tools can be performed alongside a separately identifiable evaluation and management (E/M) visit (99201-99215) providing modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) is appended to the E/M service.