How Insurance Coding Impacts Your Practice’s Profitability
Types of Codes and What They’re Used For Most Prevalent Codes
Best Practices for Getting Reimbursed
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!
How Insurance Coding Impacts Your Practice’s Profitability
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.
Avoid Claim Denials
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.
Get Paid Faster by Reducing Rejections
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.
Get Fully Reimbursed
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.
Types of Codes and What They’re Used For
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:
- The first 3 characters in the code identify the category of the disease, disorder, infection, or symptom.
- Characters 4-6 explain where in the body the injury or disease appears, how severe the problem is, and the cause of the injury or disease.
- Character 7 is an extension used for various purposes.
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):
- Category I describes most of the procedures.
- Category II codes are supplemental tracking codes. These codes are used mainly for performance management.
- Category III codes are temporary codes. They describe emerging and experimental technologies, services, and procedures.
Most Prevalent CPT and ICD-10 Codes for Speech Therapy
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.
Common ICD-10 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
Common CPT Codes for Speech Therapy
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.
- Untimed codes may include modifiers to represent atypical procedures. For example, if the procedure took longer than typical due to an anomaly, you may use a -22 modifier. (Note, however, that you shouldn’t use this code frequently because it will raise red flags — it’s only to be used in atypical situations). A -52 modifier, on the other hand, can be used for an abbreviated procedure.
- Modifier -59 is used in cases where two separate procedures were performed on the same day. (There are several rules you should be aware of regarding Modifier -59 that are outside the scope of this guide — download our Modifier 59 Checklist for more information.)
- A -GN modifier is used when Medicare Part B services are provided under plans of care for speech-language pathology.
Frequent Coding Mistakes
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.
1. Not Using the Best ICD-10 Codes
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.
2. Not Using the Best CPT Codes
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.
3. Forgetting Applicable Modifiers
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.
4. Not Tracking All Time for Time-based Procedures
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.
Best Practices for Getting Reimbursed
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.
- Use a checklist-based process — Creating a checklist that you follow every single time you go through a process will help ensure you don’t miss anything important.
- Double-check patients’ insurance coverage — Prior to scheduling a procedure, check to see that the patient’s plan covers the procedure. If not, or if you’re dealing with inconsistent approvals by an insurer, ask the patient to sign an agreement to pay if the insurance company doesn’t.
- Automate where you can — Human error happens because humans are prone to making mistakes. Automation cuts down on errors, giving you peace of mind. (One of Fusion Web Clinic’s most popular billing features is its automated claims feature!)
- Know which codes are best for which procedures — Know your codes! It takes some time to become familiar with all the codes you’ll need in your practice, but your business can’t thrive without accurate coding.
- Track all time — Be sure to track all your time spent with a patient. You’ll need records to back up time-based codes.
- Run regular reports — Without tracking claim rejections, denials, which billing codes are the most profitable, and other important data, you won’t know what to improve. Make better business decisions by running regular reports. (Fusion Web Clinic’s insights dashboard gives you full visibility into a variety of key performance metrics!)
Keep Your Speech Therapy Practice Healthy by Using Accurate ICD-10 and CPT Codes
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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