Speech-language pathologists and audiologists—both those new to billing and veteran practitioners—often raise questions about which diagnostic or procedure codes to use in certain situations. This column is devoted to some of those questions for SLPs. Questions for audiologists will be tackled in the near future. Below is the most recent speech-language pathology question—and the most difficult to answer.
Q: I was advised to use V57.3 "speech therapy" as the primary International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis when seeing a patient for speech-language pathology treatment. Further, I was told to use the actual diagnosis as a secondary diagnosis. Is this really what I should do?
The ASHA Health Care Economics Committee has discussed this matter over the past two years. The advice you received is technically correct, but you need to be cautious following this rule because of the preferences of some payers to see the actual diagnosis listed first.
Frankly, private health plans appear to ignore V codes as diagnoses, so we do not recommend their use unless the plan requires it. V codes are contained in a separate ICD-9-CM chapter and are a "supplementary classification of factors influencing health status and contact with health services." They range from V01 to V86. The ICD-9-CM Official Guidelines for Coding and Reporting (effective Nov. 15, 2006) requires that the "aftercare codes," such as V57.3 code, be listed first when a patient is receiving treatment services only in an outpatient setting. The Guidelines state, "The aftercare codes are generally first listed to explain the specific reason for the encounter."
The V57.3 code would be followed on the billing form by the therapy diagnosis (i.e., the diagnosis or problem for which the service is being performed). In other words, the reason why the patient is receiving speech-language pathology treatment is listed second (e.g., 438.11 aphasia). The therapy diagnosis code may also be followed by the underlying medical diagnosis, but the Guidelines do not specifically require the underlying medical diagnosis code (see page 90 of the Guidelines under "M. Patients receiving therapeutic services only").
The first page of the Guidelines states, "Adherence to these guidelines when assigning ICD-9-CM diagnosis and procedure codes is required under HIPAA." Interestingly, the aftercare section also states that the V code should not be used if treatment is directed at a current, acute disease or injury. Therefore, if the treatment is for a diagnosis such as delayed speech and language development, an "aftercare" code would seem irrelevant.
The ICD-9-CM guidelines are available on the Internet from the National Center for Health Statistics (a center within the Centers for Disease Control and Prevention in the U.S. Department of Health and Human Services). Pages 61-62 and 90 should be of interest to the reader.
We recommend contacting the health plan officials to remind them of the ICD-9-CM Official Guidelines for Coding and Reporting requirements and to determine their preferences for coding and billing these services.
Q: I saw a patient for voice therapy and used relaxation exercises for the jaw, neck, and shoulders; digital manipulation of the larynx; and vocal function exercises. I also advised the patient to avoid noisy situations when talking. What Current Procedural Terminology© (CPT) code should I use? Is the correct code CPT 97530, Therapeutic activities direct patient contact by the provider (use of dynamic activities to improve functional performance) each 15 minutes? Is it CPT 97532, Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training)? Or is it CPT 92507, Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual?
You may wish to check with the health plan. We know that Medicare directs you to use CPT 92507 because it is such a global code. Some officials at the Centers for Medicare and Medicaid Services (CMS) say that the 97000 series codes were developed for physical therapy and occupational therapy and should be restricted as such.
They prefer that SLPs use the codes that are found in the otorhinolaryngologic section of the CPT, with the exception of CPT 97532, Development of cognitive skills. Some Medicare local coverage decisions allow CPT 97533, Sensory integrative techniques. Health plans other than Medicare may allow the use of the 97000 series by SLPs. It is best to check with the health plan if you are going to use a code other than CPT 92507 or 97532.
Q: Can I bill for an evaluation and treatment on the same day? In other words, can I bill CPT 92506 and CPT 92507 on the same day?
CMS has coding edits called the National Correct Coding Initiative (CCI) and it allows the use of these two codes on the same day when two distinct services are provided. You would not bill these two codes once treatment has started, even though you are continually evaluating the patient's functional level.
If the patient requires a complete re-evaluation due to a significant change in the patient's overall condition, and the visit only encompasses that service, you could bill CPT 92506 alone. A coding table on the ASHA Web site lists all of the speech-language pathology CCI edits.
For any coding and reimbursement questions, e-mail firstname.lastname@example.org.