Icd 10 Cm Code for Well Baby Check
Coding for Developmental & Mental Health Screening
- Overview
- Pearls & Alerts
- ICD-x-CM Codes for Screening
- Current Procedural Terminology (CPT)
- Modifiers 25 and 59
- Coding Examples
- Resources
Overview
Coding and billing for screening performed in the medical habitation tin help cover the costs of the work done and the instruments used to monitor for developmental delays, maternal depression, risky substance use, suicidality, or mental health disorders. Screening reimbursement is complicated because state and private insurers may differ on how many screens may be reimbursed during ane visit or in ane year. Some payers contract with participating providers to bundle developmental or mental health screening with preventive care, or they may direct their providers to bill differently from the American Medical Association's CPT guidelines. Detailed coding and billing, fifty-fifty if it does not become paid past Medicaid or the insurer, is useful to track work value (RVU).
Other Names & Coding
Billing and coding for developmental and/or autism screening
Billing and coding for behavioral wellness (ADHD, feet, depression) screening
Billing and coding for caregiver low screening
Billing and coding for substance abuse screening
Pearls & Alerts
Importance of coding
Accurate, detailed coding, even for items non currently reimbursable, helps reverberate the actual clinical endeavor and identify codes that may need to be reimbursable in the future to optimize care for children with special wellness care needs.
ICD-10-CM Codes for Screening
ICD-10-CM codes from A00.0 through T88.nine, Z00-Z99 must be used to identify diagnoses, symptoms, conditions, problems, complaints, or other reason(s) for the run into/visit. The following ICD-x-CM Z codes are frequently used for screening.
Z00.1*- Well-kid check/Encounter for newborn, infant and child health examinations, including routine developmental screening.
- Z00.129 - well-child visits >28 days, without abnormal findings
- Z00.121 - well-child visits >28 days, with abnormal findings
- A Z00.1* wellness exam is always listed first, as the chief reason for the visit.
Z13.3*- Encounter for screening examination for mental wellness and behavioral disorders.
- Z13.30 …… unspecified
- Z13.31 Encounter for screening for low
- Z13.32 Come across for screening for maternal depression (this can be coded in the mother's chart simply non the infant'due south)
- Z13.39 Encounter for screening examination for other mental health and behavioral disorders
You lot practise not need to add Z13.3* as a secondary code to a well-kid check when performing routine depression and substance use screens.
If a Z00.1* well-child exam and a Z13.3* behavioral health exam are both reasons for the visit, list Z00.one* first, every bit the primary code, and Z13.iii* equally a secondary lawmaking.
Z13.4*- Meet for screening for certain developmental disorders in childhood.
- Z13.xl Encounter for screening for unspecified developmental delays
- Z13.41 Encounter for autism screening
- Z13.42 See for screening for global developmental delays (milestones)
- Z13.49 Meet for screening for other developmental delays
There is no demand to add together Z13.iv* every bit a secondary code to a well-child check when performing routine developmental and autism screening.
If a Z00.1* well-child exam and a Z13.4* developmental-screening examination are both unique reasons for the visit, list Z00.one* kickoff, as the primary code, and Z13.4* equally a secondary code. For example, both codes could exist used during a well-child check if additional screening for ADHD or anxiety is administered.
Z13.89 Run across for screening for other disorder (when not listed elsewhere in the ICD-10 codes) – usually not necessary to report in add-on to a well-child examination.
Current Procedural Terminology (CPT)
CPT codes are used to request reimbursement for the expense of each screening instrument including the scoring and documentation. Documentation should include the engagement, patient's proper name, proper noun and relationship of the informant (when data is provided past someone other than the patient), name of the instrument, score, and proper name and credentials of the individual administering/scoring the instrument. The physician must document that he or she reviewed the score in the context of the patient presentation and discussed the results with the patient/family unit as part of the related E/Yard or preventive service. Associate the CPT code with an appropriate ICD-10-CM lawmaking, oftentimes the Z00.12* well-child lawmaking.
| CPT Lawmaking | Examples of Screens |
| 96110 Developmental screening (e.g., developmental milestone survey, spoken communication and language delay screen, autism screen) | M-Conversation, ASQ-third Edition, PEDS, SWYC |
| 96127 Brief emotional/behavioral assessment (east.one thousand., low inventory, attention-deficit/hyperactivity disorder [ADHD] scale) | ASQ-SE, SCARED, Vanderbilt, PSC, PHQ-2, PHQ-nine or adolescent version, Connors |
| 96160 Administration of patient-focused health risk assessment instrument (eastward.k., wellness hazard appraisal) | CRAFFT, Inspect, BSTAD, S2BI, DAST-20 |
| 96161* Administration of caregiver-focused health risk assessment instrument (e.g., depression inventory) for the do good of the patient | Edinburgh Postnatal Depression Scale (English), PHQ-2, PHQ-9 administered to caregiver during a baby's visit |
Payers vary in their requirements and reimbursements for screening instruments.
Modifiers 25 and 59
Modifier 25 appends i service with a 2nd, separately identifiable Due east/M service. Modifier 25 states that the process performed should be considered split up from the visit. In that location is no demand to use Modifier 25 for routine screening in a well-child visit.
Modifier 59 indicates a singled-out procedural service (not-E/K service). Documentation should demonstrate the distinction between procedure(s) with each other and/or the visit to support billing both. Sometimes a modifier 59 might be required if two of the aforementioned type of screens are used during the same visit, but this can vary by payer.
Coding Examples
The ICD-ten-CM codes (reasons for the visit) are listed first, followed by associated CPT (process) codes and modifiers.
Example 1: Well-kid Check with Routine Screening and an Ear Infection
During an 18-calendar month, well-kid visit, the parent completes an autism screen and a developmental screen. The clinician reviews the results of both screens with the family and documents them appropriately in the visit note. The child also has an ear infection requiring treatment.
| CPT Codes | Associated ICD-ten-CM Codes |
| 99392*25 Early childhood preventive medicine services | Z00.121 Well-child check with abnormal findings (primary diagnosis) |
| 96110 x 2 developmental screens (reimbursement varies) | Z00.121 |
| 99213 singled-out E/M service | H66* suppurative otitis media |
Example 2: 4 Calendar month Well-child Check with Abnormal Maternal Depression Screen
During a well-child visit for a healthy iv-calendar month-old, the mother completes a SWYC developmental screen for the baby, which is normal. She also completes an Edinburgh maternal low screen, which is abnormal. The provider spends an additional x minutes talking with the mom and contacting the social worker.
| CPT Codes | Associated ICD-ten-CM Codes^ |
| 99391*25 Babe preventive medicine services SWYC | Z00.121 Well-child check with aberrant findings (chief diagnosis) |
| 96110 Developmental screen – Kid Development screening | Z00.121 |
| 96161 Caregiver assessment (Edinburgh) Mother Depression screening | Z00.121 |
^Do not report Z13.three* (maternal depression codes) as diagnoses in the baby's chart; they belong in the maternal record.
The provider is brash not to add fourth dimension-based billing for the parent counseling. Refer the parent to her own provider for boosted care.
Case 3: Routine Boyish Health Check with New Business organisation for Feet
During a well-child visit for an established 17-year-old, the patient completes a PHQ-9 and a CRAFFT 2.1, both of which are normal. The adolescent reports feeling broken-hearted in crowds and talking in front of the form at school. In improver to the routine depression and risky substance use screeners completed at check-in, the patient too completes a SCARED Version for Child (anxiety screen), which is abnormal. The provider briefly discusses the results with the patient and so recommends a follow-up visit focused on anxiety.
| CPT Codes | Associated ICD-10-CM Codes |
| 99394*25 boyish preventive medicine services | Z00.121 Well-child check with aberrant findings (primary diagnosis) |
| 96127x2 Brief emotional/behavioral assessment (PHQ-9 Depression) and (SCARED anxiety) | Z00.121 Z13.39 Encounter for screening examination for other mental health and behavioral disorders |
| 96160*59 Patient-focused health hazard cess musical instrument (CRAFFT Health Hazard/Alcohol use)^ | Z00.121 |
^Note that the likelihood of reimbursement for the 96160 is low because the 96160 can be considered a component of the 96127 code. Make sure that the documentation validates that the 96160 is a carve up run a risk assessment.
Case iv. Screens Reviewed During a Behavioral Health/Medication Direction Follow-Up Visit
During a 40-infinitesimal visit to follow upward an established patient with previously diagnosed ADHD and feet, the clinician discusses the latest results of the Follow-Up Vanderbilt for Teacher, the Follow-Up Vanderbilt for Parent (ADHD monitoring instruments), and the GAD-7 feet screen completed by the patient online prior to the visit. Medication adjustments are made likewise equally counseling on relaxation exercises.
| CPT Codes | Associated ICD-x-CM Codes |
| 99215*25 Time-based E/M (counseling/care coordination >l% of visit) | F90.2 ADHD combined type (principal diagnosis) |
| 96127 x iii Brief emotional/behavioral assessment | F90.2 F40.10 Social feet disorder |
Case 5. Developmental and Autism Screening Performed During an Unrelated Sick Visit
An established 18-month-old patient presents for an Due east/G visit for an ear infection requiring handling. During the visit, the provider realizes that the 18-month-old child missed his last well-child check and administers a developmental screen and an autism screen. The clinician reviews the results with the family.
| CPT Codes | Associated ICD-10-CM Codes |
| 99213*25 East/1000 services | H66* suppurative otitis media (primary diagnosis) |
| 96110 x2 Developmental screens | Z134.42 screening for global developmental delay |
Instance half dozen. Positive Low Screen and Screening for Substance Utilise During an Unrelated Visit
When you lot are wrapping upwards a curt visit to assess a rash in a xiv-yr-sometime male established patient, his father expresses concerns that he seems depressed. Yous administer a Patient Health Questionnaire (PHQ-9/A) (boyish version), which is positive for depression, and a Drug Abuse Screening Exam (DAST-ten), which is negative for risky substance use. You spend 25 minutes of face-to-face fourth dimension with the patient and his father reviewing the screens, prescribing an anti-depressant and providing counseling and care coordination.
| CPT Codes | Associated ICD-10-CM Codes |
| 99214 E/M services (counseling/care coordination >fifty% of visit, full of 30 minutes) | R21 Rash and other nonspecific skin eruption (primary diagnosis) Z71.89 Other specified counseling |
| 96127 Brief emotional screener (PHQ-nine/A) | Z13.30 Encounter for mental wellness and behavioral screening F32.9 Major depressive disorder, single episode |
| 96160 Wellness risk cess (DAST-10) | Z13.30 |
Case vii. Wart Removal Plus New Behavioral Concerns
During a 7-yr-old, new patient visit to your clinic for a wart removal with liquid nitrogen, the family asks how to tell if she might have ADHD. In 10 minutes, you lot take a brusk history of their concerns and draw the diagnostic procedure for ADHD. You provide Vanderbilts (ADHD screeners) for them to complete afterwards the visit and enquire them to set up upward a follow-up visit.
| CPT Codes | Associated ICD-10-CM Codes |
| 17110 Devastation of benign lesions other than skin tags or cutaneous vascular lesions; upwardly to xiv lesions | B07.9 Viral warts, unspecified (chief diagnosis) |
| 99201*25 (new patient, counseling/care coordination >50% of visit, x minutes) | Z73.9 Problem related to life management difficulty, unspecified |
^The 25-modifier is but placed on E/M CPT codes (due east.g., the 99201). Modifier 25 is non considered valid when appended to surgical codes, medical procedures, diagnostic tests and procedures, etc., so information technology does not append the 17110 code in this example.
Note that screens were non administered or reviewed during this visit, so you do not include the screening CPT codes.
Case viii. Subsequent Wart Removal Plus Give-and-take of Screening Results
At the adjacent visit, you spend 25 minutes reviewing the screens and making recommendations for handling of her newly diagnosed ADHD. You likewise perform wart removal.
| CPT Codes | Associated ICD-10-CM Codes |
| 99214*25 (established patient, counseling/care coordination >fifty% of visit, 25 minutes) | F90.0 ADHD, inattentive type |
| 96127 x2 Brief emotional screeners (both Vanderbilts) | F90.0 Z13.39 Encounter for screening test for other mental health and behavioral disorders |
| 17110 Devastation of benign lesions other than peel tags or cutaneous vascular lesions; up to 14 lesions | B07.ix Viral warts, unspecified (primary diagnosis) |
Resources
Information & Back up
For Professionals
Coding Fact Sheets (AAP)
Codes for medical home visits, mental health care, oral health, screening, and more that clinicians tin submit to insurance carriers for payment of medical services; American Academy of Pediatrics.
Coding Resources (AAP)
Books, quick references, and how-to guides for CPT and ICD-10 coding specific to pediatrics; bachelor for purchase from the American Academy of Pediatrics.
CPT Code for Caregiver-Focused Assessment (AAP)
Codes for reporting the administration and scoring of a patient-centered health run a risk assessment and a caregiver-focused health risk assessment; American Academy of Pediatrics.
International Classification of Diseases, 10th Revision (WHO)
ICD-10-CM 2020 codes accessible as PDF and XML files created by the National Middle for Health Statistics with authorization by the World Health Organisation.
Coding for Pediatric Preventive Care (AAP) (
2.0 MB)
A 44-page guide to coding for preventive care services as recommended for pediatric intendance; Brilliant Futures/American Academy of Pediatrics.
Source: https://www.medicalhomeportal.org/clinical-practice/coding-and-billing/coding-for-developmental-and-mental-health
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