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96110 vs 99420

Lori Posted Wed 12th of September, 2012 19:57:55 PM

we are billing 96110 for a development screening at ages 9,15,18,30 months ..code 99420 we are billing for ADD pts and Autism pts ..the parent or teacher will complete a Vanderbilt form and return it to our office the Dr. will review the forms and we will bill it to the Insurnace co's for pmt. I see in supercoder notes it states to bill 96110 for the Vanderbilt scale is that correct like I stated we are billing 99420 for the Vanderbilt...thks

SuperCoder Answered Thu 13th of September, 2012 21:09:55 PM

If you are performing a complete physical on the patient, then you should use the preventive-medicine codes, and not 99420. This code is to be used for a health risk assessment, not for an exam. If your provider does an abbreviated physical for the sports, school or work form, then do not use the preventive-medicine codes, but use an evaluation and management (E/M) code appropriate to the type of treatment provided. It is important to use the proper ICD-9 code with the visit: V20.2 (routine infant or child health check) and V70.3 (other medical examination for administrative purposes).

Diabetes, ADD, and asthma aren’t always an E/M-only visit. Collect for your other services as well with these tips.

Stop missing opportunities to bring in extra payment when you perform care above and beyond an E/M service when treating children who have special needs. This quick primer will make sure you’re all set to collect everything you document when seeing your patients.

Keep Continuum of Care in Mind With ADD

You can capture the initial service and ongoing visits for attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD), if you code based on a coding continuum of care.

Diagnosis, maintenance, interval checks and reassessment of ADD/ADHD with an established patient can be nurse-only, brief, or involved-physician visits. You’ll start out when the pediatrician diagnoses a patient with ADD (314.00, Attention deficit disorder; without mention of hyperactivity) or ADHD (314.01, … with hyperactivity) by typically looking at a high-level E/M service, such as a 99214 or 99215, particularly if you base your coding on the face-to-face time spent with the patient and/or family counseling and coordinating care.

Tip: Because counseling is usually a predominant component of ADD/ADHD initial diagnosis sessions, anticipate using time to code these encounters, which may take as long as an hour. Encourage the physician to document the counseling session’s content, the total face-to-face time spent, and the time devoted to counseling/coordinating care related to the ADD/ADHD disorder. When over 50 percent of the total face-to-face encounter time is spent counseling or coordinating care, the code can be selected based on time alone.

Return visit: After a patient has been diagnosed with ADD/ADHD, he’s going to have interval shorter visits on a scheduled basis. Pin down the appropriate-level office visit code for these interval sessions using this guide (these may be determined using time-based coding):

99212 -- a brief visit with medication refill
99213 -- a brief re-evaluation and medication refill
99214 -- a more extensive visit for interval concerns/parental concerns and medication adjustment or refill.
Revenue opportunity: The return visits may include a Vanderbilt ADHD standardized rating scale evaluation as included in the American Academy of Pediatrics’ ADHD Toolkit to evaluate and assess the patient’s progress. You should report this testing with 96110 (Developmental screening, with interpretation and report, per standardized instrument form). Although CPT does not require you to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the associated E/M code when reporting 9921x with standardized testing, some insurers may require this. If multiple tests are reviewed and discussed (parent, teacher), bill for each with 96110. The initial Vanderbilt form will be billed with 96110, and each additional form with 96110-59 (Distinct procedural service). Otherwise the subsequent tests will be denied.

Capture Face-to-Face Monthly Refills: Consider the next round of visits for ADD/ADHD as maintenance. These medication-management services may be based on any face-to-face encounter between the nurse and the patient.

If the patient comes into the office for an ADD/ADHD medication refill without a physician face-to-face visit, report a nurse visit (99211). During this visit, the nurse should provide an E/M service with an interval history, questions about the patient’s sleeping and eating habits, and any school or behavior issues. This should all be carefully documented.

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