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Interpretation and reporting for code 96110

John Posted Fri 06th of December, 2013 10:56:16 AM

My physicians are billing 96110 for Ages and Stages questionaire and/or Development screenings. Description of this code includes the interpretation and report. Does this mean that the physician has to provide a seperate report? If so does a 25 modifier have to be added to the E/M? Thank You

SuperCoder Answered Sat 07th of December, 2013 09:41:26 AM

In order to properly report 96110 your supporting documents need to show that your physician reviewed and interpreted a standardized test/tool. The report will be scored as either "normal" or "abnormal" on the chart.
Your physician must also indicate that he reviewed and discussed the results with the patient or a family member. Keeping a copy of the actual questionnaire in the patient's record is probably good practice as well. Make sure the documentation refers to the test by name, however that way an auditor will see that your physician used a qualifying test.
Important: Notice that you won't see codes for administering or scoring the report, because those duties are usually assigned to a nurse or other trained nonphysician personnel. Often the physician himself does not actually administer these tests as noted also by the "0" physician work valuation in the Medicare fee schedule.
Because an office nurse or other trained nonphysician personnel typically performs the service, this relative value reflects only the practice expense of the office staff and nurses, the cost of the materials, and professional liability there is no physician work value published on the Medicare physician fee schedule for this code.
Therefore, your practice's ancillary staff can administer and score the test. The physician then can review and interpret the test and reports on these findings.
You may also want to wait to bill 96110 until the date the test is actually discussed with the patient or family member.

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