Eli's Rehab Report

Question: I'm in a private practice setting for speechlanguage pathologists, and once and a while, our swallowing evaluations take longer than normal. At what point could we append a modifier 22 to account for that extra time? And if we can't account for the extra time with a modifier 22, do we have any other options, such as billing another unit of the swallowing eval code?

-- Iowa Subscriber

Answer: CPT code 92610 (Evaluation of oral and pharyngeal swallowing function) is a service-based CPT code, which means it is untimed. Regardless of how long the evaluation takes, you may only bill one unit to the insurance payer unless they tell you otherwise.

The vast majority of insurance payers follow the descriptions of the CPT codes as developed by the American Medical Association. Some payers, such as some state worker's compensation programs or state Medicaid programs, may take that untimed CPT code and reimburse for it in 15 or 30 minute increments. In that case, follow that payer's guidelines and bill the appropriate number of units based on the time spent.

Note: To safely append modifier 22 (Increased procedural service), your evaluation session needs to be significantly longer than usual. Let's say, for example, a clinical swallow evaluation typically  akes you 45 minutes, and you end up spending 75 minutes on a very complicated patient. At that point, you could append a modifier 22. But keep in mind, many payers do not recognize modifier 22 under a therapy plan of care, and if they do, most likely they will not reimburse you any more money for the extended evaluation time.

Good idea: Create a policy in your practice that names a maximum time your clinicians must reach on the swallowing evaluation in order to bill for the extra time.