Pediatric Coding Alert

Question: A pediatrician receives a completed Teachers Vanderbilt ADHD rating scale in the mail. He interprets it and provides a report in the patient's chart. The physician will discuss the results with the patient and family at the following future appointment. On the day the patient is not present, is 96110 billable? In Pediatric Coding Alert Vol. 12, No 10, the Colorado Subscriber reader question suggests that you have to bill 96110 on the day of another E/M service. Can you confirm this?

Connecticut Subscriber

Answer: You can bill 96110 (Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report) on a date when a patient is not present without a same-day E/M service (such as 99212-99215, Office or other office visit for the evaluation and management of an established patient ...) depending on insurer requirements appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure or other service). The reader question that you refer to indicates that to support 96110, documentation must include the test's interpretation, score, and discussion.

In your scenario, the discussion would occur at the next visit. So you would still have documentation of the discussion; it would just appear on a later date than the test's interpretation.

Alternative: Wait to bill 96110 on the date of service that represents the next visit involving the discussion.  Delaying reporting the full code ensures that the discussion does take place to support billing 96110.