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Our organization is having discussions about a Pediatric NP, who started an Outpatient Developmental Screening Clinic.
Our question is, when can an E/M level be coded with CPTs 96112 & 96113?
Of note, our organization does NOT have an outpatient pediatric clinic, we only have this Outpatient Developmental clinic for those children who need to be evaluated sooner than they can get in with our regions larger Hospital which provides Pediatric Psychology and Developmental services. These children are coming to the clinic on referral from their local primary pediatric provider (not affiliated with our organization) who has made the decision they need the services.
The provider in our opinion based off from her documentation, is not doing anything above and beyond the work required to code 96112 as they are coming to this “clinic” specifically for this service determined by their own pediatric provider. We believe that to bill an E/M on top of the developmental screening, it would need to be something truly separately identifiable as outlined by the AMA.
The provider’s argument is that the time spent gathering the patient history and the physical exam of the patient is not that of the screening and should be able to bill the E/M for this time (provider wants to bill a 99205 on every patient in addition to the time for the screening). Again, I am not reading documentation to support this.
thoughts, education, references?
thank you!
Our question is, when can an E/M level be coded with CPTs 96112 & 96113?
Of note, our organization does NOT have an outpatient pediatric clinic, we only have this Outpatient Developmental clinic for those children who need to be evaluated sooner than they can get in with our regions larger Hospital which provides Pediatric Psychology and Developmental services. These children are coming to the clinic on referral from their local primary pediatric provider (not affiliated with our organization) who has made the decision they need the services.
The provider in our opinion based off from her documentation, is not doing anything above and beyond the work required to code 96112 as they are coming to this “clinic” specifically for this service determined by their own pediatric provider. We believe that to bill an E/M on top of the developmental screening, it would need to be something truly separately identifiable as outlined by the AMA.
The provider’s argument is that the time spent gathering the patient history and the physical exam of the patient is not that of the screening and should be able to bill the E/M for this time (provider wants to bill a 99205 on every patient in addition to the time for the screening). Again, I am not reading documentation to support this.
thoughts, education, references?
thank you!
