Wiki 96110 Developmental Screening Code Requirements

[cnjacobs15]

I have been researching this endlessly with no clear answer..

We use the SWYC as our tool for developmental screening and have a tool build into Epic. If a Patient is seen for a Well Child check and the developmental portion (milestones and POSI) was all that was completed because there were no specfic concerns upon completion of that portion the Family or Behavior portion is not completed. Is that sufficient enough to bill CPT 96110 or does every section of the tool need to be completed?
Also we do not charge a fee for the code. we have it priced as .01 charge (We are a large FQHC and a very large majority of our patient's have medicaid insurance and it is bundled in the PPS rate regardless)

I hope this makes sense.... Thank you!

 

[rthomas@impcna.com]

In order to bill the screening all sections must be completed. We have the same tool built into our EHR, when all areas are completed we bill Medicaid or commercial insurance for it. We have never had an issue with reimbursement. Since you are doing this with a well child check and more than likely administering vaccines as well as other screenings, make sure you are using appropriate modifiers, this is more than likely why it's getting bundled.