Question regarding billing an e/m and 96112 same DOS

plbarber

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Bastrop, TX
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Hello,
I have a question that was asked by our Developmental Behavioral Pediatrics provider.

"Can you give me any information about changes to the 96112 procedure CPT code? Are there any changes to it in the new year? I typically use 96112 with time based E/M codes, are there any new restrictions for that combination"?

In doing some research there are no changes to CPT 96112.. With the new elements of time based coding allowing the provider to include the new activities.
What would be the best advice to give her regarding reporting the components of each code separately? I apologize if this sounds like a dumb question...My brain is fried.
 
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Beaverton, OR
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Hello,

Advise your provider that to report the code level based on time, the documentation must support what’s reported. For evaluation and management (E/M) time-based reporting, the encounter note must indicate the total time spent and should clearly state what the time was spent on. When your provider starts counting time for the 2021 codes, they should not include time spent on services reported separately. For example, if they report behavioral testing using a separate CPT® code, they should not include that in the time for the E/M code.

The developmental testing codes should be reported when a standardized instrument is used to assess developmental skill acquisition or developmental status. Developmental testing may be performed at initial and follow-up encounters and in conjunction with other services such as an E/M service. Codes 96112 and 96113 are reported for the total time spent administering, scoring, observing, interpreting, making clinical decisions, and generating reports related to the entire standardized test battery. The provider must spend at least 31 minutes performing these services to use a developmental testing code, and time must be clearly documented.

You can find more information on what's changing for E/M Codes on AAPC's website at https://www.aapc.com/evaluation-man...-2021.aspx#OfficeOutpatientEMCodingBefore2021.

Hope that helps!
Stacy Chaplain, MD, CPC
Development Editor
AAPC
 

plbarber

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Messages
4
Location
Bastrop, TX
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Hello,

Advise your provider that to report the code level based on time, the documentation must support what’s reported. For evaluation and management (E/M) time-based reporting, the encounter note must indicate the total time spent and should clearly state what the time was spent on. When your provider starts counting time for the 2021 codes, they should not include time spent on services reported separately. For example, if they report behavioral testing using a separate CPT® code, they should not include that in the time for the E/M code.

The developmental testing codes should be reported when a standardized instrument is used to assess developmental skill acquisition or developmental status. Developmental testing may be performed at initial and follow-up encounters and in conjunction with other services such as an E/M service. Codes 96112 and 96113 are reported for the total time spent administering, scoring, observing, interpreting, making clinical decisions, and generating reports related to the entire standardized test battery. The provider must spend at least 31 minutes performing these services to use a developmental testing code, and time must be clearly documented.

You can find more information on what's changing for E/M Codes on AAPC's website at https://www.aapc.com/evaluation-man...-2021.aspx#OfficeOutpatientEMCodingBefore2021.

Hope that helps!
Stacy Chaplain, MD, CPC
Development Editor
AAPC
Thank you very much!
 
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