09/20/2023
Blue Cross and Blue Shield of Texas (BCBSTX) conducts quarterly audits of Medicaid (STAR and STAR Kids) and CHIP well-child checkup records to ensure that providers include all required components of a thorough exam. An audit of a Texas Health Steps (THSteps) checkup record ensures the provider has completed the appropriate components based on the child’s age at the time of the exam. The THSteps Periodicity Schedule for Infants, Children, and Adolescents defines the required components of the checkup, and closely reflects the Bright Futures/American Academy of Pediatrics schedule of Recommendations for Preventive Pediatric Health Care.
The physician must document that he or she reviewed the score in the context of the patient presentation and discussed the results with the patient/family as part of the related Evaluation and Management (E/M) or preventive service.
One of the required components of the THSteps checkup is Developmental Surveillance. This requirement is divided into separate but related components. The Periodicity Schedule is specific about the tools that practitioners should utilize to be compliant with the audit. Common errors that lead to non-compliance with this component are use of an incorrect screening tool and not performing or documenting this vital component of the checkup. Remember to reference the THSteps Periodicity Schedule if you are uncertain about what documentation is required based on your patient’s age.
The THSteps Periodicity Schedule specifically requires the following: Ages & Stages Questionnaires (ASQ), Ages & Stages Questionnaires: Social-Emotional (ASQ:SE), or Parents’ Evaluation of Developmental Status (PEDS) assessments at ages 9 months, 18 months, 24 months, 30 months, 5 years, and 6 years. Please be aware that the Denver Development Assessment is not among the accepted formal assessments for these ages. Additionally, Autism Spectrum Disorder Assessments M-CHAT or M-CHAT-R/FTM are required at ages 18 months and 24 months. The table below further details the components.
Developmental Surveillance |
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Review of Milestones
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Formal Developmental Screening Tools |
Formal Autism Spectrum Disorder Screening Tools |
Ages:
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Ages:
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Ages:
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CPT codes are used to request reimbursement for the expense of each screening instrument including the scoring and documentation. |
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CPT Code |
Examples of Screens |
96110 Developmental screening (e.g., developmental milestone survey, speech and language delay screen, autism screen) |
M-CHAT, ASQ-3rd Edition, PEDS, SWYC |
96127 Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale) |
ASQ-SE, SCARED, Vanderbilt, PSC, PHQ-2, PHQ-9 or adolescent version, Connors |
96160 Administration of patient-focused health risk assessment instrument (e.g., health hazard appraisal) |
CRAFFT, AUDIT, BSTAD, S2BI, DAST-20 |
96161Administration of caregiver-focused health risk assessment instrument (e.g., depression inventory) for the benefit of the patient |
Edinburgh Postnatal Depression Scale (English), PHQ-2, PHQ-9 administered to caregiver during a baby’s visit |