Healthcare Fraud Shield’s Latest Article: Developmental Testing Code Changes

5 Jan

Happy New Year! With a New Year comes new codes, coding changes and of course coding challenges.   This article will focus specifically on the changes made to developmental testing.  In February 2018, Healthcare Fraud Shield wrote an article about the differences between Current Procedural Terminology Code (CPT) 96110 and 96111[1]. CPT 96111 was deleted; however, CPT 96110 remains.

2018 Codes and Descriptions

96110: Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument

96111: Developmental testing, (includes assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments) with interpretation and report.

2019 Codes and Descriptions

As mentioned above, CPT 96110 remains an active code for 2019.   Additionally, two new codes were added:

96112: Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour

+96113: Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; each additional 30 minutes (List separately in addition to code for primary procedure)

What is Developmental Testing?

It used to diagnosis developmental problems among children.   For example, according to the AAP (American Academy of Pediatrics), CPT 96111 including tests such as the Bayley Scales of Infant Development (Third Edition).[2] This test is used to “identify possible developmental delay, inform professionals about specific areas of strength or weakness when planning a comprehensive intervention, and provide a method of monitoring a child’s developmental progress.”[3]

What to look for?

  • Since the new codes are time based, look for providers billing excessive time per patient, per day across all patients, and/or excessive units of the add-on code (96113).
  • Look for bundled services. Evaluation and management codes can be billed along with developmental testing codes as long as the services are separate and distinct.

If you have general SIU questions or comments, please contact us at  SIU@hcfraudshield.com.

REFERENCES

  1. HCFS Article
  2. AAP Fact Sheet
  3. Bayley Scales of Infant Development (Third Edition)
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