Medical Billing Forum

Coding => Coding => : electrobills January 13, 2010, 12:07:41 AM

: Speech Therapy
: electrobills January 13, 2010, 12:07:41 AM
I have been billing for a speech therapist.  She usually does a 92507, 92526, 97532 and 97533.  Can anyone explain to me why she isn't getting paid for both codes together?  When I do either one on its own it gets paid.  Do I need a modifier 59 or is it something else?
: Re: Speech Therapy
: Michele January 13, 2010, 01:02:05 PM
I'm a little confused because you listed 4 codes, but said "she isn't getting paid for both codes together".  I'm not sure if you meant all 4 codes together, or that only 1 code gets paid and 3 get denied.  Anyway, I'm wondering on the 97532 & 97533 codes, since they are listed in the Physical Medicine section, if they are considering those outside the scope of practice.  Really to help I would need to know the exact denial reasons.

Thanks
Michele
: Re: Speech Therapy
: electrobills January 13, 2010, 11:56:58 PM
Sorry, I guess I wasn't too coherent.  The 97532 and 97533 are being denied from Oxford with a TCOD - the service is ineligible for reimbursement as a separate procedure.  Some of the 92520s are being denied for the same reason and some are being paid.  BCBS is denying with a U749 - basically the same thing.
: Re: Speech Therapy
: Michele January 14, 2010, 09:05:24 PM
From what you are describing it sounds like it is a contract exclusion.  If that is the case, a modifier will not help.  If the provider states the 59 modifier would be appropriate for the services you can try it.

Michele
: Re: Speech Therapy
: StephD January 15, 2010, 12:40:12 PM
I do billing for speech, OT and PT.  I don't think the 97532 or 97533 codes are within the scope of practice for speech therapists.  I have billed them for my PT's and OT's, but never any of my speech therapists.   A really good source of information is the ASHA website.  (American Speech Language and Hearing Association)  If your therapist is a member you can find lots of information regarding coding, billing and reimbursement issues.  www.asha.org.
Stephanie