Crack the Codes Correctly Payers reject claims with incorrect diagnosis and treatment codes. A new resource helps you determine the most appropriate descriptions. Bottom Line
Free
Bottom Line  |   January 01, 2017
Crack the Codes Correctly
Author Notes
  • Janet McCarty, MEd, CCC-SLP, is director of ASHA private health plan reimbursement. jmccarty@asha.org
    Janet McCarty, MEd, CCC-SLP, is director of ASHA private health plan reimbursement. jmccarty@asha.org×
  • This article is adapted from “2017 Coding and Billing for Audiology and Speech-Language Pathology” (on.asha.org/2017code-bill).
    This article is adapted from “2017 Coding and Billing for Audiology and Speech-Language Pathology” (on.asha.org/2017code-bill).×
Article Information
Hearing Disorders / Practice Management / Bottom Line
Bottom Line   |   January 01, 2017
Crack the Codes Correctly
The ASHA Leader, January 2017, Vol. 22, 34-35. doi:10.1044/leader.BML.22012017.34
The ASHA Leader, January 2017, Vol. 22, 34-35. doi:10.1044/leader.BML.22012017.34
Treatment codes that often change can make it difficult for clinicians in health care to complete claims forms accurately.
Health care clinicians use two sets of codes to accurately reflect the treatment they provide for a specific condition. Codes to describe a client’s condition (diagnosis codes) come from the International Classification of Diseases, 10th Revision (ICD-10). Codes that describe the treatment a clinician provides come from Current Procedural Terminology (CPT), published by the American Medical Association.
Choosing the correct diagnosis and procedure codes can be tricky. ASHA’s annual publication “Coding and Billing for Audiology and Speech-Language Pathology” reflects any revisions that took effect in the past year. The 2017 edition also has a new section that outlines more than 40 case scenarios that illustrate the process of using clinical details to assign the most appropriate codes. The following scenarios are examples of those included in the publication.

It’s important to read the descriptions of codes carefully to determine what they cover.

Describe services
CPT codes describe what the clinician does for the patient.
Scenario 1. What code does a speech-language pathologist use when performing a speech-language evaluation and a speech fluency evaluation?
Answer: If you provide a full speech-language evaluation, you should use CPT code 92523 (evaluation of speech and language). If you also conduct a full fluency evaluation, you would also use CPT code 92521 (evaluation of speech fluency). Document both codes clearly to indicate that the procedures are separate and distinct evaluations.
It’s important to read the descriptions of codes carefully to determine what they cover. Codes for audiologic testing of infants and children illustrate this point.
Scenario 2. Using visual reinforcement audiometry (VRA), an audiologist tests an infant (CPT code 92579) or, using conditioning play audiometry (CPA), tests a child (CPT 92582). Is it appropriate to use separate codes for speech awareness/threshold testing (CPT 92555) and tonal testing (CPT codes 92582 and 92579)? Do VRA and CPA codes include speech testing or tone testing only?
Answer: The code for VRA—CPT 92579—includes the speech awareness threshold as part of the description and evaluation; therefore, a clinician can’t report both CPT 92579 and 92555 (speech awareness/threshold testing) for the same patient. In contrast, however, CPT code 92582—the code for CPA—represents only tonal stimuli obtained via CPA techniques and does not include speech testing. Therefore, a clinician can report CPT 92555 with CPT 92582 for the same patient.
Assign a diagnosis
Determining a diagnosis for a patient is a professional responsibility. The scenarios in the new publication provide guidance, but it’s important to consider individual patients’ circumstances and medical records as you assign diagnoses.
Scenario 3. What diagnosis do you assign when your evaluation reveals normal results? An audiologist sees a patient who complains of tinnitus, but the results of the patient’s evaluation are within normal limits. What ICD-10 code should the audiologist use?
Answer: H93.13 (tinnitus, bilateral). The audiologist should code the presenting complaint, even if the testing results are normal.
Scenario 4. What diagnostic code would an SLP assign to a voice patient for paradoxical vocal fold disorder or vocal cord dysfunction (VCD)?
Answer: J38.5 (laryngeal spasm).

The scenarios in the new publication provide guidance, but it’s important to consider individual patients’ circumstances and medical records as you assign diagnoses.

A last word
An actual patient’s medical record may be more complex and different from the scenarios presented, and clinicians should take these into account when reviewing the coding scenarios. Additionally, payers—Medicare, Medicaid and private insurers—may have policies that affect code assignments. As providers, however, audiologists and SLPs have the professional responsibility to determine a patient’s diagnosis and to assign and support the most appropriate ICD-10 and CPT codes.
The coding case scenarios in ASHA’s “2017 Coding and Billing for Audiology and Speech-Language Pathology” describe a number of different clinical situations, including:
  • Providing treatment for speech production and cognitive. rehabilitation in a single session.

  • Programming and modifying a speech-generating device when the patient is not present.

  • Providing language treatment for a child with Asperger syndrome.

  • Providing myofunctional evaluation and tongue-thrust treatment.

  • Completing evaluations that take place over more than one day.

  • Providing auditory rehabilitation for an adult with a cochlear implant.

  • Evaluating central auditory processing.

  • Providing audiologic testing on a child with limited or no interpretable results.

  • Using ICD-10 codes to differentiate developmental and organic conditions.

  • Coding team conferences.

0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
January 2017
Volume 22, Issue 1