Primary Care Coding Alert

Don’t forget to brush up on your ADHD coding knowledge.

If your provider has been administering more Vanderbilt Assessment screenings than usual, you shouldn’t be surprised. That’s because attention-deficit hyperactivity disorder (ADHD) diagnoses have been steadily rising over the last few years.

So, what better time to refresh your understanding of coding for Vanderbilt Assessments and ADHD by reading the answers to these frequently asked questions about the condition and the widely used tool used to diagnose it?

What Is the Vanderbilt Assessment and How Is it Administered?

The Vanderbilt Assessment Scales help diagnose ADHD in children 6 to 12 years of age. Parents of the child answer 55 questions that are aligned with the 18 criteria for the condition, along with three other comorbid conditions — oppositional-defiant disorder, conduct disorder, and anxiety/depression — as established in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The results of the parent rating scale can be used in tandem with a 43-question Vanderbilt rating scale administered by the child’s teacher.

Is the Vanderbilt Assessment a Developmental or a Behavioral Screen?

While ADHD is mostly associated with childhood, suggesting that the Vanderbilt Assessment assesses a child’s development, the screen is more accurately regarded as a behavioral screen.

Here’s why: “Developmental screenings really look at a patient’s overall development and will include questions on motor skills, language skills, cognitive function, and possibly questions on social, emotional, and behavioral issues. An emotional or behavioral assessment instrument will look specifically at behavior and emotional health related to key symptoms of behavioral or emotional conditions, such as ADHD, depression, or anxiety,” notes Jessica Miller, CPC, CPC-P, CGIC, manager of professional coding for Ciox Health in Alpharetta, Georgia.

Why Does This Matter?

The distinction matters a lot from a coding perspective, as it determines the CPT^Ò code you will use to bill the service and, thus, the reimbursement you will receive for the service.

For developmental screens and tests you’ll use 96110 (Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument) or 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).

For emotional/behavioral screens such as the Vanderbilt, you’ll use 96127 (Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument).

A note on screens and tests: The difference between 96110 and 96112 lies in how they are administered. Screens involve administering, scoring, and documenting a standardized instrument, while a test involves provider observation and evaluation. But a test, confusingly, may or may not involve the use of a standardized instrument, hence the words “when performed” in the descriptor to 96112.

In other words, “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,” according to the American Academy of Pediatrics (AAP) article “How to Navigate Changes to Developmental Testing, Neurobehavioral Status Exam Codes.”

All of this explains the difference between the Medicare fees for the different services, with Medicare compensating the work involved in developmental testing at $127.12 for 96112 (2025 national nonfacility fee). This is much more than the less work-intensive rate for scoring and interpreting a developmental screen ($11.32 for 96110 at the 2025 national nonfacility fee), and the even lower rate for simply interpreting the results of an emotional/behavioral screen such as the Vanderbilt ($4.53 for 96127 at the 2025 national nonfacility fee).

Can I Bill a Vanderbilt Assessment With an Evaluation and Management (E/M) Service?

Yes. “All screening and testing services can be billed with any E/M service, whether it be a preventive or a sick visit E/M under appropriate circumstances,” advises Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania. You can do this by appending 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 appropriate E/M.

Remember: Since the Vanderbilt Assessment requires teachers and parents to submit questionnaires to get a more objective look at symptoms, “Time spent reviewing these assessments can be counted toward the time used to report an office/outpatient E/M code if done on the same date as the encounter with the patient,” explains Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

Can I Bill a Vanderbilt Assessment Multiple Times?

According to Medicare’s current Medically Unlikely Edits (MUE) table, you can report up to 3 units of 96127 per date of service. Medicare does not specify how many units you can report per year. Depending on payer preference, you might bill per unit or add modifier 59 (Distinct procedural service) to successive codes.

What ICD-10 Codes Should I Use Before, Durning, and After the Assessment?

To justify administering the Vanderbilt Assessment, and before the provider assigns a definitive diagnosis, you’ll look to use a signs and symptoms code that describes the patient’s emotional state at the time. That means turning to the Symptoms and signs involving cognition, perception, emotional state and behavior (R40-R46) codes and choosing a code, or codes, such as the following:

• R41.840 (Attention and concentration deficit)
• R45.81 (Low self-esteem)
• R45.82 (Worries)
• R45.87 (Impulsiveness)
• R45.89 (Other symptoms and signs involving emotional state)

Additionally, you’ll use Z13.39 (Encounter for screening examination for other mental health and behavioral disorders) to document the assessment administration.

Once the provider has made a definitive diagnosis, coding for ADHD becomes tricky. That’s because the provider will have to pin down the exact form of ADHD revealed in the assessment. Depending on the patient’s presentation, you’ll code one of the following:

• F90.0 (Attention-deficit hyperactivity disorder, predominantly inattentive type)
• F90.1 (Attention-deficit hyperactivity disorder, predominantly hyperactive type)
• F90.2 (Attention-deficit hyperactivity disorder, combined type)
• F90.8 (Attention-deficit hyperactivity disorder, other type)
• F90.9 (Attention-deficit hyperactivity disorder, unspecified type)

But be careful. The entry for “Disorder, attention-deficit without hyperactivity (adolescent) (adult) (child)” in the ICD-10 Index directs you to F98.8 (Other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence). While that sounds like another way of coding F90.0, or attention-deficit disorder (ADD), the inclusion terms for F98.8 are very different and include excessive masturbation, nail-biting, nose-picking, and thumb-sucking.

In fact, the term ADD has long been considered outdated, so unless your provider and/or payer express a clear preference for coding ADD to F98.8, you should steer clear of that code and use F90.0 for the condition instead.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC