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by Mark Kander and Janet McCarty
Clinicians working with patients with voice disorders have an array of coding options to consider. What codes can be used for voice evaluation and treatment? What about instrumental assessments? Are there circumstances when physician supervision is necessary—and, if so, what level of supervision? The following questions and answers will provide speech-language pathologists with information about coding and billing for voice disorders.
What codes should I use to bill for voice evaluations?
A: CPT code 92506 (evaluation of speech, language, voice, communication, auditory processing disorder, and/or aural rehabilitation status) should be used to code voice evaluations. CPT 92597 (modification for use and/or fitting of voice prosthetic) is analogous to the temporary Medicare code G0200, which applies to artificial larynges as well as voice amplifiers. Note that the G codes will be replaced by new CPT codes in 2003.
Instrumental evaluation of voice disorders includes the following codes, as appropriate: 92520 (laryngeal function studies) for aerodynamic (laryngeal resistance) and acoustic voice measures; 31579 (laryngoscopy, flexible or rigid fiberoptic, with stroboscopy) for videostroboscopy; 31575 (laryngoscopy, flexible fiberoptic; diagnostic); 70371 (complex dynamic pharyngeal and speech evaluation by cine or video recording); and 92511 (nasopharyngoscopy with endoscope).
Each health plan may have specific guidelines on what instrumental evaluations SLPs can perform. You can advocate for instrumental assessment by referring payers to ASHA’s Scope of Practice in Speech-Language Pathology, which states, "The practice of speech-language pathology involves: using instrumentation (e.g., videofluoroscopy, EMG, nasendoscopy, stroboscopy, computer technology) to observe, collect data, and measure parameters of communication and swallowing, or other upper aerodigestive functions in accordance with the principles of evidence-based practice."
What codes are available for voice treatment services?
A: For voice treatment, use CPT 92507 (treatment of speech, language, voice, communication, and/or auditory processing disorder). This code is comprehensive and includes most aspects of voice treatment. Clinicians should be cautious in using additional CPT codes in combination with 92507 to describe voice treatment. For example, using 97112 (neuromuscular re-education) or 97110 (therapeutic exercises to develop strength, endurance, and range of motion and flexibility) to describe exercises for, say, improving respiratory function, along with 92507 may be viewed by some payers as "unbundling" (i.e., coding one component of a treatment as a separate billable service when that component is already captured under a more generic and appropriate code—in this case, 92507).
CPT 92598 (modification of voice prosthetic device) is parallel with the temporary Medicare code G0201 designated for modification of artificial larynges and voice amplifiers. The codes also are used for adjustment of speaking valves.
What about physician supervision for the instrumental assessments?
A: When performed in a hospital setting, physician supervision of the instrumental assessments identified above is usually assumed to be adequate. Regarding Medicare policy, often adopted by private health plans, endoscopy is not identified in the list of diagnostic tests that require direct physician supervision (Program Memorandum B-01-28, April 19, 2001). Regarding hospital outpatient therapeutic services, the Medicare Intermediary Manual states, "The physician supervision requirement is generally assumed to be met where the services are performed on hospital premises" [Section 3112.4(A)].
Endoscopic procedures performed by an SLP as an employee or contractor of a physician practice are considered, by Medicare standards, under the supervision of a physician, as long as a physician is in the office suite. Private health plans may vary in these supervision guidelines.
Mark Kander is ASHA’s director of health care regulatory analysis. Janet McCarty is the Association’s private health plans advisor. For more information, email mailto:mkander@asha.org or mailto:jmccarty@asha.org.
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