This text-based course is a transcript of the webinar, “Which Codes Do I Use Now? New 2014 SLP Evaluation Procedures Codes,” presented by Dee Adams Nikjeh, Ph.D., CCC-SLP.
>> Dr. Dee Adams Nikjeh: Today I am going to talk about MIPPA, which is the Medicare Improvements for Patients and Providers Act, what it means and why it is so important. I am going to talk about the four new SLP evaluation procedure codes and how to use them. Then I am going to talk about all the other codes that are out there for speech pathologists to use.
Medicare Improvements for Patients and Providers Act of 2008
Let’s start with the Medicare Improvements for Patients and Providers Act. I like to start with this because it is extremely important for speech-language pathologists. July 1 should be a national holiday for all of us. It was on July 1, 2009, after years of lobbying that we were finally granted independent billing to Medicare. That is what most people remember about MIPPA, that it changed our status with the Centers for Medicare and Medicaid Services (CMS) to a Medicare provider. However, the most important thing that this piece of legislation did was to recognize SLPs as professionals, rather than technical assistants. Prior to this time, Occupational Therapists (OTs) and Physical Therapists (PTs) were considered professionals, but SLPs were not. We were tech assistants. The big picture is that when our status was changed to professional, it allowed for the relative value of all of our procedure codes to be revalued to include a professional work component. For the last several years, this is what the ASHA Health Care Economics committee, that I am co-chair of, has been working on. We have taken all of the codes back through a very tedious and arduous process to be revalued.
Current Procedural Terminology (CPT)
For the next hour, we are mainly going to focus on current procedural terminology; that is, CPT codes. I have a feeling that you are all probably more familiar with these than you ever wanted to be. CPT codes are five-digit numbers that are assigned to every medical, surgical, and diagnostic procedure that a medical practitioner or health care provider can provide. We use them to determine the amount of reimbursement received by a provider, but they also ensure a uniformity of communication. They were established to make communication much simpler. It is important to remember that these are developed, maintained, and copyrighted by the American Medical Association. CPT codes are run by the AMA, whereas ICD codes, International Classification of Diseases and Disorders, go through the government. That is a big distinction between those two types of coding. The CPT manual is updated annually and we have probably more than 8,000 codes in that.
How do we get a procedure? It is not an easy process. First, a procedure has to be something that is unique. It cannot be covered by any other of the established 8,000 or so codes in that book. It also has to represent a procedure that is widely used within the U.S. and within the profession itself. It cannot be investigational and it has to have substantial peer-reviewed literature to support the procedure. Many times I have SLPs who ask “Why do we not have a procedure code for this and why do we not have a procedure code for that?” I hope that by giving you the criteria, you can see why it is difficult to establish a new procedure.
As I said, we are going to focus on CPT. These are procedural codes that describe what we do with a patient or the client, whereas ICD codes describe the disease or the disorder. It is very common, unfortunately, for people to get these two types of health care coding systems confused. We are talking about codes that describe what we do with the patient or the client.
