Pediatric Coding Alert

Question: Can the DDST code be used for annual well exams if the questionnaire is completed and documented?

Indiana Subscriber

Answer: You can report 96110 (Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report) for the interpretation and report of a standardized, validated, evidence-based developmental screening tool such as ASQ, ASQ-SE, PEDS, CSBS-DP, or MCHAT that a parent may complete and a professional score and interpret at an E/M visit, typically a preventive medicine service (99381-99395).

Code 96110 lists the Denver Developmental Screening Tool II (DDST-II). American Academy of Pediatrics (AAP) guidelines recommend a developmental screening at 9, 18, (24)*, and 30 months. In addition, AAP autism practice guidelines recommend an autism-specificscreening (for instance, the M-CHAT) be performed at 18 and 24 months.

*Note: 30 months is the preferred age for administering a validated screening tool, but if the physician does not see the child for a 30 month preventive medicine service, a standard screen should be used at the 24 month visit.

You can also use a developmental screening tool any time you, parents, teachers, other professionals, or other caregivers raise behavioral or developmental concerns about the child. An example of a standardized developmental screening tool with interpretation and report for a child six years and older is the Pediatric Symptom Checklist.

Beware: You may want to research using high-quality developmental screening evidence-based tools such as the PEDS, ASQ, and CDI, rather than the DDST-II. The Denver-II screening test is used widely but has modest sensitivity and specificity depending on the interpretation of questionable results, according to the AAP policy statement on Developmental Surveillance and Screening of Infants and Young Children.

In fact, the Oklahoma State Department of Health does not consider a DDST interpretation and report acceptable for 96110. While it is included in the AAP practice guidelines chart of screening tools, the DDST continues to perform less than ideally as a screening tool, according to the agencys Developmental Screening FAQs. The DDST does not have a sensitivity and specificity of 70 percent, which is the standard agreed upon in the AAP developmental screening practice guidelines as the acceptable minimum for a screening instrument. In other words, the DDST screening tools miss too many childrens developmental delays.