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96110

It looks like your hard work paid off!  From a CMS bulletin dated 12/29/2011:

The AAP has issued an important call to action for pediatricians, and those who work for them, relating to a proposed change to the 96110 CPT code, a subject about which I've written many times (these are just a fraction of the blog entries, you can see them all here).

A request was made on SOAPM for a better understanding of the payment for developmental screening, namely the 96110 and 96111.  Here's the update for 1Q 2011, where we examined tens of thousands of 9611X CPT codes used by our clients.

OK, I think I have written about the 96110 more than any other specific subject!

First, big thanks go out to Igor for getting this data for me. Sure, he deserves a raise...we all do.

The list below should not be considered a 100% accurate report of which payers, by state, cover the 96110 (or 96111, for that matter) for two reasons:

I have had a number of off-line and on-line requests for details about who, exactly, is paying for the deveopmental testing (96110 and 96111) and non-face-to-face codes (or the "telephone codes"), so Igor was kind enough to look it up for me.

I've written extensively about 96110 usage among practicing pediatricians in the past and wanted to provide an update for 2008/9.

96110 Charge Reimbursement Data

(Paid-off Charges, 2008/9)

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…

I have some fascinating data about the after hours, etc., codes (9905x) coming, but I wanted to share these two followup tidbits before I forget:

  • The Developmental Screening Toolkit For Primary Care Providers looks like an excellent site to add to the list I posted the other day. In particular, here's a great comparison chart of the more common screening tools, which includes costs, links, time it takes to complete, etc. As I've said before, why practices don't perform these services and bill for them is beyond me.
  • Two more articles about personalized medicine, microcapitation, whatever we want to call it. The first is from northjersey.com and is the classic vignette-style article about docs dropping insurance. The second piece is from Medical Economics and, as one would expect, it offers more details about how a practice might go about dropping out of insurance. There are some insightful comments (for example, pointing out the challenges of dropping out one insurance company at a time vs. all-at-once), but their reference to a specific generic billing package is kinda' weird (why would they suggest people look at a billing system whose legal troubles are showcased on their own front page?). Any content about this subject with the "...skip the middleman.." in the title is good by me.

9905x coming next, I think. Interesting stuff.

As promised, here's a followup to my 96110 data from the other day. It's interesting to see how 96110 usage has increased in pediatricians over the years, but what are folks getting paid? Here's the data:

96110 Reimbursement

I know it's hard to read, so click here or on the image to see the entire thing.

So, what do we learn? Back when the 96110 was rarely used by pediatricians, it was paid pretty well ($50+). However, in 2004, CMS first published RVUs for the code and the average reimbursement plummeted. Today (and 2008 projects the same), the average payment is often between $14 and $15...or right about 100% of Medicare for most folks. Given that this is a service many of you already perform - and all of you should! - it's nice to get reimbursed at all in today's climate. Frankly, 100% of Medicare is right in line with average pediatric reimbursement in general - sad, but true - so this looks like it should slip right into the daily expectation of your well visits, etc.

In order to see the total effect of 96110 income on a pediatric practice, compare this with the previous graph...if the average PCC client (who uses this code) recorded 1800+ of them in 2007, that's almost $30,000. Add to this Dr. Stoller's message (and, yes, you too, Dr. Cain!), and you're talking about lots of potential income. Enough to make the effort. What are you waiting for, agian?

During the production of this blog, I have noticed a certain amount of serendipity with the information I take the time to share. If I mention, say, the concept of concierge medicine, I'll get a call the next day out of the blue from a client who is working on it and shares her experience with me.

Yesterday, I started the first of two or three posts about the use of the 96110 CPT code in pediatrics. It's symbolic of a series of codes (any of the screening codes, after hours codes, telephone codes, etc.) that many pediatricians perform, but don't record. As you can see from the graph I posted, only ~30% of PCC customers bill for it presently. Here, in her own words, is Dr. Stoller's proof for why you should bill everything all the time:

I got good news today from ... the Cigna class-action facilitator. I (and several other pediatricians) filed a grievance with Cigna stating that bundling of 96110 was not in compliance with the settlement (I have one pending with Healthnet also). Well, today I heard that effective 5/1/08 Cigna is paying pediatricians separately on this code AND I have prevailed in my grievance and will get paid for all my 96110s I submitted to Cigna retro to 2005 (or whenever I first started billing it)! I just ran ira [a PCC report program] - I will be able to submit 819 charges to Cigna - if they pay $20 per charge that's a little extra change. I hope this help me prevail with Healthnet, too. And only the docs that actually filed the grievance get to file for all the retro charges - everyone else benefits as of 5/1/08.

Like I said, I can't make this stuff up.

So, thank you Dr. Stoller, on behalf of the rest of us. It's time more and more pediatricians get paid for doing this important work. And congrats on having the foresight to always bill for this, even when you weren't getting paid...it just shows that diligence pays off. BTW, the Cigna settlement is one of the earliest things I blogged about - wow, does that seem like a long time ago. And this isn't the first time Dr. Stoller has busted the inscos.

I like days like this.