I am seeing a patient for a cognitive assessment. I used to use CPT 92506. What should I do now?
I recommend that you use CPT 96125. It is for standardized cognitive performance testing. It is a per-hour code for a full cognitive evaluation. If you recall, there was an MUE for how many times you can bill this. You can bill this up to two times. It requires at least 31 minutes for one hour. That 31 minutes includes your evaluation time, your report writing, and development of your plan of care. Ninety-one minutes is the minimum for two hours of billing. For two hours of billing, it would go from 91 minutes to 151 minutes of time. This includes administration and documentation. The descriptor says standardized cognitive performance testing. Nonstandardized subtests can also be included in your battery of measurement tools.
What if you do language only, and are not doing cognitive? You can use the 92523 with a -52 modifier. Cognitive assessment using informal tools and lasting less than 31 minutes is not an evaluation. You cannot evaluate cognitive performance, document the results, and develop a treatment plan in less than 31 minutes of time. If that is the case, we need to use this as an opportunity to improve our practice parameters. Something like that is actually a screening; it is not considered an evaluation. Payment will probably be denied.
Dr. Nikjeh is co-chair of the Health Care Economics Committee of the American Speech Language and Hearing Association (ASHA). She has appeared before the U.S. Dept of Health and Human Services on behalf of ASHA to propose new diagnostic codes and modifications of existing codes for the benefit of speech-language pathologists. Dr. Nikjeh is an ASHA advisor to the American Medical Association Health Care Practitioner Advisory Committee where she has presented speech-language pathology procedure codes for valuation of professional service.