Pediatric Coding Alert

Question: I know you often recommend 96110 for the MCHAT administration, but we use 99420, which our Medicaid payer advises us to do on its website (www.ncdhhs.gov/dma/healthcheck/guide2011.pdf). It states that for autism screening, which is recommended at 18 and 24 months, we should bill 99420 in addition to the PEDS or ASQ (96110). So now I’m confused. For the MCHAT, should I report 99420 or 96110? Who is the authority to go to for the answer?

North Carolina subscriber

Answer: Unfortunately, there is no one authority that prescribes how it should be billed to individual insurers. Although the American Academy of Pediatrics recommends 96110 (Developmental screening, with interpretation and report, per standardized instrument form ) for all developmental screenings including the MCHAT, that doesn’t mean all payers will listen.  

As most practices are aware, each state’s Medicaid program has its own way of reporting specific services. Because your Medicaid payer actually advises reporting 99420 (Administration and interpretation of health risk assessment instrument (eg, health hazard appraisal) and you have that in writing from them, then you need to report 99420 just for that payer.

For all other payers, bill the more appropriate code 96110. Private payers are much more likely to pay and reimburse at a higher level with this code in most cases.

Important: Never vary from appropriate CPT guidelines and codes unless you have that specific variation documented in writing from the payer.