Pediatric Coding Alert

Question: One of our insurance companies started bundling CPT 96110 into the well visit codes 99391-99393. Does a preventive medicine service include a developmental test, such as the Parents' Evaluation of Developmental Status (PEDS)?


Illinois Subscriber

Answer: A preventive medicine service does not include a standardized, validated developmental screen. The national American Academy of Pediatrics Committee on Coding and Nomenclature recommends that you report 96110 (Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report) "in addition to a preventive medicine service code (99381-99397) when a developmental screening tool is used during the course of a well child exam," states the Illinois Chapter of the AAP in its Spring 2004 Bulletin.

Problem: Insurers are often including the screen in the exam code. In fact, the Illinois Department of Public Aid incorrectly assumes "that for third-party payers the billing for the screening is bundled under the preventive well child exams."

Good news: "Medicaid is tackling this issue and trying to ensure that in all states, the 96110 procedure code for developmental/behavioral screening carries reimbursement apart from the bundled well visit if quality instruments are deployed," say Frances P. Glascoe, PhD, and Henry L. Shapiro, MD, in "Introduction to Developmental and Behavioral Screening."

Tip: Send the insurer documentation showing 96110's separate interpretation and report. Many payers want to see this information before recognizing the screen as separate from the E/M visit.