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.