Codes and ethical considerations for autism screening clinic

[borne_before]

Hello,

Autism be outta control. We have shut down all external referrals and made a waiting list. Just yesterday, I basically told a parent who had been on my schedule since april that they shouldn't drive from three hours away because their AP student's therapist think they might have a touch of the 'tism. I referred them to another place, after I explained that our facility generally focuses on kids with more severe needs and I generally focus on a more classic (read highly impairing) form of autism.

Now out care coordinators are wondering when they can start scheduling again (i'm scheduling out until next feb, and I am hesitant schedule more, because a dude needs time off and I just dont know my travel schedule for next year.

The problem is: a lot of the referrals I am getting are good. The nonverbal 30 month old. But a lot are just tiktok teens, anxious kids who think they have autism because some lameo MSW thinks they know alot about autism, etc.

So a screening clinic would allow me to get a gander and better allocate resources and only spend like 30 min with the kiddo. "ya know, I think there are some issues here, but your issues are just not a good fit for our clinic" - > and refer to community mental health)? Versus, "holy hell, your kid needs aba yesterday."

Are they any codes I could bill for this? Any ideas?

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[WisNeuro]

Why don't you just bill 90791? Pretty easy to meet the documentation requirements in such a visit. And, with a templated report, you can cruise through a lot of these.

 

[ClinicalABA]

Depends on what your main receiving providers (e.g. aba providers) need to get their services authorized. A one hour 90791 screening eval might work where you are. Here, for kids under three that might be enough to get them aba until age, where services are through our DPH early intervention program. However, after 3 insurance funded aba authorizations require some form of standardized testing with 2 different metrics.

We're in the same boat- trying to figure out how to see more kiddos who need autism therapy. Hard to do without setting pretty young (~30 months) max age limits. We're looking at prioritizing kids under 2 yo- less testing needed,less differential diagnosis, better access to treatment, and better outcomes.

 

[Therapist4Chnge]

Why don't you just bill 90791? Pretty easy to meet the documentation requirements in such a visit. And, with a templated report, you can cruise through a lot of these.

That’s prob the easiest. Being untimed, any assessment given is basically a freebie, so cost of materials should at least be considered. I’d also want to look downstream and have a process hammered out for “now what?” ABA, parent/family therapy, etc.

 

[WisNeuro]

That’s prob the easiest. Being untimed, any assessment given is basically a freebie, so cost of materials should at least be considered. I’d also want to look downstream and have a process hammered out for “now what?” ABA, parent/family therapy, etc.

Yeah, it sounded like OP wanted something that served as a sort of triage, prior to a full assessment. So, having a sort of "intake clinic" set up seems doable. Though, depending on those current waitlists, they'd have to have a system set up so that those who do need a full assessment don't get screwed by having to get an another wait list.

 

[smalltownpsych]

I have a question related to this since I often do a diagnostic interview or consultation before doing a formal assessment. Does it matter if I use an assessment code like 96130 or should I use 90791 for this initial visit? Sometimes I will hand out some screeners and schedule more testing, but others I might just start doing therapy with me or one of my therapists or schedule a consult with their current therapist. I charge the same for either and I don’t do insurance although patients will submit a superbill for reimbursement at times.

 

[WisNeuro]

I have a question related to this since I often do a diagnostic interview or consultation before doing a formal assessment. Does it matter if I use an assessment code like 96130 or should I use 90791 for this initial visit? Sometimes I will hand out some screeners and schedule more testing, but others I might just start doing therapy with me or one of my therapists or schedule a consult with their current therapist. I charge the same for either and I don’t do insurance although patients will submit a superbill for reimbursement at times.

I'd shy away from psych/neuropsych testing codes if you are not doing a full assessment. Some insurances limit to one eval per year and you could be blowing that eval in case they do need a comprehensive eval. There are ways around this, but it's more hassle.

 

[smalltownpsych]

I'd shy away from psych/neuropsych testing codes if you are not doing a full assessment. Some insurances limit to one eval per year and you could be blowing that eval in case they do need a comprehensive eval. There are ways around this, but it's more hassle.

That makes sense. Thanks.

 

[borne_before]

That makes sense. Thanks.

I always do 90791 before billing the testing codes.

 

[FlowRate]

Some perspective from a psychiatrist who sees a lot of patients who are convinced they have ASD who almost certainly do not have ASD. They're just weird/odd/eccentric/emotionally dysregulated and mostly don't have a diagnosable level of pathology in those areas.

The way my organization runs, there is no utility to my making screening phone calls. But if I were in private practice, that's exactly what I would do. You only need a few minutes talking to someone to get a sense that they have very good socio-emotional function. Like you said, then you can just say "our clinic specializes in more severe autism, you should seek care elsewhere." (And ideally have a suggestion for where.) Then you avoid the almost universally difficult conversation of trying to tell someone who spends too much time on "neurodiversity" forums that they don't have ASD.

 

[psychma]

I do an interview intake before testing which helps me guide people in other directions. I am full through January. I make sure to build breaks into my schedule so I stay sane. I’m working with adults.

 

[AcronymAllergy]

If some of you who perform autism evals in adults could relocate over this way, that'd be great. I've got no idea where to refer these patients because either no one in the area is doing the evals, or I don't trust the quality of the work that is being done.

 

[smalltownpsych]

Some perspective from a psychiatrist who sees a lot of patients who are convinced they have ASD who almost certainly do not have ASD. They're just weird/odd/eccentric/emotionally dysregulated and mostly don't have a diagnosable level of pathology in those areas.

The way my organization runs, there is no utility to my making screening phone calls. But if I were in private practice, that's exactly what I would do. You only need a few minutes talking to someone to get a sense that they have very good socio-emotional function. Like you said, then you can just say "our clinic specializes in more severe autism, you should seek care elsewhere." (And ideally have a suggestion for where.) Then you avoid the almost universally difficult conversation of trying to tell someone who spends too much time on "neurodiversity" forums that they don't have ASD.

I don’t argue much with patients about Autism or not. Especially since Autism is not a clearly defined construct with an etiology. From my perspective they are just saying that they have problems with life and I am very good at helping them with whatever those problems are. What is good is that at least there isn’t a pharmaceutical for autism yet, we’ll really see an explosion if that happens.

 

[FlowRate]

I don’t argue much with patients about Autism or not. Especially since Autism is not a clearly defined construct with an etiology. From my perspective they are just saying that they have problems with life and I am very good at helping them with whatever those problems are. What is good is that at least there isn’t a pharmaceutical for autism yet, we’ll really see an explosion if that happens.

Seems like the bolded goes for most of the stuff in the DSM/psychiatric ontologies?

If they were seeing me for therapy and were motivated to change/improve then I'd 100% take that approach. But that's not my role in this system (I'm the meds/diagnosis/treatment plan quarterback guy).

Most patients seeing me for an ASD eval are part of the online communities that label adaptive behavior as harmful "masking." They want the ASD "diagnosis" to then be able to tell their employer and other relationships that they get to act however they damn well please and shouldn't get in trouble for it because they see behavior labeled as ASD as immutable. They don't say these things so directly but they do say these things during the course of our evaluation ("how do you imagine things may be different or change for you if you were to find out you had ASD?").

Meanwhile, I have higherish functioning patients with actual autism who want to get better at socializing. Or patients with more severe forms of autism who benefit from medications to help keep them from having meltdowns all the time.

 

[smalltownpsych]

Seems like the bolded goes for most of the stuff in the DSM/psychiatric ontologies?

If they were seeing me for therapy and were motivated to change/improve then I'd 100% take that approach. But that's not my role in this system (I'm the meds/diagnosis/treatment plan quarterback guy).

Most patients seeing me for an ASD eval are part of the online communities that label adaptive behavior as harmful "masking." They want the ASD "diagnosis" to then be able to tell their employer and other relationships that they get to act however they damn well please and shouldn't get in trouble for it because they see behavior labeled as ASD as immutable. They don't say these things so directly but they do say these things during the course of our evaluation ("how do you imagine things may be different or change for you if you were to find out you had ASD?").

Meanwhile, I have higherish functioning patients with actual autism who want to get better at socializing. Or patients with more severe forms of autism who benefit from medications to help keep them from having meltdowns all the time.

Probably more of an issue with something that is also tied to something as intangible as social ability than our other diagnoses. Maybe I don’t have to deal much with the “I just want a diagnosis” crowd pretty quickly since I won’t give it to them without a comprehensive evaluation that will cost a lot and I don’t take insurance.

 

[singasongofjoy]

After a great deal of time and headache over the "quirky and curious" (primarily tiktokers) in our clinic to get on the waitlist at all there needs to be 1) some way to get reliable early reporter (could include records that include behavioral obs or concerns etc) and also 2) some evidence of clinically significant impairment in life functioning. Also 3) the referring provider must be someone who has known the person for a while and lists reasons for the referral (not "patient requested"). For those that don't make it on the waitlist we have a templated letter that explains as much, and (briefly) the reasoning why, along with invitation to attend a seminar we will start offering periodically that will cover neurodivergence more broadly as an umbrella, lovely venn diagram of things common in ASD/anxiety/ADHD, resources of various types. and also that they are welcome to send in more info and we will re-review their chart or they can contact us for list of other places that do adult evals. Got a few more aspects we may roll out but trialing this to see how things go... I have otherwise been reasonably successful with giving that spiel at the conclusion of 90791s but I don't want to waste time on those particular 90791s when those who very much need the eval for services- especially that transition to adulthood / end of high school crowd - are waiting so long. Hopefully this trial goes well... if anyone has tried a similar approach and has some feedback/ideas I'm all ears