Neurology & Pain Management Coding Alert

Question: We would like to provide speech therapy for our patients. There is a hospital that bills 92507 x 4 for each hour of therapy, but CPT does not provide a time component for this service. How should this be billed?

Texas Subscriber
 
Answer: Speech-language pathology services are  necessary for the diagnosis and treatment of speech-language disorders that result in communication disabilities. As specifically indicated by Medicare memo 2001-8.0 (Aug. 1, 2001), 92507 (treatment of speech, language, voice, communication, and/or auditory processing disorder [includes aural rehabilitation]; individual) and 92508 ( group, two or more individuals) are not time-based codes. Therefore, it is incorrect to bill multiple units on the same day, regardless of the time spent with the patient.
 
Local Medicare carriers specify varying guidelines, but many require that ongoing speech-therapy services be provided by a speech-language pathologist (SLP). For instance, Mutual of Omaha Insurance company, a fiscal intermediary in all states except Alaska and New York,  specifies, "Documentation must be present to support the presence of the disorder or symptoms" prior to referral to the SLP (policy #2000-03). And, "The order for the evaluation and any desired specific testing in areas of concern should be designated by the referring physician [e.g., the neurologist]." The treatment plan determines the services, is designated by the physician or therapist providing the treatment and requires that the assessment or initial evaluation be completed prior to initiating therapy. If the treatment plan is developed and written by the therapist, it must be signed and dated by the referring physician thereafter at least every 30 days. A rubber-stamped signature will not be accepted.
 
Medicare reimburses for speech re-evaluation when medically necessary and appropriate. The appropriate code is 92506 (evaluation of speech, language, voice, communication, auditory processing, and/or aural rehabilitation status).