Billing Codes for
Iowa's EPSDT Care for Kids Services
|
Comprehensive Preventive Medicine Services |
Comprehensive preventive medicine services
are also referred to as:
Services billed under this code are specified by age in the Iowa
Recommendations for
Scheduling Care for Kids Screenings. Services include:
-
Comprehensive health,
nutrition, and developmental history
-
Review of physical, mental
health, and developmental status
-
Review of family risk
factors, including family stress and maternal depression
|
-
Unclothed physical exam
-
Immunization history
-
Oral health screening
-
Counseling, anticipatory guidance, risk factor
reduction interventions
-
Ordering appropriate immunizations or
laboratory/diagnostic procedures
|
|
Comprehensive Preventive
Medicine Services
|
|
Age range
|
Codes:
New patients |
Codes: Established
patients |
Younger than
1 year |
99381 |
99391 |
|
1-4 years |
99382 |
99392 |
|
5-11 years |
99383 |
99393 |
|
12-17 years |
99384 |
99394 |
|
18-21 years |
99385 |
99395 |
Additional codes may be billed on the same date of service as the
comprehensive preventive codes. They include:
Referral:
Add the U1 modifier
to the screening code where a condition identified during the screen results in
a referral for treatment.
|
Developmental, Social, Emotional,
and Family Risk
Screening, Testing, and Diagnosis |
The
Iowa
Proposed
Minimum Standards for Screening for the Identification of Developmental, Social,
Emotional, and Behavioral Concerns in Children Age Birth through Three Years
suggest a variety of tools that may be used to review a child’s development.
Suggested tools include those for screening all children, screening children at
risk, and carrying out follow-up assessment or evaluation.
Codes for billing screening
assessment and diagnosis of developmental, social and emotional or family risk
concerns are:
|
Preventive Medicine Codes |
|
|
New
patients
for Preventative Medicine Services,
age birth to 5 years.
Use when you conduct a review of developmental, social
emotional and family risk status as part of the comprehensive
well-child exam. |
99381-99383 |
|
Established patients for Preventative Medicine Services, age birth to 5 years.
Use when you conduct a review of
developmental, social emotional and family risk status as part of the
comprehensive well-child exam. |
99391-99393 |
|
Limited
developmental testing
with interpretation and report.
Developmental screening and social
emotional screening that includes use of a limited screening instrument
may be billed in addition to the preventive medicine services, or with
other evaluation and management services. In order for the test to be
billed as a separate service the interpretation and report must be a
significant, distinct service. |
96110 |
|
Extended
developmental testing
with interpretation and report.
Extended testing using a standardized instrument is usually completed
by the physician or other trained personnel and includes assessment of
motor, language, social, adaptive and/or cognitive function by
standardized developmental instruments. Examples of extended
developmental testing include the Bayley Scales of Infant Development,
Woodcock-Johnson Test of Cognitive Abilities, and Peabody Picture
Vocabulary Test. This may be reported separately or with another code
such as an E&M code or Preventive Medicine code.
|
99111 |
|
Assessment and diagnosis of developmental, social,
and emotional concerns
|
Providers are encouraged to use ICD-9 diagnostic
codes whenever those codes are appropriate and reasonable. However, DSM IV
psychiatric diagnoses sometimes do not fit well for the problems of young
children and their families, and the mental health interventions to serve them.
The Diagnostic
Classification of Mental Health and Developmental Disorders of Infancy and Early
Childhood (DC: 0-3) from Zero to Three provides a promising practice model for
the assessment of infants, young children, and parent-child
relationships. However, many payers do not yet recognize DC: 0-3 coding alone.
To assist providers to
bill mental health services for children, Iowa Medicaid has recommended the use
of “crosswalks” between Early Childhood DC: 0-3 and DSMIV or ICD-9
diagnostic codes. The crosswalk recommended by Iowa Medicaid is
based on the model used in Maine and can be found at
www.zerotothree.org/imh/crosswalk/maine.pdf.
|
Billing for
developmental
and mental health assessment and diagnosis |
Below are appropriate
billing codes for use with the tools suggested in the Minimum Standards
for the Identification of Developmental, Social, Emotional, and
Behavioral Concerns in Children Age Birth through Three Years:
|
Level 1:
Screening for ALL children |
|
Tool
|
Billing code |
|
Developmental screening for all children |
|
Iowa Child Health and
Development Records
(Iowa CHDR), ages
2 weeks to 5 years.
Service must include
entire comprehensive
physical examination. |
As appropriate for age:
99381 99391
99382
99392
99383 99393
|
|
Parents evaluation of
Developmental Status
(PEDS), ages birth to 8 years
|
96110 |
|
Ages and
Stages (ASQ), ages
2 months to 5 years
|
96110 |
|
Child
Development Review,
ages 3 months to 6 years
|
96110 |
|
Social, Emotional, and Behavioral Screening |
|
Iowa Child Health and Development
Records,
(Iowa CHDR) ages
2 weeks to 5 years.
Service must include
entire comprehensive
physical examination.
|
As
appropriate
for age:
99381 99391
99382 99392
99383 99393 |
|
Ages and Stages SE [Social Emotional]
(ASQ SE), ages 2 months to 5 years.
|
96110 |
|
Brief
infant-Toddler Social and
Emotional Assessment (BITSEA) |
96110 |
|
Child Development Review and Infant
Development Inventory, ages 3 months to 6 years
|
96110 |
|
Screening for family risk factors, including parental stress |
|
Iowa Child Health and Development Records,
(Iowa CHDR) ages
2 weeks to 5 years.
Service must include
entire comprehensive
physical examination. |
As appropriate
for age:
99381 99391
99382
99392
99383
99393 |
|
Pediatric
Intake Form (PIF from Bright Futures).
Service must include entire comprehensive
physical examination. |
As appropriate
for age:
99381 99391
99382
99392
99383
99393
|
|
Level
2: Screening Children at Risk for Developmental Delay
|
|
Developmental screening for children at risk |
|
Ages and Stages, ages
2 months to 5 years |
96110 |
|
Brigance
Infant and Toddler Screen
(birth to 23 months) |
96110 |
|
Bayley
Infant Neurodevelopmental Screener
( 3 – 24 months) |
96110 |
|
Denver Developmental Screening
Test II (0 – 6 years) |
96110 |
|
Social, emotional, and behavioral screening for children at risk |
|
Ages and Stages SE [Social Emotional]
(ASQ SE),
ages 2
months to 5 years |
96110 |
|
Brief infant-Toddler Social
and Emotional
Assessment (BITSEA) |
96110
|
|
Child Development Review and Infant Development
Inventory, ages 3 months to 6 years |
96110 |
|
Screening
for PDD and Autism for children at risk
|
|
Modified
Checklist for Autism in
Toddlers (M-CHAT) |
96110
|
|
Pervasive
Developmental Disorders Screening
Test II (PDDST II) Stage 1 |
96110
|
|
Screening
for family risk factors, including parental stress, for children at risk |
|
Edinburgh
Postnatal Depression Scale
(EPDS, for mother) |
To be determined |
|
Parenting
Stress Index
Short form |
To be determined |
|
Level III: Developmental and Mental Health Assessment and
Diagnosis
|
|
For developmental testing using standardized tools
and performed for the purpose of diagnosis and planning treatment
use 99111.
|
|
For other assessment and
diagnosis
use Iowa mental health
services
Crosswalks. |
