Pediatric Coding Alert

Question: When the pediatrician scores and interprets multiple Vanderbilt screenings (for instance, four from teachers and two from the patient’s parents), can we report multiple units of 96127, or do we bill just one unit of the code?

Answer: Pediatric practices report that insurers don’t all agree on this issue, but many payers will reimburse you for each form the doctor interprets. They report success by billing multiple units of 96127 (Brief emotional/behavioral assessment [eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale], with scoring and documentation, per standardized instrument), although some payers may prefer a comment on the claim noting that each Vanderbilt was from a different source.

You may have more success billing it as two lines as well: 96127 on the first line, followed by 96127-76 second line with the quantity. Many payers will not recognize units without modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) to indicate that the same procedure was performed more than one time for the same patient, on the same day by the same physician.