Financial and Business Issues: Establishing Medical Necessity With Cognitive Linguistic Therapy Medicare coverage of cognitive communication services has been ambiguous for quite some time because of multiple CPT codes for the same therapy and the documentation of medical necessity. Recently, a Medicare intermediary (Cahaba) serving Alabama, Mississippi, and several Midwest states indicated it would ask the CMS central office about ... Article
Article  |   October 01, 2006
Financial and Business Issues: Establishing Medical Necessity With Cognitive Linguistic Therapy
Author Affiliations & Notes
  • Peter R. Johnson
    Select MedicalClearwater, FL
  • Peter R. JohnsonColumn Editor
Article Information
Speech, Voice & Prosodic Disorders / Practice Management / Professional Issues & Training / Attention, Memory & Executive Functions / Financial and Business Issues
Article   |   October 01, 2006
Financial and Business Issues: Establishing Medical Necessity With Cognitive Linguistic Therapy
SIG 11 Perspectives on Administration and Supervision, October 2006, Vol. 16, 10-12. doi:10.1044/aas16.3.10
SIG 11 Perspectives on Administration and Supervision, October 2006, Vol. 16, 10-12. doi:10.1044/aas16.3.10
Medicare coverage of cognitive communication services has been ambiguous for quite some time because of multiple CPT codes for the same therapy and the documentation of medical necessity. Recently, a Medicare intermediary (Cahaba) serving Alabama, Mississippi, and several Midwest states indicated it would ask the CMS central office about the appropriate use of cognitive code 97532 by speech-language pathologists. The intermediaries generally review two areas, coding and medical necessity (ASHA, 2006). The coding question is quite straightforward in that the SLP needs to use this code as it relates to the local fiscal intermediary local coverage determination (LCD) and the national Correct Coding Initiative (CCI) initiative. Basically, the coding needs to follow the CCI edits and not bill for cognitive therapy (97532) on the same day that the speech therapy code (92507) is utilized. The CCI edits allow 92507 and 97532 to be billed on the same day only as it applies to another discipline performing 97532. The speech use of the code 97532 is differentiated from the occupational therapy use of the code 97532 on the same day by the required Medicare modifier “GN” added to the CPT code that denotes performance by an SLP. Speech pathology and occupational therapy would not be providing duplicate treatments if the occupational therapy documentation clearly indicates use of the code with ADL functioning and the speech pathology use of the code indicates swallowing safety or language functioning as it relates to cognitive skills.
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