Five reasons to screen well for developmental and behavioral problems

July 1, 2007

An explanation of why developmental and behavioral assessments are important components to pediatric practice.

Why are detection rates for developmental and behavioral problems so low, especially when most clinicians report routinely screening for disabilities?1 The most significant obstacle to early identification is the type of screen used. Most providers rely on selected items from longer screening tests such as the Denver-II or on informal milestones checklists.2,3 These approaches are not valid; they lack accuracy, and are the equivalent of putting a hand to a forehead to measure for a fever.

The following five self-assessment exercises will let you know how simple, valuable, and economical it is for you to make an investment in quality developmental-behavioral screening tools.

1 Referral rates

2 Visit time

Quality screening tests designed for pediatric clinics-PEDS, ASQ, and PEDS:DM-are typically completed by parents in waiting or exam rooms. That frees providers to concentrate on the more important tasks of making referrals and educating parents about behavior and development. In practice, most clinicians find that deployment of good tools actually saves time.

3 Reimbursement

Worries about costs and reimbursement have held back many practices from adopting good tools. So a third exercise is to view reimbursement before and after implementing a good screening tool.

Reimbursement is only assured when quality instruments are used, and only when billed correctly. When a screening test is performed along with any evaluation and management service (eg, preventive medicine or office outpatient), the modifier –25 should be appended (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). The procedure code 96110 is used to indicate that screening occurred (if two or more screens were administered add X2, X3, etc.). In 2005, the Centers for Medicare and Medicaid Services published a total relative value unit (RVU) of 0.36 for 96110, which amounts to a Medicare payment of $13.64. 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, x4022, or at aapcodinghotline@aap.org
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The RVUs do not cover a physician's time. This means that screening is largely a staff function, and thus staff training and commitment to determining the optimal work-flow is essential. Figure out if screens should be distributed to families in waiting rooms or exam rooms and who will score the screen, attach results to the chart, and create referral letters.