96110 Developmental Test Data (Not Eagleville, CA)

This weekend, a very faithful reader wrote to me:

Couple of things I wanted to mention. First, my two doctors said they LOVED the conference in Columbus. They said it was definitely worth it. As a result, it seems I have some work cut-out for me. They’ve come back energized and telling me “… we have to start doing this… and you have to create this form… and we have to audit our super bills before they go out,” on and on and on. Whew…

The other thing I wanted to run by you is in regards to your Top Peds Code Post. I noticed you didn’t have 96110 - Developmental testing; limited (eg, Developmental Screening Test II, Early Language Milestone Screen), with interpretation and report - code listed.

We use this code frequently. In fact, it ranks very high in our top codes list. Do your practices use this code? I’d be interested in knowing your thoughts or if any of the readers have any thoughts on this code.

Brandon beat me to the punch, as the 96110 and 96111 have been on my radar to discuss again and I love it when someone else can do all the hard work for me.  Plus, I also had to throw in those comments about the coding event last week :-)

I have discussed the 96110 a number of times but I don’t think I’m making much of an impact.  Not only is the 96110 considered the standard of practice now (Bright Futures!), but it even has RVU values and gets paid.  Here’s a quick review of the most common 96110 questions.

I looked up the 96110 usage among our clients and it ranks…55th.  Brandon offered to provide us with details of his experience.  He writes:

1) Reimbursement has been going down over the years on average. Some have started to pay more. Average reimbursement for 2007 was $24. Average reimbursement in 2008 is $21.

2) Total revenue in 2007 for our practice was $15,766; so far this year we’ve collected $7774

3) IDPA (IL Dpt of Public Aid) accounted 55% of 2008 revenue and 51% of YTD revenue. Frankly this one of the main reasons we continue using the code; it helps boost our per visit Public Aid revenue. When you factor in the dev test, vision, hearing and other services we normally perform, IDPA revenue per visit comes very close to other private plans. Between 25 - 30% of our patient mix is IDPA by the way.

4) UHC contributes 32% of YTD revenues. As you know UHC is one of the least compliant inscos with regards to reimbursement. So this 32% helps to compensate for all the other bad things they do.

5) Of the bigger insco Cigna pays the best.

There is some work involved in performing the test. Parents have to fill out a questionnaire and the MD have to review and interpret the responses. But the questionnaire is very simple and the interpretation does not take too long. In terms of quality of care there are numerous advantages. The AAP highly encourages the test.

From a clinical perspective we believe we are providing a higher quality of care by performing the test. And my doctors would probably still discuss or address most of the things the questionnaire highlights without providing the questionnaire as part of our well child visit protocol. Since we would be doing the work as it is, why not hand out the form and get paid for it? It is roughly 14K a year that we would not get otherwise.

What excellent analysis, really.  That last paragraph says it all.  Note that even though his reimbursement is declining (which matches our data), it is still above Medicare rates!

So, why aren’t more of you performing this service and billing the code?