Pediatric Coding Alert

Question: I am looking for guidance in billing for PHQ, Vanderbilt, ADHD and SCARED tools. Do all of these fall under 96127? Should we bill 96127 for three units if all these tools are reviewed by provider? And what code can we use if our provider talks with the family regarding the outcome after reviewing these tools?

AAPC Forum Subscriber

Answer: First, all of these tools — the Patient Health Questionnaire (PHQ); the Vanderbilt assessment scale to evaluate and diagnose attention-deficit hyperactivity disorder (ADHD); other ADHD tools, such as the Conners Parent and Teacher Rating Scales; and the Screen for Child Anxiety Related Disorders (SCARED) tool — should be billed using 96127 (Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument).

However, the question of unit billing is difficult to answer as it is so payer-specific. Some payers will prefer billing with units, as you say, while others will prefer line billing using modifier 59 (Distinct procedural service) on successive 96127s.

As for the counseling, you should be able to use an office/ outpatient evaluation and management (E/M) service code from 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …), using 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) to indicate that the counseling is a separate service from the assessments.