How Do You Code Executive-Function Services for Children? Appropriate billing codes depend on the reason for the deficit, underlying medical conditions and other factors. Bottom Line
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Bottom Line  |   May 01, 2015
How Do You Code Executive-Function Services for Children?
Author Notes
  • Janet McCarty, MEd, CCC-SLP, is ASHA private health plans adviser. jmccarty@asha.org
    Janet McCarty, MEd, CCC-SLP, is ASHA private health plans adviser. jmccarty@asha.org×
Article Information
Attention, Memory & Executive Functions / Bottom Line
Bottom Line   |   May 01, 2015
How Do You Code Executive-Function Services for Children?
The ASHA Leader, May 2015, Vol. 20, 28-29. doi:10.1044/leader.BML.20052015.28
The ASHA Leader, May 2015, Vol. 20, 28-29. doi:10.1044/leader.BML.20052015.28
Speech-language pathologists work with children who have deficits in their executive function—their ability to manage cognitive processes such as initiating, goal-setting, self-evaluation, planning, organization, flexibility, reasoning and problem-solving. Children with executive-function deficits may have a neurological condition or may have no known neurological condition.
If you are working on improving a child’s executive-function skills—such as setting goals for a task, increasing the ability to sequence steps for an activity, and initiating problem-solving strategies when difficulties arise—how do you bill and code for those services?
What code can I use when I evaluate a child for executive-function problems?
Executive function is integral to the ability to communicate, in children and adults. There are specific CPT codes (Common Procedural Terminology, © American Medical Association) for evaluating cognitive abilities:
  • 96125 (standardized cognitive testing), used with 92523 (evaluation of speech sound production and language comprehension and expression), provides a comprehensive assessment of speech, language and cognitive skills.

  • 96111 (developmental testing; motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments) is more likely to be used for a very young child, perhaps with multiple impairments, and this procedure alone may give the clinician sufficient information to develop a plan of care.

Many clinicians refer to 97532 as the code for “cognitive rehab”—however, note that the code does not say “rehabilitation” of cognitive skills, but rather “development” of cognitive skills. This important distinction allows this code to describe cognitive treatments for the pediatric and adult populations.

What CPT code can I use for treating executive-function problems?
CPT 97532 (development of cognitive skills to improve attention, memory, problem solving [includes compensatory training]) best addresses the components of executive function, and can be used to describe executive function treatment for children and adults.
Many clinicians refer to 97532 as the code for “cognitive rehab”—however, note that the code does not say “rehabilitation” of cognitive skills, but rather “development” of cognitive skills. This important distinction allows this code to describe cognitive treatments for the pediatric and adult populations.
Can I use 92507 and 97532 on the same day in the same session?
Medicare policy does not allow codes 92507 (treatment of speech, language, voice, communication and/or auditory processing disorder; individual) and 97532 to be used for the same patient on the same day when billed by the same clinician. Private health plans often follow Medicare policy; clients should check with their payers to find out whether both codes are allowed on the same day.
What diagnostic codes can I use for executive-function impairments?
For patients with TBI, ICD-9-CM diagnostic code 799.52 (cognitive communication deficit) is appropriate. Another possibility is 799.55 (frontal lobe and executive function deficit), although SLPs most likely would use 799.52 to capture the executive-function problems as part of the cognitive communication impairment.
The 799 series of codes may not be used with many conditions, such as attention deficit hyperactivity disorder, cerebrovascular accident and developmental conditions such as 315.32 (mixed receptive-expressive language developmental disorder).
For patients with a neurological condition that is not TBI, such as epilepsy or brain cancer, SLPs could use 784.69 (other symbolic dysfunction) to describe executive-function impairment. SLPs use this code for organic-based language and cognitive problems, so executive-function problems with a secondary medical diagnosis could be coded with 784.69.
For children with neurological conditions that impair language and cognitive skills, including executive-function abilities, the SLP may need to decide if the cognitive and executive-function impairments are better addressed as a component of the language deficit and coded accordingly. (See below about private health plans.)
For children without a related medical condition, but who present with executive-function impairment and language deficits, 315.32 (mixed receptive-expressive language developmental disorder) may be the most appropriate code to convey a language-related cognitive disorder.
For children without a related medical condition or language deficit, but who have executive- function deficits addressed in speech-language treatment, code 315.8 (other specified delays in development) may be the best descriptor. Under ICD-10-CM (effective Oct. 1, 2015), code 315.8 maps to F88 (other disorders of psychological development). Informal descriptors for F88 include “cognitive developmental delay.”
According to ASHA website information on the role of SLPs in treating individuals with ADHD, “Speech-language treatment will focus on individualized language goals, such as teaching better communication in specific social situations, and study skills (planning/organizing/attention to detail).”
Because ADHD is a medical diagnosis, SLPs could assign 784.69 for executive-function deficits for these children, and indicate the medical diagnosis of ADHD as the secondary diagnosis, obtained from the child’s medical record.
Do private health plans cover speech-language treatment for executive function?
A number of private health plans specifically exclude coverage for cognitive rehabilitation (executive function being a component of cognitive rehabilitation) for specific conditions, including cerebral palsy, Down syndrome, ADHD, autism and dementia.
WellCare, which also manages certain Medicaid and Medicare plans, covers cognitive rehab for acquired conditions—such as stroke, TBI and encephalopathy—but excludes coverage for developmental delay, cerebral palsy, ADHD and learning disabilities, noting there is insufficient published evidence to support the use of cognitive rehabilitation for these conditions.
Aetna considers “cognitive behavior modification (cognitive rehabilitation)” as experimental and investigational “for the assessment and treatment of ADHD because the peer-reviewed medical literature does not support the use of these procedures/services for this indication.”
UnitedHealthCare states, “Cognitive rehabilitation is unproven and not medically necessary for the treatment of cerebral palsy, Down syndrome, Alzheimer’s disease, attention deficit hyperactivity disorder, developmental disorders such as autism, schizophrenia and Parkinson’s disease.”
1 Comment
November 2, 2015
Adam Stokey
Insurance Coverage
Thank you for the informative article. I have a client whom I am considering billing in this manner for. She was previously treated for cognitive-communication deficits in conjunction to mixed language deficits, but recently tested within normal limits on standardized testing for language. She clearly still demonstrates deficits in cognitive-communication; namely planning, organizing, and attending. Do you know of any health plans which do cover billing under the mentioned cognitive treatment codes (I saw only those 3 which specifically exclude)? I am debating right now if it makes more sense to continue treating under the cpt and diagnostic codes for language disorder as you also mentioned in the article. Any help appreciated. Thank you.
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May 2015
Volume 20, Issue 5