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How do I bill and code for PEDS and/or PEDS:DM? How can I get reimbursed for screening?
You may need to use the following:
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 firstname.lastname@example.org
96110 or 96111 procedure codes will not cover the Denver because it is not validated.
How do I code a screen when the result is normal and will I get reimbursed?
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'.
What are the best diagnosis codes to use for problematic PEDS/PEDS:DM results?
Commonly used ICD-9 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:
783.4 - Developmental Delay
309.23 - Academic Inhibition (school problems)
315.4 - Developmental Coordination Disorder
784.5 - Other Speech Disturbance
309.3 - Disturbance of Conduct