Bottom Line: Cracking the New Evaluation Codes New speech-language codes pose some confusion for clinicians evaluating clients for aphasia, cognitive communication issues and other disorders. Check here for answers to the most common conundrums. Bottom Line
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Bottom Line  |   March 01, 2014
Bottom Line: Cracking the New Evaluation Codes
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Speech, Voice & Prosodic Disorders / Practice Management / Language Disorders / Aphasia / Attention, Memory & Executive Functions / Bottom Line
Bottom Line   |   March 01, 2014
Bottom Line: Cracking the New Evaluation Codes
The ASHA Leader, March 2014, Vol. 19, 30-31. doi:10.1044/leader.BML.19032014.30
The ASHA Leader, March 2014, Vol. 19, 30-31. doi:10.1044/leader.BML.19032014.30
It seems fairly straightforward: Instead of using a single billing code for any speech-language evaluation, as of Jan. 1 clinicians must use new codes that more accurately describe the specific type of evaluation.
But the introduction of the new CPT codes (Current Procedural Terminology™ American Medical Association) has produced a flurry of confusion. CPT 92506 (evaluation of speech, language, voice, communication, and/or auditory processing) no longer exists, replaced by four codes that evaluate speech fluency, speech sound production with or without language, and voice and resonance. (See “One Code Does Not Fit All,” December 2013, on.asha.org/new-eval-codes).
The four new codes are:
  • 92521, Evaluation of speech fluency (for example, stuttering, cluttering).

  • 92522, Evaluation of speech sound production (for example, articulation, phonological process, apraxia, dysarthria).

  • 92523, Evaluation of speech sound production (for example, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (for example, receptive and expressive language).

  • 92524, Behavioral and qualitative analysis of voice and resonance.

Q How should I bill for a cognitive evaluation?
Speech-language pathologists should use CPT 96125 (Standardized cognitive performance testing, per hour) if you use a complete cognitive standardized test and the combined time it takes to conduct the evaluation, interpret the results and write the report is at least 31 minutes. You can use subtests of standardized tests if the subtests themselves also are standardized.
Because 96125 is a per-hour code, if a cognitive evaluation takes less than 31 minutes—including the time it takes to interpret the test and write the report—it should be coded with a -52 modifier to indicate a reduced service. (See an explanation of modifiers in the box below).
Q What if the cognitive evaluation does not include standardized cognitive testing?
You may bill CPT 96125 (standardized cognitive performance testing) only if standardized testing is part of the evaluation process. If you are providing a cognitive-only evaluation (for example, memory, attention and executive function) that does not include a communication component (language), there is no appropriate billing code.
Payers are placing increased emphasis on the use of standardized tests and SLPs are encouraged to include them as part of the cognitive evaluation process. Examples of standardized tests include the Montreal Cognitive Assessment, St. Louis University Mental Status Examination, and Ross Information Processing Assessment– Second Edition. For a list of other cognitive tests, visit www.asha.org/assessments.aspx.
Q Can I use 92523 (speech sound production and language evaluation) for a cognitive-communication evaluation?
If you are assessing cognitive skills using only nonstandardized tools in conjunction with a full speech and language evaluation, you may use CPT 92523. Speech-language abilities should be the focus.
Q Can I bill 92523 and 96125 together on the same day?
Yes, if you have completed both a full cognitive evaluation and a full speech sound production and language evaluation.
The cognitive evaluation should include standardized testing and take at least 31 minutes, including the time it takes to interpret and write the report. You also must add a -59 modifier to CPT 96125 to indicate the evaluations are separate and distinct procedures. (See an explanation of modifiers on p. 29).
Q How should I code an evaluation for an auditory processing disorder?
SLPs may bill an auditory processing disorder evaluation using CPT 92523 with a -52 modifier to indicate that a speech sound production evaluation has not been conducted.
Q What code should I use for an aphasia evaluation?
SLPs should use their own judgment in choosing the code that best describes the evaluation they are providing. Two codes have similar descriptions:
  • CPT 96105, assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, for example, by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour.

  • CPT 92523, evaluation of speech sound production (for example, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (for example, receptive and expressive language).

When you consider which code is most appropriate, consider your past billing patterns (which code you typically billed—92506 or 96105— before the evaluation code changes) and the types of tests you use (standardized or nonstandardized). You should always select the code that most accurately describes the service you provided.
Q What codes best capture pediatric speech-language and cognitive evaluations?
When you evaluate a child’s speech and language abilities, use 92523. If you also complete a full evaluation of that child’s cognitive abilities using standardized cognitive tests, use 96125 and follow the guidelines for billing those two codes alone and together.
For example, use 96125-52 for a cognitive assessment that takes less than 31 minutes. If you see a very young child, perhaps with multiple impairments, you could consider CP T 96111 (developmental testing, includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments).
Q Are there any restrictions on same-day billing of the new codes with other codes?
The National Correct Coding Initiative stipulates what specific code pairs cannot be billed on the same day for Medicare and Medicaid services, and many third-party payers also follow these regulations. Neither the CPT Handbook nor the National Correct Coding Initiative restricts an SLP from billing the new evaluation codes together, because there are circumstances in which same-day evaluations for multiple disorders are appropriate.
The only exception is same-day billing of 92522 and 92523, evaluations of speech sound production with or without language. (All current CCI billing restrictions on speech-language services are available at on.asha.org/cciedits-slp.)
Billing the new codes with some existing codes, however, may require the -59 modifier to indicate that the procedures are separate and distinct services; if multiple evaluations are appropriate, your documentation should clearly reflect a complete and distinct evaluation for each disorder. Do not bill evaluation codes for brief assessments that could be considered screenings. Time for identification of other disorders is already built into the value of each evaluation code, and inappropriate use of multiple evaluations on the same day could result in future CCI restrictions.
Q Whom should I contact if I have problems billing the new codes?
You should start by getting in touch with your payers to make sure they are aware of the coding changes. Coding systems may not be updated completely by the first of the year, causing billing problems. Payers may instruct SLPs on alternative coding until systems are updated.
For Medicare difficulties, contact the Medicare administrative contractor in your geographic area (find a list of contractors at on.asha.org/partb-macs).
If you continue to have problems or believe the codes are being implemented incorrectly, contact ASHA’s health care economics and advocacy team at reimbursement@asha.org.
Q Where can I find more information about the new codes?
ASHA’s continually updated CPT pages (on.asha.org/new-SLP-codes) include information, coding tips and FAQs.

Master Those Modifiers

Use -52 (reduced service) when the services you provide are significantly less than the code describes. For example, a language-only evaluation should be billed as 92523-52 (evaluation of speech sound production with evaluation of language comprehension and expression, with -52 modifier), because you did not administer a speech sound production evaluation. In the documentation, include a statement explaining the reason for the -52 modifier.

Use -59 (distinct procedural service) to indicate that a procedure or service was distinct or independent from other services appropriately performed on the same day. The National Correct Coding Initiative requires this edit when certain combinations of speech-language evaluation and treatment codes are billed for a single patient on the same day.

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March 2014
Volume 19, Issue 3