Pediatric Coding Alert

Surprise: The AAP still recommends billing the MCHAT with 96110.

You’re aware of the revisions to the behavioral assessment codes that went into effect Jan. 1, but do you know how to use them? We’ve got the lowdown on how to bill these codes, and how to ensure you’re coding properly.

One Big Revision Pairs With A Big Addition

As we reported in Vol. 17, no. 12, CPT® revised the often-used code 96110, and debuted new code 96127 effective Jan. 1. These codes are now defined as follows:

• 96110—Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument
• 96127—Brief emotional/behavioral assessment [eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale], with scoring and documentation, per standardized instrument

Rationale: CPT® established 96127 as a way to report the service associated with administering a standardized behavioral and emotional assessment instrument, including a depression inventory or ADHD scale, said Julia M. Pillsbury, DO, at the AMA’s CPT® Editorial Panel Meeting in November when explaining the updates to these codes. The assessment service helps identify previously-undetected emotional and behavioral conditions in any age of patients, Pillsbury said.

Physician interprets test: “The individual administering the assessment explains the purpose of the instrument to the patient and/or family member and explains the response choices, scores the instrument, records the results, and delivers the results to the physician,” the AMA says in CPT® Changes: 2015. The pediatrician then interprets the results and explains them to the patient and/or his family.

Example: CPT® Changes: 2015 offers the following example of 96127 in clinical use:

An 8-year-old patient reports a history of short attention span, inability to sit through a meal at home, and impulsive comments and actions. For the past six months, he has been irritable and has refused to cooperate both at home and at school. “A parent version of a behavior assessment system for children is administered to his mother and scored. The medical provider explains the results to the mother and notes results in the medical record. A teacher’s version of the behavior assessment tool is sent to the child’s teacher for additional input and a follow-up appointment is scheduled to review the teacher’s responses and discuss diagnosis and treatment options.”

How this differs from 96110: The revision of 96110 clarifies that it now “describes an assessment that is focused on identification of childhood and adolescent development levels (eg, fine and gross motor skills, cognitive level, receptive/expressive and pragmatic language abilities, neuropsychological areas [attention, memory, executive functions] and social interaction abilities) rather than behavioral or emotional status, using a standardized instrument,” Pillsbury said.

Which test applies? Unfortunately, CPT® does not list which specific tests apply to each code. According to the American Academy of Pediatrics’ “Bright Futures and Preventive Medicine Coding Fact Sheet,” however, under the new code structure, you’ll bill the following codes for each type of test:

96110: Examples include (but are not limited to) the Ages and Stages Questionnaire, Third Edition (ASQ), the Modified Checklist for Autism in Toddlers (MCHAT) and the Parents’ Evaluation of Development Status (PEDS).

96127: Examples include (but are not limited to) the Patient Health Questionnaire (PHQ-2 or PHQ-9) and the Beck Youth Inventory.

The AAP’s test assignments may come as a surprise to practices who were expecting to bill the MCHAT with new code 96127. However, you’ll only collect $5.36 for 96127, while 96110 pays almost double that this year. As individual insurers issue guidelines for these codes, keep an eye on Pediatric Coding Alert for more information.

Resource: You can find the AAP’s Bright Futures and Preventive Medicine Coding Fact Sheet at www.aap.org/en-us/professional-resources/practice-support/Coding-at-the-AAP/Pages/Bright-Futures-and-Preventitive-Medicine-Coding-Fact-Sheet.aspx.