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Billing speech therapy - Can I bill 2 codes?

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Alice Scott:
Question
We would like to use 99211 office visit (I unit) with 92507 (1 unit) to bill for each therapy speech therapy session.  The office visit would be for the part where we discuss progress and treatment as well as home exercises with the parent and the 92507 would be for the direct treatment in session.  Both codes are on our rate sheet for speech therapy with all of our networks.  Is this appropriate as long as it is documented?
Anne

Answer
   As long as your documentation shows the criteria for both codes were met, there should be no problem in billing both codes.  I would recommend looking at using the 25 modifier on the 99211 code which states:

Significant, Separately Identifiable E&M Service by the Same Physician on

the Same Day of the Procedure or Other Service: The physician may need to

indicate that on the day a procedure or service identified by a CPT code was

performed, the patient’s condition required a significant, separately identifiable E&M

service above and beyond the other service provided or beyond the usual preoperative

and postoperative care associated with the procedure that was performed. The E&M

service may be prompted by the symptom or condition for which the procedure

and/or service was provided. As such, different diagnoses are not required for

reporting the E&M services on the same date. This circumstance may be reported by

adding modifier 25 to the appropriate level of E&M service. Note: This modifier is not

used to report an E&M service that resulted in a decision to perform surgery.

See modifier 57.
Michele

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