procedure codes for speech therapy

[Guest guest]

Hi, I am relatively new to this list serve and have a question regarding CPT

codes, primarily some codes that I either wasn't aware were allowable for speech

therapy to use or have heard controversies about speech being reimbursed for.

Any input anyone can offer would be appreciated. The codes I am wondering about

are 99532, 97110 and 97530. I am also wondering how much ST's use 96105 vs the

generic sp/lang assessment code 92506. thanks!

Norton, CCC/SLP

SJRMC

jnorton@...

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[Guest guest]

The issue of how to code for speech therapy is in active discussion in my

organization. The speech-language pathologists are using e-stim and deep

pharyngeal nerve stimulation (DPNS) treatments for diagnoses such as Bell's

Palsy, brainstem CVA, and other neurological difficulties affecting the

brainstem. One SLP is using e-stim in a case of status post carotid

endarderectomy for facial symmetry alone, NOT for speech or swallowing. They

are also using DPNS is for swallowing diagnoses as a part of a muscle

strengtheing program for the palatal, pharyngeal, and laryngeal areas.

I have the benefit of being able to refer to an Outpatient PT/OT/SLP Educational

Update put out by the Michigan Fiscal Intermediary, United Government Services,

and have given the following opinion to our SLP's. I have to add the

disclaimer, though, that the SLP's are not convinced that I'm right. I'd value

reading the opinions of others on this subject.

My read on the Medicare/FI guidelines and CCI edits:

For the two major categories of treatment, Treatment of swallowing dysfunction

and/or oral function for feeding, 92526, and Treatment of speech, language,

voice, communication, and/or auditory processing disorder (includes aural

rehabilitation), individual, 92507, there are several codes that are considered

to be components. Neuromuscular Re-education, 97112, and Therapeutic Exercise,

97110, are the two main procedure codes that have been suggested for use in SLP

billing for e-stim and DPNS, and both are considered components of both 92526

and 92507. We may not bill for either of them on the same visit as 92526 or

92507 without applying a -59 modifier, and our FI cautions against routine use

of -59.

Could we bill for 97112 or 97110 instead of 92526 or 92507? It depends. In

treating Bell's Palsy and facial asymmetry, if the SLP is not listing improved

swallowing function or improved speech, language, voice, communication, and/or

auditory processing as a goal, I believe billing for 97112 or 97110 is

appropriate if and only if the documentation clearly shows that the treatment is

not for improved swallowing or oral function for feeding, or for any speech,

language, voice, communication, and/or auditory processing disorder, but is for

some other goal unrelated to these areas.

However, in cases in which the goal of treatment is to improve swallowing or

oral function for feeding, or to improve speech, language, voice, communication,

and/or auditory processing, using 97112 or 97110 would be viewed by CMS as an

attempt to bill for a more expensive timed procedure instead of billing for the

more accurate, but less expensive, untimed procedure. Our fiscal intermediary

warns, " Do not select the CPT code based on the reimbursement amount associated

with a particular CPT. Rather select the CPT based on the code that most

accurately describes the services actually provided. " Remember that CMS views

92526 or 92507 as comprehensive codes; anything that falls into these general

categories is supposed to be charged to these treatment codes.

I have not yet discovered any pertinent documents related to the use of the

modality codes for e-stim when also billing for speech or swallowing treatment.

If anyone on the list serve has information on this issue, please let me know.

I'm eagerly awaiting your reaction to my read of the guidelines,

Jeannette Holton, MPA, BSW, CPHQ

Patient Care Manager

Lakeland Health Park Rehabilitation Center

3774 Hollywood Road

St. ph, MI 49085

269 428-7084

jholton@...