On December 30, 2013, the Centers for Medicare & Medicaid Services (CMS) released the 1st quarter 2014 National Correct Coding Initiative (CCI) edits, effective January 1, 2014, through March 31, 2014. The CCI edits have incorporated four new evaluation Current Procedural Terminology (CPT® American Medical Association) codes related to fluency, speech sound production, language, and voice and resonance.
The updated CCI edits do not restrict same-day billing combinations of the new codes with other codes, except for the pairing of 92522 and 92523, which is barred by the CCI edits. Additionally, some combinations with existing codes (e.g., 96125 Standardized cognitive performance testing) will require the addition of a -59 modifier to differentiate between procedures/services.
A listing of speech-language pathology edits is available on ASHA's CCI edits webpage, including edits for the following four new evaluation codes:
- 92521, Evaluation of speech fluency (e.g., stuttering, cluttering);
- 92522, Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
- 92523, Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language);
- 92524, Behavioral and qualitative analysis of voice and resonance.
In cases where multiple evaluations may be appropriate, documentation should clearly reflect a complete and distinct evaluation for each disorder. Evaluation codes should not be billed for brief assessments that could be considered screenings. Time for identification of other disorders is already built into the value of each code; inappropriate use of multiple evaluations on the same day could result in future restrictions through CCI edits.
The National Correct Coding Initiative (NCCI or, more commonly, CCI) is an automated edit system to control specific CPT code pairs that can be reported on the same day. CCI was developed by CMS for use in all Medicare Part B and, more recently, Medicaid claims. Other third-party payers may also adopt the CCI edits. The CCI is updated quarterly.
For questions, please contact ASHA's health care economics and advocacy team at [email protected].