Neurology & Pain Management Coding Alert

Question: Our neurologist assessed a stroke patient for aphasia and reported ICD-9 code 438.11 (Aphasia). How do we report this assessment?

Maryland Subscriber

Answer: You report code 96105 (Assessment of aphasia [includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, e.g., by Boston Diagnostic Aphasia Examination] with interpretation and report, per hour) for assessment of aphasia. Included in the code are the administration of the test, scoring the test, interpretation of the various findings, formulating a diagnosis and developing treatment guidelines.

Aphasia is a loss or compromise in language and speech abilities, including a loss of word comprehension. The condition can occur as a late effect of a cerebrovascular accident, which would be reported with 438.11 (Aphasia as a late effect of cerebrovascular disease).

Notice that 96105 is a time-based code, so report it for every hour of assessment your neurologist completed. For example, if your neurologist was with the patient for one hour and 15 minutes for the assessment and then spent another 45 minutes to analyze the test results, you would bill two units of 96105.  Reminder: CPT requires a minimum of 31 minutes must be provided to report any per hour code.