Decoding CPT Codes - July 2012

Each quarter we focus on decoding the mystery of a specific CPT code. This quarter we will focus on CPT code 92526.

Decoding CPT CodesThe definition of CPT code 92526 is treatment of swallowing dysfunction/oral function for feeding. CPT code 92526 is an untimed code, billed as 1 unit per day. If two or more shorter sessions are performed during the same day, these should be combined and billed as 1 unit. CPT code 92526 is a comprehensive code that includes most aspects of dysphagia treatment. Do not use additional CPT codes in combination with 92526 when the focus of the treatment is for swallowing. For example, if the patient performs strengthening exercises to improve swallowing/feeding, bill 92526 and not 97110. The same is true if the patient is performing neuromuscular reeducation exercise to improve feeding/swallowing—the SLP must bill this intervention under 92526 and not 97112. CMS does not reimburse separately for it because its efficacy has not been proven. However, as long as an SLP documents other reasonable and necessary dysphagia treatment was provided with or without VitalStim, you can bill for 92526. Dysphagia treatment commonly addresses the following issues:

• patient caregiver training in feeding and swallowing techniques;
• proper head and body positioning;
• amount of intake per swallow;
• appropriate diet;
• means of facilitating the swallow;
• feeding techniques and need for self help eating/feeding devices;
• food consistencies (texture and size);
• facilitation of more normal tone or oral facilitation techniques;
• oromotor and neuromuscular facilitation exercises to improve oromotor control;
• laryngeal elevation training;
• training in laryngeal and vocal cord adduction exercises;
• compensatory swallowing techniques; and
• oral sensitivity training.

Coding Corner FAQ

1. Is there a CPT code for iontophoresis or should I bill it under electrical stimulation?

Yes, there is a CPT code for iontophoresis. It is CPT code 97033 and is a timed code. Iontophoresis should never be billed as electrical stimulation due to it having its own CPT code. It is important to be aware of your FI/MAC’s LCDs and commercial payor contracts related to iontophoresis as they may have coverage limitations and/or restrictions. For example, both NGS and CGS will only cover iontophoresis for the treatment of intractable, disabling primary focal hyperhidrosis (ICD-9-CM code 705.21) that has not been responsive to recognized standard therapy.

2. How do I bill for time spent in co-treatment?

The answer is dependent on the payor source. For Medicare Part A patients when two clinicians, each from a different discipline, treat one resident at the same time (with different treatments),both disciplines may code the treatment session in full. The decision to co-treat should be made on a case basis and the needfor co-treatments should be well documented for each patient. For Medicare Part B patients, the time must be divided betweenthe treating disciplines.

3. Can you clarify the Medicare regulations for student billing?

The answer is dependent on the payor source. Under Medicare Part A the student is an extension of the therapist meaning that the definitions of group, individual and concurrent are applied as if the student and therapist are one in the same. For example, if the student is treating and billing individual, the therapist may not be working with another patient at the same time and billing and vice versa. The definition of concurrent is met If both the student and therapist are seeing one patient and billing at the same time; the student is seeing and billing two patients performing different activities simultaneously and the therapist has no patients; or the therapist is seeing and billing two patients performing different activities simultaneously and the student has no patients.

The definition of group is met if the student is seeing and billing 2-4 patients performing the same/similar activity as long as the group was originally planned for 4 patients and the therapist has no patients during this time and vice versa.

Under Medicare Part B, students are allowed to participate in the treating of Medicare Part B patients only if the supervising therapist is directing the service, making the skilled judgment, and is responsible for assessment and treatment. The supervising therapist must not be engaged in treating another patient or doing other tasks at the same time and must be present in the room the entire treatment.

4. I get confused when to use 719.7 vs. 781.2 for my patients with gait difficulty. Can you please help clarify?

ICD-9 code 781.2, abnormal gait, includes ataxic, paralytic, spastic, and staggering gait. All other gait issues should be reported with 719.7, difficulty walking.