This answer is provided from Linda Walsh at the AAP's Office of Coding and Reimbursement and Dr. Lynn Wegner, Chair AAP Section on Developmental and Behavioral Screening): There are two levels of coding: optimal coding and acceptable coding. While optimal coding would indicate that you link the V79.3 or V20.2 code to 96110 in a patient that screens as "normal," payors do vary on their tendency to (financially) recognize such reporting. A coding purist would tell you to continue to report that code combination and fight it at the contractual level. That's a viable long term solution (and one that should be taken into account when your contract next comes up for renewal) but it doesn't work well in the short term (ie, mid-contract). Therefore, if you find that your payors are not recognizing that code combination, we suggest that you engage an acceptable coding alternative, such as seeing if a code in Chapter 16 of ICD-9-CM (Symptoms, Signs, and Ill-Defined Conditions) is a reasonable alternative. So, Developmental screening ICD-9 codes are all v codes, unfortunately. For example, Screening for: developmental handicap V79.9 (Screen developmental problems V79.c)in early childhood V 79.3 Now, if you had documented in the chart any reported delays (despite normal results after the screening), you could use: 783.42 Delayed Milestones 315.8 Other specific Delays in Dev 315.9 Unspecified Delays in Dev AFTER, the screening (ie next visit) you could NOT use these three codes as you would have screened 'normal'.

Code | Description

F98.9 | Unspecified behavioral and emotional disorders with onset usually occurring in childhood and adolescence

F82 | Specific developmental disorder of motor function

F80.89 | Other developmental disorders of speech or language

F90.9 | Attention Deficit Hyperactivity Disorder, unspecified type

F79 | Unspecified intellectual disabilities

F81.9 | Developmental disorder of scholastic skills, unspecified

You may need to use the following:

1. Attach the - 25 modifier to your preventive service code or E/M service code (to denote the office visit is a separate service from the screening. Then list 96110 times the number of screens given, (e.g., X 3 if using PEDS^®+PEDS:DM^®+MCHAT). [Note that some States (e.g., North Carolina) do not allow an unbundled 96110 but have increased reimbursement substantially for the entire well-visit]. If billing a private payer, particularly Cigna, the -59 modifer is usually required instead of -25.
2. Multiple units, with the modifier appended to the visit as described above, best describe the separate entity of performing multiple 96110s. For insurers not accepting units, the distinct procedural service of each test is best represented with - 59 modifier appended to each additional unit of 96110:

Example: A level 3 office visit in which three developmental screening instruments were administered, scored and interpreted:

• 99213
• 96110
• 96110-59
• 96110-59

Appeal all denied claims--sometimes State Medicaid Directors aren't aware of the federal ruling from 2005, in which the Centers for Medicare and Medicaid Services published a total relative value unit (RVU) of 0.36 for 96110, which amounts to a Medicare payment of about $10.00. For Cigna and many other private payers, reimbursement is about $20.00. This RVU represents only malpractice expense and office expense --no physician work is included--meaning that screening is largely a staff function except for explaining results to families.

None of this can guarantee that a valid claim will be accepted, so the American Academy of Pediatrics (AAP) is willing to help with denied claims via their Coding Hotline: 800-433-9016, ext. 4022, or at aapcodinghotline@aap.org

96110 or 96111 procedure codes rarely cover the Denver because it is not validated.

CPT Codes and Descriptors Effective January 1, 2019

Beginning in 2019, developmental testing codes 96112 and 96113 should be used for developmental testing including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed. These codes cover administration by physician or other qualified health care professional, with interpretation of results and creating a report.

Use 96112 for the first hour of testing (> 31 minutes). (wRVU 2.56).

Use 96113 for representing each additional 30-minute increment required to complete the service (list separately in addition to code for primary procedure). Note that the mid-point rule requires 76 minutes to pass before adding the first 96113. (wRVU 1.16)

This new coding structure enables physicians or other qualified health care professionals to report these services based on total time. This is a change from the previous 96111 code which limited you to reporting a single unit of code, regardless of time spent providing the service. These new reporting codes cover multiple days of review and interpretation of data.

Time Spent Developmental Testing Code(s)

< 31 mins N/A (report an E/M service if appropriate)

31-76 mins (1 hr and 16 mins) 96112

77-106 mins (1 hr and 46 mins) 96112 and 96113

107 mins –136 mins (2 hr and 16 mins) 96112 and 96113 x 2 units

137 mins –166mins (2hr and 46 mins) 96112 and 96113 x 3 units

These ICD-10 codes are general in nature so as not to interfere with more refined diagnoses available when children are older and can be administered very detailed measures.

Code | Description

F98.9 | Unspecified behavioral and emotional disorders with onset usually occurring in childhood and adolescence

F82 | Specific developmental disorder of motor function

F80.89 | Other developmental disorders of speech or language

F90.9 | Attention Deficit Hyperactivity Disorder, unspecified type

F79 | Unspecified intellectual disabilities

F81.9 | Developmental disorder of scholastic skills, unspecified

Commonly used ICD-10 codes are those sufficiently vague as to not interfere with a more complete diagnoses made by those to whom you refer:

Commonly Used Diagnosis Codes in response to screening test results include:

Code | Description

F98.9 | Unspecified behavioral and emotional disorders with onset usually occurring in childhood and adolescence

F82 | Specific developmental disorder of motor function

F80.89 | Other developmental disorders of speech or language

F90.9 | Attention Deficit Hyperactivity Disorder, unspecified type

F79 | Unspecified intellectual disabilities

F81.9 | Developmental disorder of scholastic skills, unspecified