Pediatric Coding Alert

Question: Insurers deny 96110 and/or 96110-59 when we bill both at an 18-month-old visit. What might be the problem? Maryland SubscriberAnswer: You're correct in reporting 96110 (Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report) for ageappropriate, standardized developmental screenings (such as Ages and Stages) with and an autism screen (MCHAT). The problem might lie with screening limits. Check your payer contracts to verify any limits on the number of screenings you can perform during a single visit or over a certain period of time.Example: Aetna policies often pay only one unit when you bill two. Aetna also allows only five screenings in the first 36 months of life. If you start screenings before the payer expects, you could run out of reimbursable visits before the child reaches 36 months.Modifier: You'll also submit the appropriate E/M code for the associated well visit (choose [...]