Author Topic: Speech Therapy  (Read 1702 times)

electrobills

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Speech Therapy
« on: January 12, 2010, 09:07:41 PM »
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?

Michele

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Re: Speech Therapy
« Reply #1 on: January 13, 2010, 10:02:05 AM »
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
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electrobills

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Re: Speech Therapy
« Reply #2 on: January 13, 2010, 08:56:58 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.

Michele

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Re: Speech Therapy
« Reply #3 on: January 14, 2010, 06:05:24 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
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StephD

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Re: Speech Therapy
« Reply #4 on: January 15, 2010, 09:40:12 AM »
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
« Last Edit: January 15, 2010, 09:53:30 AM by StephD »