The first of November we welcomed the publication of the CY 2020 Medicare Physician Fee Schedule (PFS) Final Rule, which clarified coding rules around cognitive function intervention.
The same week we also welcome a new creature into the Kinder home.
Remember from my last blog?
House Rule #1: Be kind, love one another and all creatures are welcome.
Three dogs, 4 chickens and a hedgehog simply couldn’t be enough, so when a sweet little kitten showed up stranded on our front porch, the logical step was to take the poor guy in.
Initially, due to his gentle nature, and ease at making himself at home, I was certain he was lost and confused, much like the industry over the past few years as we have stumbled through CPT changes associated with cognitive treatment and intervention.
When did we stop using 97532? And what is with this G0515 code? Medicare accepts one code and other payers are accepting 97127? Are they time- or service-based? Can I use with 92507? So confusing!
Determined to find the kitten’s home, the kids made posters, we hung them (in the rain) on street poles, we shared pictures will neighbors, and even passed out signs to local businesses.
Then as we waited for the owners to call, I made an appointment to take newly named Comet to our vet.
Determined to find a home for the cognitive coding series, the American Speech Language Hearing Association (ASHA) and the American Psychology Association (APA) have been diligent in working through the CPT and RUC process for defining and valuation of the new 97129 and 97130 CPT codes.
Over the past few years, many providers have waited for clarification on cognitive treatment coding. Many have felt a bit lost when deciphering the rules, changes and apparent multiple coding options around CPT coding for cognitive function intervention.
Why the confusion?
In 2018, CPT 97127 Cognitive Function Intervention was created to replace CPT 97532 (a 15-min cognitive treatment code). Initially CPT & AMA RUC HCPAC approved the new procedure. CMS, however, did not accept the recommended value and labeled 97127 an invalid code for Medicare patients.
CMS then created G0515, Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes, which mimicked the prior deleted CPT 97532
As a result, in 2018 both CPT 97127 (untimed) and G0515 (timed) existed causing misunderstanding for patients, providers, and payers.
Subsequently, ASHA and the APA developed a new time-based cognitive intervention treatment code and recommended that all others be deleted.
CPT 97129 (base code) and 97130 (add on code) are the results of this collaborative process
With established codes published in the final rule, we are no longer lost!
Similarly, following empty leads for findings his owners, a round of shots, shopping for cat supplies, and new daily additions to Joseph’s chore schedule, Comet has now found his home ruling the roost at the Kinders’.
Back to coding.
To begin, 97127 is being deleted and replaced with 97129.
Think the descriptors look the same? You are correct.
Both 97127 and 97129 have the same long descriptor; therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing and sequencing tasks)
97129, however, differs from the 97127, which was an untimed code, as 97129 is a timed code, direct (one-on-one) patient contact code; for an initial 15 minutes.
97129 as a time-based code follows the standards for 15-minute codes and should be reported only once per day.
Q: What should we use if we provide skilled care beyond one unit?
A: 97130, is an add on code for each additional 15 minutes to be used in conjunction with 97129.
Q: How many units of 97130 can be used as an add-on?
A: Five, based on medically unlikely edit (MUE) rules.
Q: When should I use Cognitive Intervention CPT Codes? CPT 92507 versus CPT 97129 & CPT 97130?
A: SLPs should verify with each payer to confirm policies related to the evaluation and treatment of patients with cognitive disorders and to make sure that systems have been updated to accept new codes.
- Choose the CPT code that most accurately describes the treatment provided
- CPT 92507 (session-based, bill only once/day): Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- CPTs 97129 & 97130 (time-based): Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem-solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one)
- Remember: Some payers will not pay for both codes billed to the same patient on the same date!
In closing, though it’s not always an easy road, much like our sweet Comet has made himself part of our home, we can now all find relief and comfort in settling in with the updated cognitive intervention codes for 2020.
Renee Kinder, MS, CCC-SLP, RAC-CT, is Vice President of Clinical Services for Encore Rehabilitation and 2019 APEX Award of Excellence winner in Writing–Regular Departments & Columns category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty, and is an advisor to the American Medical Association’s Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).