Coding Conundrums The correct diagnosis and treatment codes on claim forms can mean the difference between payment or denial. Make the right choices with an updated ASHA resource. Bottom Line
Bottom Line  |   January 01, 2018
Coding Conundrums
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ASHA News & Member Stories / Bottom Line
Bottom Line   |   January 01, 2018
Coding Conundrums
The ASHA Leader, January 2018, Vol. 23, 34-35. doi:10.1044/leader.BML.23012018.34
The ASHA Leader, January 2018, Vol. 23, 34-35. doi:10.1044/leader.BML.23012018.34
Every year, changes in two health care code sets require clinicians to revise how they code some of the services they provide and diagnoses they treat.
Clinicians use both sets of codes—one that describes a patient’s condition (diagnosis codes) and one that describes the services the clinician provides (procedure codes)—on claim forms they submit to insurers for payment. If the codes are incorrect, the claim may be denied. To increase your chances of getting paid, keep on top of annual procedure code updates.
ASHA’s “2018 Coding and Billing for Audiologists and Speech-Language Pathologists” summarizes these updates and provides case scenarios that help clinicians code correctly. More than 40 coding examples demonstrate how each case’s clinical details guide coding.
How do I describe the treatment I provided?
Use Common Procedural Terminology codes (CPT, ® American Medical Association) to describe the treatment you provided to the patient.
Scenario 1. I see a patient for speech-production treatment and cognitive rehabilitation in a session. What codes should I bill? Can I bill for both?
Answer: It is likely that you can bill only CPT 92507 (treatment of speech, language, voice, communication and/or auditory processing disorder) or CPT 97127 (therapeutic intervention focused on cognitive function)—but not both. Medicare and Medicaid do not allow both 92507 and cognitive treatment to be billed for a patient by the same provider on the same day, and private payers may follow that rule.
Note that CPT 97127 is a new code that replaces the old 97532 (Development of cognitive skills to improve attention, memory, problem solving) in January 2018. However, Medicare will not accept 97127—instead, it is using its own 15-minute G-code for cognitive treatment (G0515).
Check with the patient’s insurer if you are providing cognitive treatment. You need to know if the payer accepts the new 97127 code or is following Medicare’s system, and if the payer follows Medicare by not allowing 92507 and cognitive treatment on the same day.

Medicare will not accept 97127—instead, it is using its own 15-minute G-code for cognitive treatment.

How do I code an unsuccessful service or procedure?
Sometimes, your session doesn’t go as planned.
Scenario 2. I have tried to administer audiologic testing on children, but I obtain only limited results or no interpretable results. How should I code this testing?
Answer: There is no simple answer to this situation—the clinical details will help you choose how to code this encounter.
If a child is completely uncooperative with any test procedure, you can cancel the appointment or use a reduced-service modifier (–52) to indicate that the entire protocol of the diagnostic procedure was not completed.
If, however, you have a child who requires frequent reconditioning and reinstruction—and you’ve spent considerable time and used different techniques but you obtained only limited audiologic information—you should bill a full evaluation, not a reduced service with the –52 modifier.
You should document all evaluation efforts, including a note of how much time was involved.
How do I record a diagnosis?
The codes in the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), describe the patient’s disorder or symptoms.
Scenario 3. I am treating a child with childhood apraxia of speech (CAS). What is the ICD-10-CM diagnosis code for CAS?
Answer: The correct code is R48.2 (Apraxia). Generally, codes in the R00–R99 series are used for organic-based disorders. SLPs are able to diagnose apraxia—and R48.2 is one of the few codes in the “R” series of codes an SLP can assign without the patient having a secondary medical condition.
What if the appropriate ICD-10 code isn’t clear?
As with CPT codes, assigning ICD-10 codes can also be perplexing.
Scenario 4. What code do I assign for a newborn who fails a hearing screening?
Answer: There are several options, so check with the patient’s payer. ICD-10 codes in the H91.9X series (Unspecified Hearing Loss) or in the H91.8X series (Other Specified Hearing Loss) may be appropriate.
Some audiologists have success using the “Z” codes, which represent reasons for encounters, and are part of ICD-10. Some payers may accept “Z” codes, but they are used less frequently than other ICD-10-CM codes. The “Z” codes include the following:
  • Z00.110 (newborn check under 8 days old).

  • Z00.111 (newborn check 8 to 28 days old).

  • Z00.121 (encounter for routine child health examination with abnormal findings).

  • Z00.129 (encounter for routine child health examination without abnormal findings).

  • Z01.10 (encounter for examination of ears and hearing without abnormal findings).

  • Z01.110 (encounter for hearing examination following failed hearing screening).

  • Z01.118 (encounter for examination of ears and hearing with other abnormal findings), used to identify abnormal findings.

Clinicians should consider each patient’s unique clinical situation … also, payers may have their own specific policies that affect code assignment.

And more…
Scenarios in the book address how to code a variety of speech-language and hearing diagnoses and treatments, including:
  • Language treatment for a child with autism.

  • Orofacial myofunctional disorder treatment.

  • Central auditory processing disorder treatment.

  • Team conferences.

  • Evaluation and management (E/M) codes.

  • Normal testing results.

  • Assigning a stuttering code.

  • CVA-related diagnostic codes.

  • Codes related to speech-generating devices.

  • Auditory rehabilitation after cochlear implant.

Remember that these case scenarios are designed for educational purposes only. An actual patient’s medical record may be more complex and different from those presented, and clinicians should consider each patient’s unique clinical situation. Also, payers may have their own specific policies that affect code assignment.
Ultimately, it is up to the provider to assign and support the most appropriate ICD-10 and CPT codes.
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January 2018
Volume 23, Issue 1