Pediatric Coding Alert

Question: We want to use 96112 for ASQ-3 questionnaires, but we’re not sure what the code’s descriptor means by “first hour.” How should we time the service? 

Massachusetts Subscriber

Answer: Because 96112 (Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour) describes the administration of a test and not a screen, the service involves a great deal more work than merely administering and scoring an Ages and Stages Questionnaire (ASQ).

At a minimum, the service requires your pediatrician to interpret the test’s findings and provide a report. In addition, per CPT^® guidelines, 96112 “typically include[s] integration of patient data with other sources of clinical data, interpretation, clinical decision making, and treatment planning and report” and may also include “interactive feedback to the patient, family member(s) or caregiver(s) when performed.”

That is why the code’s descriptor uses the term “first hour.” Per CPT^® guidelines, “a minimum of … 31 minutes for 1-hour codes must be provided to report any per hour code.”