Reflections on Coding The ASHA Leader article on coding for evaluations (“Cracking the New Evaluation Codes,” March 2014) caused me to reflect on how we got to this point. These codes separate many procedures that, in reality, overlap, as do the tests, testers and conditions being tested. Why can we not all just ... Inbox
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Inbox  |   May 01, 2014
Reflections on Coding
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Inbox   |   May 01, 2014
Reflections on Coding
The ASHA Leader, May 2014, Vol. 19, 4. doi:10.1044/leader.IN1.19052014.4
The ASHA Leader, May 2014, Vol. 19, 4. doi:10.1044/leader.IN1.19052014.4
The ASHA Leader article on coding for evaluations (“Cracking the New Evaluation Codes,” March 2014) caused me to reflect on how we got to this point. These codes separate many procedures that, in reality, overlap, as do the tests, testers and conditions being tested.
Why can we not all just simply state that we diagnose and treat disorders of speech, oral and written language, memory, auditory processing, hearing sensitivity, cognitive ability, executive functioning, attention, and oral motor function; state our test battery; compute time spent; and submit the claim under one code? This divide-and-conquer approach is just a ploy to reduce payment and is an opportunity for manipulation.
If some SLPs call a vocabulary test and an oral language test battery a speech-language evaluation, fine, but it took only three hours and has limited value. By contrast, a comprehensive assessment may take 16 hours, but can clarify the basis of the person’s communication breakdowns in school, work and society and be the basis of a treatment plan that will change that person’s life. These codes offer no distinctions for degrees of professional preparation.
Sometimes an articulation problem is just an articulation problem; sometimes it is the tip of an iceberg that requires a highly qualified professional to unravel. For many years, I worked with third-party payers and am familiar with the objections, and I realize that not all school and clinical settings allow us to practice what we are qualified to do, but do we just roll over and play the coding game?
Carol Kamara, Rockville, Md.

Medicare—whose policies and payment rules are often adopted by other third-party payers—requires accurate valuation of distinct procedures based on a number of factors. “Umbrella” codes—those that include multiple, distinct, procedures—are difficult to value under this system. The new codes that replaced the previous evaluation code (92506) are based on professional work, rather than technical support, and are therefore less likely to fluctuate in value.

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May 2014
Volume 19, Issue 5