Coding for ASD
When the physician documents a diagnosis of ASD, use ICD-10-CM code F84.0
Autistic disorder. The
Code also note in the Tabular List under subsection F84, Pervasive developmental disorders, instructs you to report codes for any associated medical conditions such as an intellectual disability (F70-F79).
A type 1 exclusion note indicates not to report F84.0 with F84.5
Asperger’s syndrome; the code set considers them to be mutually exclusive. The difference, according to ICD-10-CM, is that Asperger’s is milder, and while it shares some symptoms with autism, people with Asperger’s syndrome don’t have the language and cognitive impairments that are usual in other autism spectrum disorders.
The CPT® code for both general developmental screening and for autism screening is 96110
Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument. When billing for ASD screening, report 96110 with modifier KX
Requirements specified in the medical policy have been met. For general developmental screenings, use 96110 without modifier KX. When more comprehensive developmental testing is performed — assessment of fine and/or gross motor, language, cognitive level, social, memory, and/or executive functions — look to CPT® codes 96112
Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour and +96113 …
each additional 30 minutes (List separately in addition to code for primary procedure).
To enhance specificity, there are Z codes you can use to identify the screening performed during the visit. Check with your payer to verify these codes are accepted and reimbursable:
Z13.41 Encounter for autism screening
Z13.42 Encounter for screening for global developmental delays (milestones)
When a screening test is performed with a significant, separate evaluation and management (E/M) service, append modifier 25
Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service to the E/M code to specify the E/M service was distinct and necessary during the same visit.
Spot the signs of ASD early to minimize challenges and maximize potential. Autism spectrum disorder (ASD) is a complex neurodevelopmental condition that Spot the signs of autism spectrum disorder (ASD) early to minimize challenges and maximize potential.
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