Pediatric Coding Alert

Question: Can a pediatrician bill as a supervising provider when the staff member (in our case, a credentialed teacher) is providing a cognitive therapy service for autistic or ADD kids, using computers as the therapy tool? The pediatrician is in the office while the service is being provided. We would like to report 97532 (Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact by the provider, each 15 minutes) or 96116.

Florida Subscriber

Answer: This issue concerns not only correct coding, but also state scope of practice laws. In many states, the therapy codes can only be billed when performed by a physician or a physical, occupational, or speech therapist. For instance, Aetna’s policy says that cognitive rehabilitation is only payable when performed by an OT, PT, SLP, neuropsychologist, or physician. Cigna, on the other hand, typically does not cover these services for ADD or learning disabilities.

Therefore, it’s possible that your services, when performed by a teacher, may not be payable, even with 97532, which appears to be the most accurate match for your services. In this case, you should discuss this fact with the patient’s parents prior to the visit, and ask them to sign an advance beneficiary notice before you administer the service.

In addition, you would have to check with your payer to confirm that the computer can be utilized as the therapy tool for these services.