Did you know that 8-9% of young children experience speech sound disorders, such as phonological or articulation disorders? Additionally, by the time they reach grade I, approximately 5% children have noticeable speech disorders. These include dysarthria, stuttering, and speech sound disorders with no known cause.
Troubling right? Speech-language pathologists (SLPs) are the real-life heroes who help detect and treat these issues. Thus, they should be rightfully reimbursed for their services.
This guide will discuss everything you need to know about CPT code 92522, from applicable modifiers to reimbursement guidelines. Continue reading!
CPT Code 92522 – Description
CPT code 92522 covers the speed sound production evaluation of the patient for issues such as incorrect pronunciation and patterns. Moreover, it includes the examination of the tongue, lips, and jaw for proper structure and function.
Scenarios Where CPT Code 92522 is Applicable
Let’s review a few real-world clinical scenarios where CPT 92522 applies:
Pediatric Evaluation for Phonological Disorder
Picture a 6-year-old boy who recently started grade I in school. He has been experiencing difficulty understanding, especially complex sentences. His other issues include inconsistent speech errors, frequent use of substitute sounds, accompanied by a lisp.
As a result, the pediatrician, after receiving concerns from the school, orders a speech sound production evaluation covered under CPT code 92522.
An SLP administers a standardized test (Goldman-Fristoe Test of Articulation 3, GFTA-3) to quantify articulation errors. He also conducts a deep phonological process analysis to identify patterns of sound errors.
Moreover, the specialist examines the boy’s hard/soft palate, tongue rest posture, and rapid, alternating movements of the lips and tongue. Therefore, 92522 can be reported for accurate billing.
Suspected Childhood Apraxia of Speech (CAS)
Assume a 5-year-old girl with significant communication delays. Her parents are highly concerned because she is highly unintelligible. She uses very few consonants/vowels, and her attempts at repeating new words are inconsistent.
Therefore, the SLP performs a dynamic assessment of speech motor planning. It focuses on the consistency of sound production across multiple contexts, the ability to sequence multisyllabic words, and varying vowel/consonant shapes.
Moreover, a detailed functional and structural exam was administered to rule out muscle weakness. This includes evaluation of diadochokinetic (DDK) rates (rapid, alternating speech movements).
Here, the SLP should report CPT code 92522 to bill for the rendered services.
Adolescent with Chronic Orofacial Myofunctional Disorder (OMD)
Imagine a 15-year-old female patient whose orthodontist diagnosed that she has an OMD or tongue thrust. He also noted that the condition is negatively impacting her orthodontic work and causing a lateral lisp.
Thus, the orthodontist referred her to an SLP for assessment to address the contributing tongue function before or during brace treatment.
This assessment focuses on sibilant sounds and other phonemes affected by the forward tongue posture. Besides, the SLP evaluates the resting posture of the lips and tongue, examines the swallow pattern to rule out/confirm tongue thrust, and checks the lingual frenulum for mobility restrictions.
Here, CPT code 92522 applies.
Applicable Modifiers for CPT Code 92522
Listed below are some of the applicable modifiers for CPT 92522:
Modifier GN
You must append modifier GN while billing for speech sound production evaluation covered under CPT code 92522. But why? Because the Centers of Medicare and Medicaid (CMS) mandate it for all Medicare Part B claims.
It highlights that rendered services were a part of a speech-language pathology plan of care.
Modifier 59
What happens when you perform a speech-generating device (92607 or 92609) evaluation along with a speech production assessment? You report CPT code 92522 with modifier 59 to indicate that it was a separate, non-overlapping diagnostic service.
CPT Code 92522 – Billing & Reimbursement Guidelines
Discussed below are the key billing requirements for CPT 92522:
Do NOT Use CPT Code 92522 with 92523
Yes, modifier 59 is a great tool for bypassing correct coding initiative (CCI) edits. However, it should never be used blindly. Its overuse or misuse can trigger alarms and lead to audits and financial penalties, not just denials.
Why? Because there are some bundled procedures that you are not allowed to unbundle. The same is true for CPT codes 92523 and 92522. The reasoning is simple. CPT 92523 is a comprehensive code and includes the services covered under 92522. Therefore, reporting both will be considered a duplication of services, and the payer will deny the claim on the charges of overbilling.
Justify the Medical Necessity
Demonstration of medical necessity is the primary requirement for timely CPT code 92522 reimbursement:
- The patient’s functional deficit must be significant enough to require the specialized skills of an SLP.
- The speech production evaluation must help in diagnosis, differentiate between competing diagnoses, establish objectives, and set measurable therapy goals.
- The referring physician’s diagnosis should align with the assessment, i.e., a qualifying ICD-10-CM code is essential.
Fulfill Documentation Requirements
Did you know that insufficient documentation is one of the major reasons leading to denials? Luckily, you can prevent it for CPT code 92522 by ensuring the following:
- Your documentation must confirm the completion of the following two mandatory components and include:
(1) Formal Speech Sound Assessment
- The name of the standardized test employed, e.g., DEAP, GFTA-3, etc.
- Details related to the achieved scores, including the standard score and percentile rank.
- Comprehensive analysis of the error types, including types of distortions, consistency of errors, phonological processes, etc.
(2) Oral Motor Examination
- The specific function and structure evaluation of the oral mechanism, i.e., lips, jaw, velum, and tongue.
- Details related to the findings on strength, symmetry, range of motion (ROM), and DDK rates.
- A clear connection between the assessment findings and the patient’s functional limitations.
- The resulting ICD-10 diagnosis code and an initial care plan detailing the frequency, duration, and measurable long-term goals for subsequent therapy.
Summary
With that said, it is time to conclude. But before bidding farewell, let’s quickly summarize the key takeaways.
CPT code 92522 covers speed sound production evaluation with examination of the tongue, lips, and jaw.
When performed with a speech-generating device assessment, you can easily bypass the bundling edit with modifier 59 and supporting documentation. However, using the same modifier to get reimbursement for CPT codes 92523 and 92522 can backfire. If the bundling rules confuse you, partner with MediBillMD for professional medical billing services.
