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Developmental Screening FAQs
Excerpted from the ABCD Project Discussion Listserve and OHCA website by Laura McGuinn, MD, revised March, 09

1. QUESTION: Can I bill for using a parent-completed validated developmental screening tool (like the ASQ, ASQ-SE, PEDS, CSBS-DP, M-CHAT or others) and if so, how?

ANSWER:
Yes. Bill using the CPT code 96110. This code can be used whenever the office asks a child’s family member to complete a parent-completed questionnaire and a professional interprets the scored answers.

For patients with SoonerCare (Medicaid/S-CHIP) CPT code 96110 can be billed in addition to other CPT codes such as evaluation and management (E&M) codes or preventive visit codes (e.g. well-child visits/child health checkups). As of 1/1/09, OHCA reimburses $9.30 per instance of 96110.

For patients with private insurance, you will need to check with the payor to see what their policy is for reimbursing for 96110.

For patients whose private insurance does not reimburse 96110, physicians in other states have chosen to bill using time-based CPT E&M codes instead of preventive care codes.

For patients who have no insurance coverage, setting an office policy on how to manage patient billing is useful.

2. QUESTION: Can I use 96110 during visits that are not well-child visits?

ANSWER:
Yes, if the child is insured by SoonerCare.

If the child has private insurance, check with the specific payor to determine their reimbursement policy for developmental/socioemotional/ autism screening outside of preventive care visits.

3. QUESTION: Can I bill for 96110 more than once in a day (for example, if I have a parent complete an ASQ and an M-CHAT at the 18 month visit)?

ANSWER:
Yes, in this example, a professional could bill for 2 instances of 96110.

4. QUESTION: Can I bill for administering a parent-completed maternal depression screen (e.g. the Edinburgh Postnatal Depression Scale, the Postpartum Depression Screening Scale, the Beck Depression Inventory-II, and the Primary Care Evaluation of Mental Disorders) or family functioning screen (e.g. the Parenting Stress Index) for mothers/ family members of my pediatric patients?

ANSWER:
If the primary patient is a child, and this child is insured by SoonerCare, at this time (as of March, 2009) no mechanism for billing for a maternal depression or family functioning screen is in place. OHCA is currently exploring strategies for reimbursing for this clinical activity.

If the primary patient is a child and has private insurance, check with the individual insurance company to see if they reimburse this activity.

If the primary patient is an adult, check with the adult patient’s insurance company to see if mental health screenings by primary care providers are a covered benefit.

5. QUESTION: What is the difference between developmental ‘surveillance’ and developmental ‘screening’?

ANSWER:
Based on the 2006 AAP Developmental Screening practice guidelines developmental surveillance is performed at each child health checkup visit and consists of a short series of age appropriate questions.

Developmental screening, on the other hand, consists of the administration of a standardized validated screening tool (including parent-completed tools such as the Ages and Stages Questionnaire-ASQ or the Parents Evaluation of Developmental Status-PEDS, etc.).

Many physicians use a short checklist of questions that check milestones. These are considered surveillance NOT screening.

Examples of surveillance questions can be found on the OHCA child health check up visit template forms; these age-specific forms can be accessed from the OHCA website under Child Health/ EPSDT.

Child development is a dynamic process and therefore often difficult to measure. Using clinical impressions (surveillance) only rather than formal screenings leads to under-detection and reduces the possibility of early intervention. This is why the AAP recommends a combination of both surveillance and screening.

6. QUESTION: What tools count as a standardized validated screening tool as defined by the AAP and the OHCA for reimbursement using 96110?

ANSWER:
Technically, any tool included in the AAP 2006 developmental screening practice guidelines (ref). Realistically, most practitioners in the ABCD projects have elected to use the ASQ, ASQ-SE, PEDS, CSBS DP, and MCHAT. Each of these is a parent-completed tool, all of which are more efficient to administer as a routine screening instrument than the directly-observed developmental screening tools that require more provider time to administer.

7. QUESTION: What tools DO NOT count as a standardized validated screening tool?

ANSWER:
The ubiquitous Denver Developmental Screening Tool (DDST). While it is included in the AAP practice guidelines chart of screening tools, the DDST continues to perform less than ideally as a screening tool (see question 8 for more information on this topic).

The Denver Parent Developmental Questionnaire (PDQ) is used by many practitioners in Oklahoma. This instrument is a parent questionnaire derived from the practitioner-administered Denver. The PDQ forms are usually printed on light purple or gold-colored paper (when ordered from the publisher) although they may have been photocopied onto non-colored paper. Like the Denver Developmental Screening test from which it was derived, the Denver PDQ has less desirable screening properties and can miss kids who may have problems.

Practitioner designed informal milestone checklists have no associated sensitivity and specificity. They do not qualify as a screening tool either by AAP or OHCA standards. They DO qualify as developmental surveillance.

8. QUESTION: Why do the tools in question 7 not count as a standardized validated screening tool?

ANSWER:
These tools do not have a sensitivity and specificity of 70% (the standard agreed upon in the AAP developmental screening practice guidelines as the acceptable minimum for a screening instrument). They miss too many children.

9. QUESTION: At what ages do the 2006 AAP’s Developmental Screening practice guidelines recommend a developmental screening be performed for children aged 0-3?


ANSWER:

The AAP guidelines contain an algorithm to guide these processes. Summary of the surveillance and screening steps in the algorithm:

Developmental surveillance should occur at every well-child visit.

Regardless of concerns, physicians/practitioners should supplement surveillance by using a screening tool that is standardized, validated, and evidence based at the following ages:

9, 18, (24)* and 30 months + PRN developmental and/or behavioral concerns (this means the use of a screening instrument is NOT REQUIRED at every well child visit).

*NOTE: 30 months is the preferred age for administering a validated screening tool but if physician prefers to see child at 24 months instead of 30 months for a preventive well-child visit, a standard screen should be used at the 24 month visit.

10. QUESTION: At what ages do the AAP autism practice guidelines recommend an autism-specific screening be performed?

ANSWER:
At 18 and 24 months PRN parent, clinician or other caregiver autism concerns

11. QUESTION: If a developmental/behavioral screening has been performed, using a standardized, validated, evidence based screening tool, and documented, is it still necessary to perform and document surveillance questions.


ANSWER:

No (refer to question 9)

12. QUESTION: What are some strategies I can use to discuss with a parent while I am recommending a referral/evaluation for their child?


ANSWER:
If a child fails in one of the five developmental areas, explain to the parent that a more in depth evaluation is recommended. Children age 0-3 are referred to Early Intervention for an evaluation. Someone from a local agency that is involved with Early Intervention will contact the family to set up a no cost evaluation.

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