Screening Instruments: Caring for the Whole Child


AndyBarnesBy Andrew Barnes, MD , MPH, FAAP, Assistant Professor, Developmental-Behavioral Pediatrics, Division of General Pediatrics and Adolescent Health, University of Minnesota

If you’ve ever wondered whether you’re seeing more children with disabilities in your clinic over the past 15 years, you are – from 2000-2010, this population of children grew the fastest since it started to be recorded in the U.S. This increasing prevalence was mostly due to neurodevelopmental differences and mental health conditions – up 20% in the past decade (while physical health disabilities were down 10%), rising fastest among families with higher socioeconomic status. We may be identifying some of these children better in our clinics because of improved standardized developmental screening, as recommended by the American Academy of Pediatrics in their 2006 policy statement. This policy (and other related policies relating to autism, social-emotional, and mental health screenings) recognize that early intervention is critical for children with developmental and behavioral needs, and that these conditions are best managed within a medical home that cares for the whole child.

Growing evidence suggests that clinicians are well positioned not just to perform surveillance at every well child visit and formal developmental screening only at select visits, but moreover to fully implement screening for risk and resilience across childhood and adolescence. This includes:

  • Developmental and behavioral screening from birth to school-age
  • Autism screening for toddlers
  • Maternal depression screening during the newborn period and infancy
  • Social-emotional and mental health screening for toddlers, preschoolers, school-age children and adolescents
  • Adverse childhood experiences, psychosocial risk, and protective factors for all children and teens

Although it can seem daunting to integrate and sustain such screenings in clinical practice, practical advice for systematically doing so is available at under the “Practice Management” tab.

Feasibility issues to consider when selecting screening tools include whether the tool has established validity and reliability for diverse populations; ease of scoring and interpretation; literacy level of the tool; whether translated versions or culturally-neutral versions of the tool exist; costs of the tool and the time to administer and score it; and the method of delivery and scoring (paper/pencil, tablet computer, online kiosk).

Practice considerations include defining when and where the tool is given (before, during, or after the visit), who administers and scores it, and how completion rates and quality will be monitored.

Coding and billing should take into account that the Centers for Medicare and Medicaid Services changed the Current Procedural Terminology (CPT) codes for these screenings in early 2015. The prior CPT code that covered all such screenings, 96110, is now to be used only for “physical development” such as milestone-oriented surveys and speech and language screenings.

A new CPT code, 96127, is to be used for emotional and behavioral screenings (such as those used for ADHD, mental health, substance abuse, or psychosocial risk). Both of these codes can be billed in multiple units; for example, if a child has two parents who both complete an autism checklist screening tool to provide multiple perspectives, then 96110 should be billed x2 units for that visit. These CPT codes are intended to cover the office costs associated with their administration (e.g., nursing assistant time and the cost of obtaining the survey), not for clinician time and effort, which are included in the Evaluation and Management code for that visit.)

Methods for screening the five areas mentioned above will be covered in this newsletter in more detail in the coming issues. Understanding how and why to use these screening methods can help us engage with our patients, practice community, and systems of care to improve how we care for the whole child.

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