Screening & Monitoring
Routine developmental screening of young children is recommended by the American Academy of Pediatrics (AAP) and is fully described in the 2006 Policy Statement titled Identifying Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening. The use of evidence based developmental screening tools is also encouraged by the American Academy of Family Physicians and is included in the curriculum recommendations for Family Practice residents in the care of Infants and Children. The AAP recommends that routine developmental screening be conducted at least three times before a child’s third birthday and provides an algorithm that includes developmental screening at 9, 18 and 24 to 30 months. Furthermore, the policy recommends the use of an evidence based screening tool anytime the parent or physician has any developmental concerns.
“I already do developmental surveillance. Why add a tool?”
Using a developmental screening tool adds an evidence based component to routine developmental surveillance. Research indicates that developmental surveillance identifies only about 30% of the children who do have a delay. This is because “eyeballing” children allows us to find only the most apparent delays. Neither our eyes nor our ears are sensitive enough to accurately identify those children who have moderate delays and might be eligible for early intervention (EI) or early childhood special education services (ECSE) such as speech and language, physical, occupational, mental health or educational therapies. In California, for example, children under the age of 2 are eligible to receive services if they have a 33.3% delay in any area. It is unrealistic to expect any physician to visually discriminate between a 30% or 40% delay for a child based on their age, which is why valid and reliable screening tools are recommended. For that reason, the AAP recommends routine developmental screening at the 9, 18 and 24 or 30 month well child visit.
“What screening tools are recommended?”
There are two parent completed screening tools widely used in clinics and medical practices: The Ages and Stages Questionnaires-3 © (ASQ-3) and the Parental Evaluation of Developmental Status © (PEDS). These parent completed questionnaires are valid and reliable and are used to identify children who are typically developing from those who are at risk for developmental delay. If you are a physician, you may be eligible to receive either the ASQ-3 or PEDS for free, training for you and your office staff, and a financial incentive from a project funded by the Children and Families Commission of Orange County. This project is administered through the Orange County Medical Association and includes CMEs from the American Academy of Pediatrics Chapter 4 and training and technical assistance provided by Help Me Grow Orange County.
“What if I prefer not to do developmental screening in my office?”
Currently, the AAP (2006) policy recommends developmental screening as best practice and it has been shown statistically that without developmental screening, about 70% of children who may be eligible for EI or ECSE services are missed because their delays are mild or moderate. Any practice not doing routine in-office developmental screening with an evidence based tool can refer their patients to Help Me Grow Orange County to help connect to a program or agency that will offer the service at no cost to you or your patient. If you would like to learn more about how Help Me Grow Orange County can help you refer your patients for developmental screening or to an array of community based programs please schedule an EPIC visit.
“Can I bill insurance for developmental screening?”
The CPT code for developmental screening is 96110 and can be used as a modifier when appended to a well child visit
(-25). Please see information from DbPeds.org for more information on billing and to learn more about developmental screening. Currently, many insurance companies are reimbursing offices for developmental screening. Furthermore, there are requirements under The Patient Protection and Affordable Care Act ("PPACA") that require insurance companies to cover the cost of developmental screening. Click here for more information about required reimbursements under PPACA.
If you are interested in learning more about Help Me Grow or developmental screening please schedule an in-office EPIC visit for you and your staff.