decisionhealth Newsletters, Coder Pink Sheets - 2006 Issue 12 (December)
Developmental testing bundled with well-visit
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Article Overview
This article explains payer coverage patterns for developmental testing performed in conjunction with pediatric well visits. It is aimed at coders, billing staff, and primary care practices that need to understand how Medicaid, state prepaid plans, and private payers may handle claims, documentation, and diagnosis reporting. The article also identifies the broad categories of developmental screening and evaluation tools commonly associated with the relevant testing codes.
Why This Topic Matters
Understanding whether developmental testing is paid separately or bundled can affect claim submission, recordkeeping, and the ability to support retroactive payment if a payer changes policy. The article is relevant for practices that perform pediatric developmental screening and want to align billing with payer expectations and documentation requirements.
Article Sections
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Coverage and bundling with well visits
Discusses how different payer types may treat developmental testing when performed during a well visit. It covers general billing and coverage considerations for pediatric practices.
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Diagnosis reporting and documentation
Addresses general diagnosis selection and documentation approaches for developmental screening and related testing. It focuses on how the reason for testing may be represented in the record.
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Developmental tests for 96110, 96111
Lists examples of developmental screening and evaluation tools associated with the testing codes discussed in the article. It distinguishes between broad categories of tests used for screening and more extensive assessment.
What You Will Learn
- How payer type can affect coverage for developmental testing done with a well visit
- What general documentation considerations are discussed for developmental screening claims
- Which broad categories of developmental tools are associated with screening and extended evaluation
- How the article frames the relationship between screening and more intensive developmental assessment
Who Should Read This
- Medical coders
- Billing staff
- Primary care practices
- Pediatric practices
- Practice managers
Codes Discussed
Modifiers Discussed
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