Wiki ABA and Speech Therapists Billing During Same Visit? Is This Possible?

[KJKimble]

I work for a speech therapy clinic that has been approached by ABA therapists in the same professional building with an interesting/confusing request. The ABA office would like for our speech therapists to go to their office and perform speech therapy during the same visit that they are performing ABA therapy. They would bill CPT code 97153 and we would separately bill code 92507 as we are completely different entities. I know that the two codes cannot be performed on the same day by the same provider and receive reimbursement, but is it possible for separate providers from different clinics to perform those services during a single visit and both be reimbursed legitimately? If so, what would we use as the place of service code since our therapist would not be performing the therapy in our office? Thank you in advance for any insight that you can provide.

 

[amyjph]

You would have to know the co-treatment or concurrent treatment rules first. However, I would be VERY concerned about this proposal. Think about what you said, "I know that the two codes cannot be performed on the same day by the same provider and receive reimbursement, but is it possible for separate providers from different clinics to perform those services during a single visit and both be reimbursed legitimately?"
Read the code definitions of 97153 and 92507. Specifically 97153 being a 15 minute unit code and face-to-face with one patient. And, you would have an SLP leaving their office suite to go to a different office suite to render care? Also, a modifier is not allowed per NCCI with these two codes together...
This would have to go to your practice attorney and compliance department (if it were me) I would not touch this.

 

[KJKimble]

You would have to know the co-treatment or concurrent treatment rules first. However, I would be VERY concerned about this proposal. Think about what you said, "I know that the two codes cannot be performed on the same day by the same provider and receive reimbursement, but is it possible for separate providers from different clinics to perform those services during a single visit and both be reimbursed legitimately?"
Read the code definitions of 97153 and 92507. Specifically 97153 being a 15 minute unit code and face-to-face with one patient. And, you would have an SLP leaving their office suite to go to a different office suite to render care? Also, a modifier is not allowed per NCCI with these two codes together...
This would have to go to your practice attorney and compliance department (if it were me) I would not touch this.

Thank you so much for your response. You confirmed all the bells and whistles that are going off in my head regarding this proposal. Nothing about it sits well with me and I really needed the confirmation that I am not the only one thinking it's not appropriate. Have a great day!