Effective January 1, 2020, the Centers for Medicare & Medicaid Services (CMS) implemented a new National Correct Coding Initiative (CCI) edit that prevents same-day billing of Current Procedural Terminology (CPT ® American Medical Association) codes 74230 (Radiologic examination, swallowing function, with cineradiography/videoradiography) and 92611 (Motion fluoroscopic evaluation of swallowing function by cine or video recording).
Speech-language pathologists (SLPs) typically collaborate with radiologists to perform the videofluorscopic swallowing study (VFSS), also called the modified barium swallowing (MBS) study. CPT codes 74230 and 92611 describe the work required to identify the medical diagnosis by the radiologist (74230) and to evaluate swallowing function by the SLP (92611). With the new CCI edit in place, SLPs and radiologists will not be appropriately reimbursed for each distinctly different portion of their professional collaboration during the VFSS.
ASHA is engaging with CMS and the contractor that manages the NCCI program to resolve this issue. In the meantime, ASHA recommends providers continue to submit same-day claims for 92611 and 74230. Because the new CCI edit lists 92611 as the "column 1" code, it should be placed first on the claim, followed by 74230. This means that 92611 should be processed for payment, but 74230 will be denied. If CMS reverses the CCI edit, all claims submitted since January 1, 2020, can be reprocessed for payment of 74230.
Background
The NCCI (or more commonly, CCI) is an automated edit system to control specific procedure code pairs that can or cannot be reported on the same day. CMS developed the system for use in all Medicare Part B (outpatient) and Medicaid claims. See CCI Edits for Speech-Language Pathology Services for additional information on same-day billing restrictions.
ASHA Resources
ASHA will provide updates on this issue through Headlines and advocacy news. For questions, please contact reimbursement@asha.org.
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Buffy Patton
Managing Director
Tennessee Interventional and Imaging Associates
Chattanooga TN
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Original Message:
Sent: 01-16-2020 12:10
From: Donna Richmond
Subject: Swallow Studies
Why do you think the technical component of 74230 is not being paid? It's an active code in the RVU file, and your Tennessee MAC has payment amounts for 74230-TC and 74230 global as well as 74230-26.
74230 relates to the images taken during the exam, and the radiologist should interpret those images just as he does any other exam. It is not appropriate to just refer to the speech therapist's report. (the speech therapist's work is billed with code 92611.)
For Medicare patients, he physician must be in the room during the procedure in order to bill the technical aspect of 74230. The exception is if your state law allows RPAs to do this work without a physician present, then Direct supervision applies. In a non-hospital facility that means the supervising physician must be within the office suite and not doing something that he can't drop if needed to help.
Donna Richmond, BA, RCC, CIRCC, CPC
Senior Healthcare Consultant
T 651-424-4225
C 337-412-2272
www.panaceainc.com
Original Message------
Hello All I have a few questions and would greatly appreciate it if anyone were willing to answer.
Modified Barium swallow studies have been a recent hot topic of interest for my group from a number from stand points.
With the recent changes it appears the technical portion will no longer be paid but the professional portion for the read will be paid. How are you handling the charges so that the radiologist has a charge to read from but the technical component is not charged?
What is your standard of care for pediatric swallow studies?
Does the radiologist stay in the room any or all of the procedure?
If you use RPAs do they take the place of the radiologist in the room for the procedure?
What role does the radiologist or RPA play in the procedure?
For Adult swallow studies what is your standard of care?
Do the radiologist reiterate in their report what the SLP said in theirs or just reference the report?
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Buffy Patton
Managing Director
Tennessee Interventional and Imaging Associates
Chattanooga TN
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