Pediatric Coding Alert

Question: A pediatrician has parents complete a Connor's developmental screening evaluation. He also scores the results of the test. Is it correct to code 96110-52 (Reduced services) in addition to the E/M code for the visit? The doctor feels that the service he provides does not warrant the full reimbursement of the developmental testing code. Is this correct or is there another code you recommend to report this testing?

Texas Subscriber

Answer: Unless the pediatrician actually does the developmental testing, you should not use 96110 (Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report). When your pediatrician only interprets the test, as in your example, you should instead report 90887 (Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient) for the parent consultation. Pediatricians and pediatric develop-mentalists note that insurers pay for 90887, so you should not have any reimbursement problems with the code.

Because 90887 encompasses the pediatrician's work in interpreting the test results and discussing the results with the parents, you should not separately report an E/M code (assuming the child is an established patient: 99212-99215, Office or other outpatient visit for the evaluation and management of an established patient ...) for the visit. Depending on the services rendered, however, you may instead use an E/M code to describe the entire encounter. For instance, if the pediatrician also sees the patient, and counseling and coordination of care dominate the physician/patient face-to-face encounter, you should select the appropriate-level E/M service based on the total time the pediatrician spent with the patient and his or her family. Unless the visit qualifies for a level-five established patient office visit (99215, ... physicians typically spend 40 minutes face-to-face with the patient and/or family, which pays over $117), you will receive higher reimbursement using 90887, which pays more than $87, rather than reporting a lower-level E/M code.