January 1, 2013 Association

Billing Code Changes Take Effect

Billing for some swallowing evaluations is no longer limited to physicians under billing code changes that took effect Jan. 1. In addition, there are new codes for some audiology procedures and device codes.

The modifications are related to Common Procedural Terminology codes (© American Medical Association) and Healthcare Common Procedure Coding System Level II of the Centers for Medicare and Medicaid Services.

Flexible fiberoptic endoscopic evaluation of swallowing

The codes related to fiberoptic endoscopic swallowing evaluation are now "provider-neutral," with no description of specific professionals permitted to perform the procedure. "Provider-neutral," however, does not give all providers permission to bill for the service; providers must stay within their scopes of practice, abide by state practice laws, and understand payers' coverage guidelines.

Three interpretation and report codes for certain endoscopic procedures no longer contain the term "physician":

  • CPT 92613, Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording; interpretation and report.
  • CPT 92615, Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording; interpretation and report.
  • CPT 92617 Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording (FEESST); interpretation and report. 

Speech-language pathologists can use these codes only if they have not passed the scope, but have reviewed, interpreted, and reported the results. If the SLP also passes the scope, the appropriate codes are 92612 (FEES, swallowing), 92614 (FEES, laryngeal sensory testing), and 92616 (FEES, swallowing and laryngeal sensory testing), all of which include the procedure, review, interpretation, and report.

The changes have been made to CPT, but SLPs should check with their local Medicare contractor and other third-party payers to ensure that billing by an SLP is allowed. The revised codes are posted on ASHA's CPT Codes for 2013 webpage.

Intraoperativemonitoring

Three new codes apply to audiologists performing intraoperative monitoring during surgical procedures-95940 (in the operating room), 95941 (multiple patients, outside the operating room), and G0453 (one patient, outside the operating room). The codes mandate continuous attendance by a professional qualified to interpret the testing and monitoring, and require immediate communication directly with the operating room. The codes include the ongoing monitoring time-distinct from the performance of baseline studies-testing, and data interpretation. 

CPT 95940 can be billed for Medicare patients when the monitoring is performed in the operating room. However, 95941(outside the operating room) has caused some Medicare controversy, because it allows for remote monitoring of more than one case at time. It is unclear if remote, simultaneous monitoring directly violates Medicare policy; however, CMS created a code-G0453-specifically for remote monitoring of one Medicare patient at a time. Both 95940 and G0453 are billed in units of 15 minutes, and must be billed incident to physician services.

Audiologists should contact any other third-party payers regarding coverage policies for using 95940 and 95941. ASHA is meeting with relevant stakeholders regarding Medicare's rejection of 95941, and will post additional information in future issues of the Leader and at ASHA's CPT and HCPCS Codes for 2013 webpage.

Nerve conduction studies

Seven new codes (95907-95913) that include motor, sensory, and mixed nerve conduction studies replace the two traditional H-reflex codes (95934 and 95936). Each code the number of studies performed:

  • 95907: 1 or 2 studies
  • 95908: 3 or 4 studies
  • 95909: 5 or 6 studies
  • 95910: 7 or 8 studies
  • 95911: 9 or 10 studies
  • 95912: 11 or 12 studies
  • 95913: 13 or more studies 

Tests must be performed with separate electrodes for stimulating, recording, and grounding on only those specific nerves indicated for the diagnosis in question. Waveforms must be reviewed on site in real time with reports by the examiner and interpretation by the physician or other qualified health care professional. Each type of nerve conduction study is counted only once on the same nerve, and billing continues to be incident to a physician service.

FM systems

ASHA and other organizations have successfully advocated and achieved new codes for FM/DM systems for 2013. The addition of "digital modulation" to the code descriptor allows for inclusion of new technology in health plans. Although FM/DM systems are not a Medicare benefit, the codes will be instrumental for Medicaid and private insurance programs that supplement hearing aid and cochlear implants recipients, especially children, with the technology. The new codes (all for "assistive listening device") are:

  • V5281, personal FM/DM system, monaural, (one receiver, transmitter and microphone)
  • V5282, personal FM/DM system, binaural (two receivers, transmitter and microphone)
  • V5283, personal FM/DM neck, loop induction receiver
  • V5284, personal FM/DM, ear level receiver
  • V5285, personal FM/DM, direct audio input receiver
  • V5286, personal blue tooth FM/DM receiver
  • V5287, personal FM/DM receiver, not otherwise specified
  • V5288, personal FM/DM transmitter assistive listening device
  • V5289, personal FM/DM adapter/boot coupling device for receiver, any type
  • V5290, transmitter microphone, any type

The hearing aid supply/accessory code, V5267, has also been modified to include assistive listening device supplies not otherwise specified in the new codes. 

The codes can also be found at ASHA's CPT and HCPCS Codes for 2013 webpage.

Lisa Satterfield, MS, CCC-A, director of health care regulatory advocacy, can be reached at lsatterfield@asha.org.

Neela Swanson, associate director of health care economics and coding, can be reached at nswanson@asha.org.

cite as: Satterfield, L.  & Swanson, N. (2013, January 01). Billing Code Changes Take Effect. The ASHA Leader.

  

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