Primary Care Coding Alert

Question:

West Virginia Subscriber

Submit 96110 (Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report) when you administer the Modified Checklist for Autism in Toddlers (M-CHAT). If, at the same visit, staff administer a second different screening tool (such as the ASQ, Ages and Stages Questionnaire), some payers will allow you to report 96110 with 2 units. Other payers may require you to report 96110 a second time appended with modifier 59 (Distinct procedural service). Multiple screenings typically occur at a child's 10-month visit (99381, Initial comprehensive preventive medicine evaluation and management of an individual ... new patient; infant [age younger than 1 year] or 99391, Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant [age younger than 1 year]), following Bright Futures Guidelines.

Screenings are separately reportable from preventive medicine services (99381-99387 for new patients and 99391-99397 for established patients). To indicate the M-CHAT administration is a significant and separately identifiable service from the screening, append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure or another service) to 99381-99397.