Pediatric Coding Alert

Question: In our practice, we routinely use the Ages and Stages (ASQ) developmental screen with our young patients during their well-child visits. A provider will then review the questionnaire and, depending on the scores, document any concerns they may have. Should we use 96110 or 96112 for this service?

Arkansas Subscriber

Answer: The fundamental difference between 96110 (Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument) and 96112 (Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour) lies in the clinical distinction between a screen and a test.

According to the American Academy of Pediatrics (AAP), “A developmental test requires both objective scoring and subjective observations. When objective measures/scoring are performed only using a standardized instrument, that is a developmental screen” (Source: www.aappublications.org/news/2019/04/03/coding040319). This is reflected in the descriptors for both codes, as 96110 indicates that administering, scoring, and documenting a standardized instrument is all that is required for the service, whereas 96112 indicates that the use of a standardized instrument is optional with the words “when performed.”

It is for this reason that AAP goes on to recommend that you use 96110 when you administer the ASQ screen to assess a child’s development.

Coding note: You can report 96110 with any evaluation and management (E/M) service, including sick and preventive medicine visits providing you append 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 the E/M code to show the E/M service was distinct and necessary at the same visit, or modifier 59 (Distinct procedural service) to the 96110 to show the developmental screen was separate and necessary at the same visit.