Developmental Screening: A
Pediatric Practice “How-To”
Practice Management Association
2008 Teleconference Series
Wednesday, October 29, 2008 12 noon
Dr. Pippa Abston, MD, UAB Pediatrics (Huntsville)
Janice Clark, Practice Manager, Anniston Pediatrics
Renee Bringhurst, Blancher & Stadther in Mobile
Objectives
To provide information on staffing,
scheduling, and screening protocols
necessary to implement developmental
screening into your practices
To identify generic and specialized community
resources for families and children, birth to
five years
To learn the appropriate Medicaid and AllKids reimbursement codes
To learn appropriate methods to
communicate with your parents on the
benefits of the developmental screening tools
ABCD Screening Academy:
National consortium
Supports efforts of 18 states, District of
Columbia, and Puerto Rico to implement
policy and practice change
Designed to move standardized
developmental screening from best practice
to standard of practice as part of well-child
care
15-month initiative that began in April 2007
(Alabama)
The American Academy of Pediatrics
Policy Statement Recommends that:
Developmental surveillance be performed at
every preventive visit
A screening tool should be administered at 9-,
18-, and 24- or 30-month visits and for those
children whose surveillance yields concerns
about delayed or disordered development
--Demonstration project also included an
additional screen at 4 years
What is Developmental Screening?
NASHP defines developmental screening as
the administration of a brief, standardized
tool that aids the identification of children at
risk of a developmental delay.
Developmental Pediatrics Online adds that
screening refers to the use of measures with
proven reliability and validity that are
administered in a standardized, i.e., uniform,
way.
http://www.dbpeds.org/articles/detail.cfm?TextID=139
A recent national survey found that
just over half of parents say their
child has ever had a developmental
assessment during a pediatric visit.
http://www.cmwf.org
Importance of Early Intervention
First 3 years of life are critical to brain
development*
Brain is most adaptable in childhood
Early treatment is most effective for
developmental conditions
*Shonkoff JP, Phillips DA, eds. From Neurons to Neighborhoods:
The Science of Early Childhood Development; 2000
ABCD Screening Academy
Learning Session, July 2007. Sices, Lipkin, Earls
American Academy of Pediatrics: Developmental and Screening Algorithm
AABCD Practice Improvements
Target Population (in terms of measurement)
Medicaid eligible children, 0 – 5 years
Increase in number of standardized screenings
performed in accordance with AAP Periodicity
Schedule at 9, 18, 24, and 48 months (e.g.,
screenings increased from 95 to 410)
Increase in referrals to appropriate services
(e.g., over a three-month period, referrals
increased from 28 to 57)
Another example: ALL Kids saw a 600%
increase in 96110 billing claims
Measurable Outcomes:
AABCD Demonstration Sites
University of Alabama at Birmingham Health
Center – Huntsville Regional Medical Center
(Pediatric Department): Dr. Pippa Abston.
University setting with residents and
students.
Anniston Pediatrics: Drs. Doggett and
Vullaganti. Typical office setting.
Blancher and Stadther, Mobile: Dr. Blancher
is chair of the AL-AAP Children’s Mental
Health Committee and is our State Physician
Champion. Uses the ASQ Manager (EMR)
Pediatric Office Mechanics –
UAB Pediatrics – Huntsville
Held initial training with the office staff and
pediatrician to introduce them to the ASQ
Printed several age level copies of the ASQ
test before office visits began
Age-appropriate tote bags were assembled
for parents
Pediatric residents and students administered
the ASQ to parents as part of routine exams
Pediatric Office Mechanics –
UAB Pediatrics - Huntsville
If no staff trainees or if service not covered
by insurance, the parent filled out the ASQ
prior to the pediatrician seeing the patient.
Referrals to Early Intervention based upon
results.
Our practice used home stimulation handouts
for parents to used as a teaching tool at
home.
Pediatric Office Mechanics –
Anniston Pediatrics
Schedule ASQ (Ages and Stages
Questionnaire) training with the DMH/MR
Establish the age level of patients being
screened
Establish the appropriate coding within your
practice
Identify necessary resources in your area for
easy referral
Pediatric Office Mechanics –
Anniston Pediatrics
A screening tool should be administered at 9-, 18-,
and 24- or 48-month visits.
Prepare patient charts one day in advance – place
appropriate ASQ screening tool with the scoring
sheet in individual patient charts.
Upon arrival, the receptionist hands the form to the
parent for completion while in the office.
Patient is called to exam room and offered help from
the nurse on completion of the form.
Nurse scores the questionnaire (3 – 4 minutes in
length) and places in the score sheet for the
physician to review.
Pediatric Office Mechanics –
Anniston Pediatrics
Physician performs exam and discusses the ASQ
results with the parent.
If referral is indicated, the score sheet is marked
“Referred,” placed in the patient’s chart and moved
to the nurse’s lab area (or an area where a nurse
would usually follow up with patient’s needs).
Our charge tickets were labeled “Refer to ______”
and given to the referral clerk to make the
appointment and follow up with the parent on
necessary information.
Pediatric Office Mechanics -Blancher and Stadther (Mobile)
Use the ASQ Manager (EMR). A dedicated office staff
manages the ASQ forms and places them in the
patient folders.
ASQ is sorted by pediatrician and day of visit. Parent
is given the test, explanation, and assistance if
necessary to fill while at the office visit.
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Giving the ASQ to the well child parent to fill out allows for
the pediatrician to tend to sick children.
10 to 15 minutes for the parent to complete the form and 3
minutes for the nurse or aide to score the test.
Pediatric Office Mechanics –
Blancher and Stadther (Mobile)
ASQ given at all well-child visits, but automatically at
the 9-, 18-, 24- and 48-month check-ups. All
Medicaid patients are included due to higher risk.
Scores are logged in the developmental section of
our EMR and a copy of the summary is scanned into
the chart
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
Pediatrician has the info in the chart to review prior to
seeing the patient.
Pediatrician will discuss the results of the test with the
parent – inopportunity or developmental delay.
Pediatric Office Mechanics –
Blancher and Stadther (Mobile)
Inopportunity – given a copy of the age-appropriate
activities from the ASQ manual
Development Delay – parent linked to the Mobile
county-wide referral resource list. Early Intervention
is most widely used.

No ASQ for a severe delay such as Arthrogryposis. Maybe
one for Down’s Syndrome to check for progress.
Referral Request


Form given to an office staff designated who will locate the
resource, schedule and follow up with the parent
Pediatrician will monitor for signs of improvement to report
to the parent
Coding Protocol
Medicaid – Physicians and physician-employed or
Independent Nurse Practitioners, if enrolled as Medicaid
EPSDT providers, may bill 96110. Nurse practitioners will
be reimbursed at 80% of the physician allowed rate,
which is $10.00.
In order to bill this code, a standardized developmental
screening tool must be utilized. The policy for this code is
in the January 2008 provider manual. A maximum of two
tests is allowed. Documentation of the tool used, with
interpretation and report, must be in the child’s medical
record.
ALL Kids - Will reimburse for up to four standardized
screenings tied to a well-child visit during the first four
years. Previously only paid 96110 with an abnormal code.
What is the ASQ?
Ages and Stages Questionnaires (ASQ): a parentcompleted, child-monitoring system available from Brookes
Publishing, www.agesandstages.com or 1-800-638-3775, to
screen infants and young children for developmental delays
or concerns in the first five years of life
Components include:
 19 questionnaires and corresponding scoring sheets
 ASQ User’s Guide
 CD-ROM and DVD availability
 Ages and Stages Learning Activities
 ASQ Manager, an easy-to-use computer database
program for EHR practices
State Resources
Child Find: Statewide program to locate, identify, and evaluate
children with disabilities from birth to age 21.
 Birth through 2: 1-800-543-3098.
 Ages 3 – 21: 1-800-392-8020.
Children’s Rehabilitation Service 1-800-846-3697.
State Resources
Patient 1st Care Coordinators (Medicaid only)
 Region 1: 256-383-1231
(Colbert, Franklin, Lauderdale, Marion, Walker, Winston)
 Region 2: 256-340-2113
(Cullman, Jackson, Lawrence, Limestone, Madison, Marshall, Morgan)
 Region 3: 205-554-4507
(Bibb, Fayette, Greene, Lamar, Pickens, Tuscaloosa)
 Region 4: 205-930-1427
(Jefferson)
 Region 5: 205-274-2120
(Blount, Cherokee, Dekalb, Etowah, Shelby, St. Clair)
 Region 6: 256-315-4950
(Calhoun, Clay, Cleburne, Chambers, Coosa, Randolph, Talladega, Tallapoosa)
 Region 7: 334-877-2828
(Choctaw, Dallas, Hale, Lowndes, Marengo, Perry, Sumter, Wilcox)
 Region 8: 334-361-3759
(Autauga, Bullock, Chilton, Elmore, Lee, Macon, Montgomery, Russell)
 Region 9: 251-275-4177
(Baldwin, Butler, Clarke, Conecuh, Covington, Escambia, Monroe, Washington)
 Region 10: 334-678-2805
(Barbour, Crenshaw, Coffee, Dale, Geneva, Houston, Henry, Pike)
 Region 11: 251-690-8980
(Mobile)
State Resources
AL-AAP/AABCD Pediatric Resource Toolkit:
http://www.alchapaap.org/iform.asp?id=306
Alice Widgeon, Coordinator of Early Intervention Services
Office of Children's Services, ADMH/MR
P.O. Box 301410, Suite 504
Montgomery, AL 36130-1410
Phone: 334-242-3702
Fax: 334-353-7062
Early Intervention:
 Huntsville: 1-800-283-9352
 Birmingham: 1-888-430-7423
 Talladega: 1-800-947-7140
 Montgomery: 1-800-441-7607
 Dothan: 1-800-677-9123
 Mobile: 1-800-879-8163
 Tuscaloosa: 1-800-723-0490