Wiki Coding and swallowing

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Tenicajo

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Hello All,

I am trying to figure out the correct way to code feeding therapy performed by the feeding therapist. The patients are usually kids that are in day program and the feeding therapist feeds them. We are currently using 92526 but there are times when we also use 97530, if the policy doesn't accept 92526. Can anyone please provide guidance on this? Thanks for all your help.
 
you cannot use a different code for the same service simply because one is covered and the other is not. The same service is always to be coded the same way, if it is not covered by the carrier then you need to find out why, and what you can do for that, changing the codes is never the answer. from what you have given for information the 92526 looks to be the correct code. so why do some policies not accept this code?
 
Thanks for you response, I just want to clarify that the payers do accept 92526, but since it a per DOS code some payers only accept 1 unit of 92526. So when the feeding is performed 4 times per day and the payer only accepts 1 unit of 92526, then the claim is billed with 1 unit of 92526 and 3 units of 97530. If the payer accepts multiple units of 92526, then it it billed 92526 x 4. Thank you.
 
I feel that is incorrect billing. If they accept only 1 unit then that is how it should be billed. I do not feel you have met the requirements to be able to bill the 97530. If you had met those requirements then you bill the entire service as the 97530.
 
I'm sorry I don't quite understand what you mean by meeting the requirement of 97530. Do you mean time wise or services performed? Usually 20-25 minutes is spent with the patient performing the feeding, which includes one on one time teaching the patient how to feed themselves. I was thinking that even though 92526 is the more appropriate code, 97530 can be used. Thank you.
 
a provided service cannot meet the requirements of two different codes..
92526- the treatment of swallowing disorders aimed at finding the specific cause of the dysfunction to treat the disorder. May require the assistance of a rehab specialist.
97530- the healthcare provider uses dynamic therapeutic activities designed to achieve improved functional performance such as lifting, pulling, bending.
Based on the documentation of the therapist it cannot be both of these and it is not either or. based on the 92526 being specifically aimed at swallowing dysfunction I felt that was the appropriate code, however without knowing what the therapist is documenting that is a guess on my part. If you feel you meet the qualifications for the 97530 then that would be the code to use, but it needs to be more than face to face for 15 minute.
So I guess the main issue is whether the therapist is trying to assess the swallowing difficulty or is the therapist try to teach the patient how to deal with the dysfunction and improve.
 
Thank you for further explaining, I understand now. Based on the documentation the therapist is teaching the patient how to deal with and improve the dysfunction by working on oral skills and evaluating higher texture foods. They also provide training to the caregiver and decrease inappropriate meal time behaviors. I feel that 97530 would be more appropriate for what the therapists are doing.
 
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