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Tina Posted Fri 30th of January, 2015 15:59:55 PM

We have a coding question in regards to the new Vanderbilt assessment code (96127). We often give and score many of these to one child. Do we code for the assessment on the day it is given to the patient, and is there a limit on quantity? If we give 2 for 2 teachers, and 1 for each parent, can we bill 4 times?

SuperCoder Answered Mon 02nd of February, 2015 10:08:32 AM

Thank you for your question.

The coded 96217 is coded on the Date of Service the Assessment is given. Currently there are not any documented quantity restrictions.

96127: Code 96127 is new for 2015. Use this code when the provider assesses the emotions and behavior of a patient with mental health disorders such as depression or attention deficit hyperactivity disorder, which mostly affects children who exhibit problems like inattention, hyperactivity, or impulsive behavior. The test also measures the functioning of the central nervous system. Code 96127 is a new code added to the series 96101 to 96125, Central nervous system assessments and tests, wherein the provider analyzes cognition, mental status, and speech.

Tina Posted Mon 09th of February, 2015 11:39:44 AM

Do we need a modifier? If so which do you recommend?

Tina Posted Mon 16th of February, 2015 11:22:32 AM

I'm following up on my question, which has not been answered.

SuperCoder Answered Wed 18th of February, 2015 14:55:29 PM

Thanks for your patience. I apologize that you have not received an answer sooner. In normal circumstances, you would not receive all of the forms back at the same time so you may not need to bill all four units on the same claim. If you do receive the forms back at the same time, the suggestion would be to use modifier 59 for distinct procedural service on each additional 96127. You should check with your payers to determine if they have billing policies. Some payers prefer unit billing and others prefer that you bill each line separately with the modifier appended. Hope this helps.

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