December 26, 2007 Feature

New Billing Codes for Team Meetings and Cognitive Testing is a Good Idea

Beginning Jan. 1, speech-language pathologists and audiologists who participate in medical team conferences for a patient's care will have two new codes for meetings of 30 or more minutes that meet certain criteria. SLPs also will have a new code for cognitive testing.

The new Current Procedure Terminology© (CPT) team meeting codes cover participation by a non-physician qualified health care professional in medical team conferences. ASHA worked closely with the American Cleft Palate-Craniofacial Association and other groups during the development and valuation of the codes.

Team conferences must meet two additional criteria to be eligible for the new codes—at least three qualified health care professionals from different specialties or disciplines who provide direct care to the patient must participate, and each participant must have performed face-to-face evaluations or treatment independent of the team conference within 60 days prior to the conference.

Reporting

Reporting participants should record their role in the conference, contributed information, and subsequent treatment recommendations. The time for the team conference starts at the beginning of the case review and ends at its conclusion, regardless of how much time the individual participant spends addressing the team or patient/family. Record-keeping or report-generation time, however, is not included. The participating professional must be present for the entire team conference, and only one individual from each profession may report the encounter.

  • CPT 99366 is the code for participation by a non-physician qualified health care professional in a medical team conference with an interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more. (Physicians are referred to evaluation and management codes for a comparable code.)
  • CPT 99368 is the code for participation by a non-physician qualified health care professional for a medical team conference with an interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more. (Physicians will report CPT 99367 for their participation.)

Medicare Coverage

SLPs should note that the new team conference codes will not be covered by Medicare. The Centers for Medicare and Medicaid Services (CMS) will not reimburse separately for these services, noting that "we believe these services, like other counseling services, are incorporated into existing E/M (evaluation and management) services." ASHA will urge CMS to consider that SLPs and audiologists are not allowed to bill Medicare for E/M services; therefore, these codes should be made reimbursable for 2008 and beyond.

Cognitive Testing

SLPs may report cognitive testing with a new "Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing)." ASHA and the American Occupational Therapy Association proposed the new procedure after the previous cognitive testing code (96115) was revalued and limited to use by physicians and psychologists. Leaders and members of ASHA Special Interest Division 2, Neurophysiology and Neurogenic Speech and Language Disorders, led the development and valuation processes of the new code.

  • CPT 96125 will be used for "standardized cognitive performance testing per hour of a qualified health care professional's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report." Medicare does recognize this code as reimbursable for SLPs.

For further information or questions about the new team conference and cognitive testing codes, contact reimbursement@asha.org.

Steven White, director of health care economics and advocacy, can be reached at swhite@asha.org.

cite as: White, S. (2007, December 26). New Billing Codes for Team Meetings and Cognitive Testing is a Good Idea. The ASHA Leader.

  

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