Wiki Developmental Pediatric Testing 96110, 96111, 96127

[codi.zeibig@gmail.com]

Looking for some advise on coding these services. There doesn't seem to be a lot of information out there on the internet that is more recently updated.
My providers administer test such as ASQ, KSEALS, MCHAT, CARS, GARS, ADOS, STAT, Vanderbilts, CBCLSCQ, Capute Scales, ect. and I am having a bit of a hard time deciphering which test are billed with which codes, more specifically the CARS and GARS test.

It seems that 96110 is billed for test that assess Developmental Milestones and Speech/Language Delays.
96111 appears to be more extensive with testing Cognitive, Motor, Social interaction, language delays, and adaptive ability delays. (Someone told me that this code should be used if we can prove extensive testing time of up to an hour-is this true?)
96127 appears to be used for Emotional and behavioral conditions such as ADHD.

I am newer to Developmental Pediatrics and if you have experience with these test and the requirements, please reply

Thank you

 

[kmikensana]

Hi,

I'm a coder that works really closely with the billers/account analyst for Peds. According to this website below CARS fall under 96127. I'm not sure about GARS (I'm thinking 96110 I'm not one hundred percent sure) but check out the links below. I have more saved on my computer at work. I'll post the link when I find it.

https://pa.performcare.org/.../020116-cpt-code-emotional-behavioral-assessment.pdf

http://www.aappublications.org/content/36/1/19

I know that we have been getting denial if we perform and bill 96127 and 96110 on the same day; one gets paid an the other is denied as inclusive. According to the (N)CCI edit they cannot be billed together even with modifiers. You can bill a maximum of 4 units of 96127 in one day. My recomendation is make sure you are using the appropriate modifiers and 1 line, 1 unit. Something like this:

OV-25
96127
96127-59
96127-59
96127-59

I hope this info helps.

 

[codi.zeibig@gmail.com]

When I coded 96127, I got a bunch of denials for the code because it is a Technical code...I am billing this for professional services. Do you bill these on the facility side or with mod 26?? I am confused on how to proceed with this scenario..

Hi,

I'm a coder that works really closely with the billers/account analyst for Peds. According to this website below CARS fall under 96127. I'm not sure about GARS (I'm thinking 96110 I'm not one hundred percent sure) but check out the links below. I have more saved on my computer at work. I'll post the link when I find it.

https://pa.performcare.org/.../020116-cpt-code-emotional-behavioral-assessment.pdf

http://www.aappublications.org/content/36/1/19

I know that we have been getting denial if we perform and bill 96127 and 96110 on the same day; one gets paid an the other is denied as inclusive. According to the (N)CCI edit they cannot be billed together even with modifiers. You can bill a maximum of 4 units of 96127 in one day. My recomendation is make sure you are using the appropriate modifiers and 1 line, 1 unit. Something like this:

OV-25
96127
96127-59
96127-59
96127-59

I hope this info helps.

 

[Cynthia Hughes]

Professional services and 96127

When I coded 96127, I got a bunch of denials for the code because it is a Technical code...I am billing this for professional services. Do you bill these on the facility side or with mod 26?? I am confused on how to proceed with this scenario..

Code 96127, like code 96110, is valued only for practice expense so there is no payment for the professional component (ie, no payment for physician work). Hope that helps. Cindy