Insurance coding can be confusing, especially ICD-10 codes for speech therapy. Even if you have experience in medical billing, the sheer number of codes presents a challenge. How can you reduce the number of claim rejections and denials? How do you know which codes are the most accurate for the services you’re providing? How can you make sure you’re reimbursed for all the time you’re spending with a patient?
In this guide, we’ll explain why accurate coding is essential for a profitable practice, the different types of codes and what they’re used for, the most prevalent codes — the ones you’ll probably use most often, common mistakes to avoid, and best practices for getting reimbursed. Ready to take the headache out of insurance claims? Let’s dive in!
Claims submission isn’t why you started your career in speech therapy. While medical billing isn’t an exciting topic for those who are focused on providing care, it’s essential to running a practice that is sustainable. If you want to keep your speech therapy clinic open, you’ll need to master insurance coding (or hire someone who can handle it for you). Here’s why getting claims submission right makes such a big impact.
One of the most common causes of claim denials is improper coding — using codes for individual services rather than a bundled code if services were provided in the same visit, missing modifiers, and simply using the incorrect code. If your claim is rejected, you can correct the error and resubmit the claim. A denied claim requires more work to correct. In the case of a denied claim, you’ll need to appeal the decision by submitting a reconsideration request. Denied claims put a dent in your practice’s profitability because it requires extra staff time and delays reimbursement, affecting cash flow.
Rejections aren’t as problematic as denials because you can simply correct the mistake and resubmit the claim. But this process still takes up unnecessary staff time. It’s also important to note that rejections are usually the result of simple typos or missing information, not inaccurate coding — so if you aren’t using the proper code, you’ll likely end up with a denial rather than a rejection.
Some services provide higher reimbursements than others, so even if your claim is accepted with a not-fully-accurate code, you could be leaving money on the table. Additionally, failing to track the time you spent with each patient could result in lower reimbursement with time-based codes. When you’re using the most accurate codes, you’re getting fully reimbursed for the services you provided.
ICD-10 (International Classification of Diseases, Tenth Revision) codes are used to represent diagnoses. Every disease, disorder, infection, injury, and symptom is assigned its own ICD-10 code. The structure of the codes works like this:
CPT (current procedural terminology) codes are a set of codes published by the American Medical Association that are used to describe tests, surgeries, evaluations, and other medical procedures. Each CPT code is made up of five characters (numeric or alphanumeric). There are three categories of CPT codes (but these categories do not align with types of procedures):
While there are a plethora of codes that you may use in your speech therapy practice, you’ll often find that you use certain codes quite frequently — simply because certain conditions appear more than others, and certain treatments are used more often. Here are the most prevalent codes for speech therapy.
F80.0 — Phonolgoical disorder
F80.2 — Mixed receptive-expressive language disorder
F80.81 — Childhood onset fluency disorder
R13.11 — Dysphagia, oral phase
R13.12 — Dysphagia, oropharyngeal phase
R48.8 — Other symbolic dysfunctions (The SLP would use this code if the Audiologist has assigned the H93.25 code)
R47.1 — Dysarthria and anarthria
R48.2 — Apraxia
R63.3 — Feeding difficulties
F80.4 — Speech and language development delay due to hearing loss
92521 — Evaluation of speech fluency
92523 — Evaluation of speech sound production with evaluation of language comprehension and expression
92524 — Behavioral and qualitative analysis of voice and resonance
92507 — Treatment of speech, language, voice
92526 — Treatment of swallowing dysfunction and/or oral function for feeding
92610 — Evaluation of oral and pharyngeal swallowing function
92607 — Evaluation for prescription for speech-generating augmentative and alternative communication device
92609 — Therapeutic services for the use of speech-generating device
92605 — Evaluation for prescription of non-speech-generating augmentative and alternative communication device
92606 — Therapeutic services for the use of non-speech-generating augmentative and alternative communication device
Code modifiers provide additional information about a service that’s been provided.
With the complexities that are involved in medical billing, it’s no surprise that many people make mistakes when using ICD-10 and CPT codes. If you find yourself making errors, know that you’re not alone. Here are the most common mistakes.
ICD-10 codes are detailed and specific, making it challenging to ensure you’re using the most accurate code. For example, when diagnosing Alzheimer’s, you need to differentiate between five separate codes. It’s important to be sure that you’re using the best code in order to prevent claim rejections or denials.
Using accurate CPT codes is important for the same reason — to improve your claim acceptance rate. Proper CPT usage also ensures you’re getting reimbursed for the actual services provided. While there aren’t as many CPT codes as ICD-10 codes, it can still be challenging to ensure you’re using the right one since one treatment may fall under multiple codes depending on how it was delivered and for how long.
Modifiers can significantly impact the reimbursement of a procedure, particularly Modifier -59. It’s a good idea to ask yourself if any modifiers apply before submitting a claim.
For time-based procedures, it’s essential that you track your time. For example, if you spend 45 minutes in a session, but you only track 15, you’re hurting your clinic’s financial health.
While it can be overwhelming to consider everything you need to keep in mind when submitting claims, there are best practices you can put in place to help.
Ultimately, accurate coding is about keeping your practice healthy — getting reimbursed appropriately and in a timely manner. If you’re not sure you want to dedicate the time and energy to learning ICD-10 and CPT coding, you have several options. You may want to hire a medical billing professional, outsource to a billing service, or use an automated tool to help with parts of the process. The key is that you feel empowered to run your practice using your strengths and supplement your involvement with tools and people whose skills and expertise complement your own.
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