Physicians that focus on assessing and managing children’s behavioral and emotional issues are known as “developmental-behavioral pediatricians.” These physicians specialize in the treatment of children with developmental impairments. Some examples include intellectual disability, cerebral palsy, and conditions that fall under the autistic spectrum.

Children with emotional and behavioral disorders, including ADHD, anxiety, and depression, are also included. Developmental-behavioral pediatricians evaluate children’s behavioral and developmental difficulties, diagnose them, and create treatment programs that may include medicines, psychotherapy, or other approaches.

A pediatrician specializing in developmental and behavioral disorders must use appropriate billing codes. The correct coding will guarantee that you are reimbursed fairly and aid in preventing any possible billing problems. This article will describe the CPT codes that developmental-behavioral pediatricians use most frequently.

Codes for evaluation and management

Pediatricians specializing in developmental and behavioral disorders bill for their services using evaluation and management codes. The most widely used codes are as follows:

  • 99213: This billing code is for a general patient checkup lasting between 15 and 20 minutes and requiring some degree of medical judgment.
  • 99214: This billing category describes a well-established patient visit lasting between 25 and 30 minutes and involving significant medical decision-making.
  • 99215: This code is used for a routine patient appointment requiring thorough medical judgment and 40 to 45 minutes of face-to-face interaction with the patient.
  • 99201-99205: The intricacy of a patient’s medical history, physical exam, and subsequent treatment decisions are all factored into these initial visit codes.
  • 99381-99387: These codes are used for initial patient preventative visits and vary in how much they include the patient’s age, medical history, physical exam, and counseling.
  • 99391-99397: Based on the patient’s age and the intricacy of the medical records, evaluation, and counseling involved, these codes are used for established patient preventative visits.

Codes of Psychiatry

Billing for psychiatric services given by developmental-behavioral pediatricians requires using psychiatric codes. Some of the most general codes are:

  • 90792: When healthcare services, such as psychiatric examination, analysis, reporting, and medical management, are part of a diagnostic evaluation, this code is utilized.
  • 90832: When therapists meet with patients for 30 minutes, they use this code.
  • 90834: This code is used for a psychotherapy discussion with a patient that lasts 45 minutes.

Codes for Assessment and Testing

Developmental-behavioral pediatricians employ assessment and testing codes to bill for patient diagnostics. The most prominent codes are:

  • 96110: Using standardized instruments, this code screens for communicative, motor, adaptive, and social skill development.
  • 96111: When conducted by a physician or other certified healthcare provider, this code is used for developmental assessment, including psychological, neuropsychological, and behavioral testing.
  • 96116: Doctors use this code to measure neurobehavioral status, including concentration, memory, communication, perception, problem-solving, and motor capabilities.
  • 96118: Neuropsychological testing includes direct patient care and report preparation; every hour of a doctor’s or other skilled health practitioner’s time is spent on neuropsychological testing.
  • 96120: Neuropsychological evaluations are charged hourly for one-on-one time with a technician.
  • 96125: Regular cognitive performance evaluation (such as the Ross Information Processing Assessment).

Coding for Therapeutic Interventions

Pediatricians treating children with developmental and behavioral issues utilize therapeutic intervention codes to identify their services. Pediatricians that specialize in developmental-behavioral issues most frequently utilize the following therapeutic intervention codes:

  • 90832: Individual and family psychotherapy for 30 minutes.
  • 90834: Individual and family psychotherapy for 45 minutes.
  • 90837: Individual and family psychotherapy for 60 minutes.
  • 90846: 50 minutes of family psychotherapy (during which the patient will not be present).
  • 90847: 50 minutes of in-person counseling with the patient’s family.
  • 96150: First evaluation of health and behavior.
  • 96151: Assessment and re-evaluation of behavior and health

Developmental-behavioral pediatricians must appropriately bill and code for their services, which is greatly facilitated by CPT codes. Healthcare practitioners can connect with insurers and ensure correct reimbursement using these codes to track and report medical procedures and services. Practitioners must keep up with the current CPT codes and recommendations to provide the best treatment for their patients as developmental-behavioral pediatrics evolves.

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