Pediatric Coding Alert

Question: A pediatrician performs two 96110s -- a PEDS and an ASAS. Can I report 96110 multiple times?

California Subscriber

Answer: Yes, for each interpretation and report of a standardized, validated screening tool, you should report 96110 (Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report). The code specifies testing in the singular, not "testing(s)" meaning singular or plural.

You can report multiple screens with either units or modifier 59 (Distinct procedural service). For payers that accept units, you would report I&Rs of the Parent Evaluation of Developmental Status (PEDS) and Australian Scale for Asperger's Syndrome (ASAS) as 96110 x 2 units. If a payer does not accept units, instead attach modifier 59 to the second test code.

Example: Following American Academy of Pediatrics' Bright Futures guidelines, at an 18-month-old established patient preventive medicine service, a parent completes the PEDS and ASAS questionnaires that screen for developmental delays and autism. A nurse places the answer sheet on the front of the patient's chart.

The pediatrician scores and reviews the forms. The physician asks some additional questions of the mom and confirms that the screens are "normal." The pediatrician discusses the normal screen with the parent. For a payer that does not recognize units, you could code the preventive medicine service plus multiple screens with the following:

• 99392-(25) -- Periodic comprehensive preventive medicine reevaluation and management of an individual ...; early childhood (age 1 through 4 years); significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service. Although CPT does not require modifier 25 on a same-day E/M service with a medicine code, some insurers require the modifier to indicate the screens are significant and separate from the preventive medicine service.

• 96110

• 96110-59

• V20.2 -- Routine infant or child health check.