Wiki speech therapy codes 92507 and 92523

[arinaab]

I have noticed and increase in denials from commercial policies stating that 92507 and 92523 are not billable with diagnosis code R41.841. Most of our patients are Medicare age and the advantage plans usually follow Medicare guidelines. In this case, this coding combination is billable per Medicare guidelines, but commercial advantage plans are denying for CO-96 (not medically necessary). I have tried to find LCD and coding guidelines on Humana, BCBS and Cigna websites regarding this change. I was wondering if anyone else is seeing this denial regularly and what they are doing to fix it. Codify has helped with new diagnosis coding suggestions, but I was wondering if there are any other resources I can use to help educate the therapists on how to approach this issue.

 

[TThivierge]

Hello Arinaab
Please see what chronic condition the patient has for using the dx R41. 841 senility. Did the patient have previously a stroke or memory problems see dx I60 I63 169. Also could be a sequela after a certain illness? Or is it due to brain nerves ...see dx G31 or G32 or F02 or F03. Also are using the proper modifiers of GN for speech therapy plus list the referring doctor on claim too. Check out dx block of R47,R48 or R49 or dx F80 on speech difficulties but list reasons per provider s documentation on the record of each day s treatment. Understand the difference in terms of Fluency DO, Apraxia, Dysphagia and Dysarthria. Shre this data with the provider and therapists too
I hope helped you!
Lady T