End Your Well Visit Denial of Claims

End Your Well Visit Denial of Claims

Keep a close eye on payers after correctly performing medical billing! There can be inconsistencies with how a payer interprets coding procedures and how a practice interprets them. Currently there is an inconsistency with how to bill current procedure code 96110. The medical billing code 96110 should be separately reimbursable and not bundled with well exam codes as long as quality instruments are utilized.

96110 means: developmental testing; limited, (e.g. developmental screening test II, early language milestone screen), with interpretation and report. The American Academy of Pediatrics Committee on Coding and Nomenclature reports that it is perfectly acceptable in medical billing to charge for this code along with a well visit code (99381-99397). The problem is: many payers and insurers are bundling the two codes together. They are assuming that the screening and the preventative child exam are bundled together in medical billing. They are incorrect. All they know is that there assumption saves them money.

To assist practices in getting reimbursed for 96110, the Centers for Medicare & Medicaid services will crack down on the issue. They will begin a medical billing campaign that ensures each state understands how the screening code gets reimbursed. As long as quality instruments are used in the developmental/behavioral screening, the medical billing code should be listed separately.

Until then, some payers will try to weasel their way out of paying for 96110. To prevent this from happening, send them information and documentation that explains the separate billing for 96110. Also send them patient medical records that clearly shows that quality instruments were used in the screening. If payers see this information with you medical billing, there will be nothing to argue with.

Nothing comes without a fight. If you want to be correctly reimbursed for your services you must present documentation for the reason why. We never said medical billing was easy, and these well visit exam codes are proving that.

View all Articles by: Melissa Clark, CCS-P