Welcome to the Swallow Your Pride podcast. I'm
your host, Teresa Richard. I'm a board certified
specialist in swallowing and swallowing disorders,
a mobile thieves business owner, and founder of
the MedSLP Collective.
This podcast is all about delivering the latest
evidence based practice to medical
SLPs everywhere.
Whether you're a new clinician seeking tangible tools
for treatment or a seasoned vet stuck in
a rut, my goal is to help ditch
the old school ways of the past that
no longer serve you or your patients, to
reinvigorate your passion for our field, to broaden
your knowledge about our scope of practice, and
to inspire you to practice at the top
of your license. So if you're listening, I
encourage you to swallow your pride, be open
and willing to learn because let's face it,
your patients deserve that kind of care. With
that, let's dive right in.
Just a quick disclaimer that all statements and
opinions expressed in this episode do not reflect
on the organizations associated with the speakers and
are their own opinions solely.
Good morning, Lisa Johnson.
Good morning. How are you? Good. How are
you? Thank you so much for joining me.
Yes. Yes.
Always always a pleasure. Yes. You were like,
what was that old game show where it
was like you could phone a friend?
What was that? Remember? I can't remember. You
had options. And one was like be a
millionaire. Yeah. Was it? Yeah. Yeah. Yeah. Yeah.
Before that though? Yeah. I don't know. I
don't remember. But, anyways, I am using my
option to phone a friend and phoning my
friend, Lisa Johnson, because she knows all things
about coding and billing. And, you know, obviously,
if anybody's been following me online these days,
I've been very passionate and very outspoken about
these nine two five zero seven changes
because I truly, to my core, believe that
these are good and overdue changes, and we
will talk about why I feel that way.
And if you disagree with me, that's fine.
You are totally entitled to your opinion and
what you feel might be valid because there
is a lot
of terrifying unknown out there. You know? And
I think Lisa just had a great point.
We were talking off air. You know? There's
no reason to panic when we just don't
know what the outcome is gonna be when
we can actually be proactive
and be part of the change. And I
think that's one of the things that I'm
most excited about is that
this is the opportunity we've been asking for.
We've been asking to be heard. We've been
asking to have more codes. We've been asking
to be recognized in a more complex way,
and now it's here, and we're not happy
with what's being proposed. But
the best part about this is this is
a proposal. This is a starting point. There's
lots of open comment periods for us to
express how we feel and to give our
clinical opinions. And I think one thing
that's been abundantly clear to me over these
last few weeks that I've been really outspoken
about this is I only can speak from
my own lived experience. Right?
And people will type into me, like, that's
not my experience with this code and this
patient population.
And I I can only speak from my
lived experience.
And that's why I want to encourage everyone
to speak up because we all know what
we do is so complex.
We work from birth to death. Right? We
work across a myriad of different conditions.
We have kids that are verbal. We have
adults that are nonverbal. We it everything impacts
everyone so differently.
And I I can't say this enough. I
can only speak from my own lived experience,
and I never ever mean to
say this applies to everyone because that's never
the case. But my whole point in speaking
out about this is to get people to
look into it, to dig into it because
I think there's so much information out there
that we as speech pathologist just don't know
to begin with, and then and that can
be paralyzing. And then how do we actually
advocate for change? So I've gotten on a
roll. Lisa, introduce yourself to the people. No.
And I think,
I think it's very interesting, especially when we're
looking at coding and
really,
you know, we've had a few codes introduced
in the past few years. So, like, caregiver
training code, which was an amazing advocacy win
for us. We've been wanting something like this,
and
whenever you talk about whether it's coding revision,
addition of new codes, or deletion of codes,
you're opening up a can of worms.
And we've been, you know, fortunately or unfortunately,
however you wanna look at it, we've been
in this really sweet spot as speech pathologists
for fifteen years
where we've had this big catch all code,
92507,
and we've been able to kinda dump almost
everything into it
at almost our own peril. And,
you know, a lot of us haven't even
been practicing that long.
You know, fifteen years ago, a little over
that was when I started practicing, and
we just had this code. It was like,
yeah. We have this amazing code we get
to dump everything into.
And I think a lot of us
kind of get complacent with our coding
and really
continually
documenting and advocating for what that code actually
means. Yep. And,
you know, if we look at 92507
kind of at its core, when it was
originally
re revised,
you know, fifteen years ago, it was looked
at as a sixty minute code, more or
less, but it was put in an untimed
block.
And it was really this catchall for everything
we did because
we didn't really define what we did very
well, but we did a lot of things
very well. But those definitions weren't really clear,
so everything kinda went into this code and
nobody's really touched it.
We did have this time frame, which probably
the last time anybody's gotten really heated about
coding was about 2018.
So we had and 2018 was really interesting
especially in the cognitive spectrum because because that's
when we had all of the revisions and
deletions,
09/1932
and then that G01505.
And then we had the replacement codes, but
CMS didn't want them, so it was this
back and forth. And that was the first
time we had some really tangible timed codes
come forward
that were
somewhat framed like PT and OT, but not
really because that was a thirty minute code
plus an additional 15, which is what we're
potentially seeing coming out of some of these
reviews.
But we haven't really had to advocate for
code or for a change in a while.
So a lot of us are out of
practice with it, and
I think, you know, kind of getting back
to those basics of, you know, how did
we get here?
What does this code change process mean? And
what are the opportunities presented to us? Because
when
we talk about code changes,
it's something you kind of once you get
a good code, you kinda don't wanna touch
it
because we know anytime we touch coding in
any aspect or any kind of billing revision,
chances are we're gonna get a reduction in
payment.
And we've had this great opportunity with 92507
where the payment's pretty good. We can put
a lot of things into it.
So opening up that code,
while it's scary, there is a lot of
opportunity, but chances are we are gonna see
reductions
on the surface of payment.
But that doesn't mean everything is being reduced,
and there is a lot of opportunity still
out there because the value of the code
hasn't been set. Thank you. That that is
okay. So two things. I want you to,
in a minute, introduce yourself so people know
where you're talking from. But number two, that
is the one main point I wanna get
out of here is that people are seeing
that this one code is now being reduced
to $33,
and that is not the full story at
all. So go on that.
Yeah. Yeah. So
code submission,
so right now so
the rally relative value unit, our RBU. So
there are some proposed numbers out there. AMA
and the RUC, they don't set the payment.
They don't set what that looks like. CMS
ultimately is going to set that, but it's
not a one and done. So when we
look at
kind of how payment is set and structured,
and we see this happen a lot of
times where the code isn't changed, but the
payment structure is changed. So, essentially, what CMS
does, and they do it almost on an
annual basis, is they update the conversion factor
factor. So that's something that goes into kind
of the overall
equation of the code.
So, essentially, you have your end payment, but
that's built between
your RVU, your conversion factor, your CF, and
your geographic adjustment
plus any policy add ons or any adjustments
with, like, your NC
CI edits, or your modifier codes
and also
the order in which you code or how
many codes you put on. So a lot
of math goes into
the end number or the end payment
and that's just on the Medicare side.
We also have all of those same things
happening for every single MAC, every single local
coverage determination,
every single insurance payer, all of our Medicaid
payers, and all of those are different
per setting and per state.
So when we see kind of this
number that's coming out initially,
that's not the end number. That's kind of
our our starting base
plus all of these modifiers and all of
these multiplications
to get the end payment. And it's gonna
look different across the board.
So that's why as, you know, speech pathologists,
as you were saying, we practice across a
vast setting
with a
vast difference of patient population.
So upfront, really getting that
RVU
looked at of what does the value of
this code look like. And that doesn't mean
numerically
what does this value look like. We wanna
be talking about the structure of the code.
We wanna be talking about
the workflow, the system logistics within it, the
clinical logic of how we get to these
code sets. So really giving
definition to all of the clinical complexities that
go into the structure of this code,
and that starts to build that value and
that starting base. Then all of those modifiers
are added onto it and all of those
multipliers.
So,
we talk about, like, what is our opportunity
right now,
and
a lot of people
you know, we talk about, okay. Let's advocate
for the code. Let's advocate for the change.
But are you involved in the process? Do
you even know what that process looks like?
So I would one of the first things
I would challenge everybody who's listening and challenge
you to talk to your SLP friends about
it is, are you registered
for the next meeting? Are you registered for
the upcoming CPT editorial panel review?
We're we're on the spot right now. It's
the registration's open right now. So, if you're
listening to this, I would encourage every single
one of you, go on to the AMA
website,
get registered for the editorial panel meeting. The
meeting is April 30. And
in order to get any insight, in order
to get any of the meeting minutes, the
notes, all of that nitty gritty stuff, you
have to be registered. They're not just gonna
send it out to you. It's not gonna
be publicly made information for quite some time.
But if you're registered and you're attending those
meetings,
you're gonna get some of the information. You're
gonna get a chance
potentially
to speak up about what the value
of all of these codes are.
And the reality is
what we've historically seen is when a code
is identified as a high use code, like
92507
was,
we're gonna see revisions.
Whether that's going to be a revision in
the definition of the code and the payment
or a new code set, which we've seen
multiple proposals of, different code sets going through
here.
But this is our chance to come forth
and say
and really
advocate for why these codes are so important
and the complexities of them.
It's a great opportunity for us. Individuals who
have started looking at some of the revised
code structure
proposals
have already identified, okay, we're missing some key
elements here. Yep.
So
that's what we need to be doing. We
need to be saying, like, this code is
really complex. Nine two five zero seven is
a very complex code.
And when I bill nine two five zero
seven, I'm not treating the same thing that
my pediatric friends are treating. I'm not treating
the same thing that my outpatient friends are
treating. I'm not treating the same thing as
my home health patients are seeing.
And we need to be able to put
that dialogue and put that clinical complexity and
skill into words
and present it to the panel to say
this is complex. Yeah. It's not
just a one size fits all. Yeah. I
I remember when I was fresh out of
grad school. Right? You know? And I barely
even had any medical SLP training at all
in grad school, and and I and I
don't say that to shame a grad program.
It was just it it was the reality
of I had a very pediatric focused grad
program. That being said, I ended up loving
the sniff setting. And I just had a,
you know, wonderful director rehab who just said,
you know, these are your codes. If you're
doing speech or language, bill 9 2507.
If you're doing swallowing, bill 9 2526. And
I just
was a Yep. Good little SLP and did
what I was told and went and saw
patients and billed those codes and just never
thought about it. Right? And it really wasn't
even till,
I don't know, many years later, I'm ashamed
to say. And I was having a conversation
with, you know, one of my friends, and
I was like, well, tell me, you know,
like, what codes do you bill? Because I
I had started doing some own digging myself,
and I was like, why are there all
these other codes in here that
we're not billing? Like and it wasn't it
it just sparked a lot of interest in
me, and I was like, what do you
bill? And she she only sees
she sees really complex
pediatric cases, and she's like, oh, I bill
92507.
I was like, wait. That's what I bill
in the nursing home. Like, and to me,
I was like, that's insane, like, that there
was so much overlap on that. I mean,
even that was probably ten years ago that
I had those conversations. But
all that said, I wanna stop right here,
Lisa. I want you to introduce yourself and
share your background. I we this this is
just like a movie. We just gave you
guys the preview, and now we're gonna introduce
the cast. Okay? So go ahead, Lisa. Share
who you are.
Okay.
I'm Lisa Johnson. I am a speech language
pathologist.
I work, kind of a cross continuum in
the adult and geriatric
sector. I spend a lot of my time
in regulatory compliance,
program development,
audits and denials across the continuum.
I work in a six state region,
so multiple local coverage determinations in that that
I'm dealing with. I'm actually in the Midwest,
and so I see and spend a lot
of my time working with
managed care, private care insurance, payment,
really digging into those aspects. I've been working
primarily in senior care and geriatrics for over
fifteen years now. This is my my happy
place.
I'm I'm kinda the point person when there's
coding changes, when there's rumblings about different things
within our organization,
really digging into that nitty gritty.
I get excited with the numbers.
I'm kind of the numbers nerd, so that's
me in a nutshell. Yes. Thank you. Thank
you for sharing that. I I just wanted
everyone to know that you this is truly
all you eat, sleep, and breathe. So so
thank you for that. Yeah. Okay. So let's,
let's back up a little bit. Let's dive
into
all the different players at play,
because I there's so much complexity in that.
And and to be honest, that was just
nothing that I had ever learned until
I started opening a clinic and learned all
about it myself. And, you know, it's one
of those things that it's like SLP should
learn this stuff. Yeah. We should. And I
and I don't know where this belongs. I
don't know if it's something that really needs
to be taught in grad school or or
how we learn this stuff, but it is
so important to know. And you should know
these things because they do
impact everything that we do. They impact our
service delivery.
They there's just so much that goes into
it. So Definitely. Definitely. So, you know, I'll
try and keep it
as simple as possible because it is very,
very complex when we're talking about coding and
billing and reimbursement.
So kinda to start with AMA, so the
American Medical Association,
That's
who creates our CPT codes and,
looks at really the structure of the codes.
They manage code creation, revision, deletion, description of
the code, and instructional guidelines. And that's kind
of where
AMA and CPT end. They kinda own the
coding and what it looks like.
Then we have CMS, so Center of Medicare
and Medicaid Services. They don't create the codes.
Sometimes they do some interesting things with codes,
but they decide how how the codes are
valued and paid under Medicare.
So what that looks like is once a
code is more or less approved
by AMA and the CPT editorial committee and
goes into
the revision,
which that itself is a huge process, and
that's kind of where we're sitting right now
with these codes.
If the code is approved, if the code
is basically
planned for publishing,
then CMS steps in. So after AMA approval,
code goes through what's called a valuation review,
and that's done by CMS.
And CMS starts determining the relative value units
or the RBUs,
the payment amounts, the coverage policies,
the frequency edits associated with them,
and the documentation
expectations.
They will look at recommendations
from
AMA's RUC or relative value
scale update committee,
and
really look at what's going into the code,
how is the code valued from kind of
a clinical complexity standpoint, and then they'll compare
it to other code structures.
Then
they're also going to look at,
basically,
some of the other players coming in is
is the code budget neutral?
Is this for a specific setting, for a
specific region? So you continue to have all
of these shifting
coverage determinations.
Then your local coverage determination comes in. So
AMA has said, here's the code. CMS has
said, here's how we think we're gonna pay
for the code, then the local coverage determination,
kind of run by your max,
are gonna say, here's the rules we're gonna
accept within this structure that we're gonna say
yes or no on, and then we may
or may not add some additional revisions to
it or some additional
modifiers that you have to have or maybe
diagnostic codes that you have to have with
it. So you're starting to see the split
as we go across the country with that.
Once that happens, and sometimes it happens in
tandem, you also have Medicaid
running their same parallel, and sometimes they get
ahead of CMS. Sometimes they're a little bit
behind. We're seeing some
areas where Medicaid is ahead of CMS right
now with this structure.
And they will say, okay. Well, that's great
that you have that code. We're gonna add
all of these revisions to it, and we're
gonna add all of these additional requirements.
Or we're gonna say that you can use
this code, but only if you add this
modifier.
And if you hit this time frame, it's
gonna be multiplied by this much or divided
by this much. So, again, modifying what we're
paid at the end.
Then while that's all happening, the other person
or other entities playing into it are
are managed care or our private care insurances,
our
advantage plans. So think like Humana Blue Cross,
Aetna, all of those insurances.
They're also going to take
what the MACs and the LCDs said, and
they're gonna say, okay. That's great. Here's our
interpretation.
And we may or may not accept what
Medicare said.
We may or may not accept that as
the billing rate. Or we might say, yeah.
You know, we don't really want that code.
You can keep using this old one because
we liked how easy it was to audit.
So you have all of these players coming
in, and
it's it's very confusing.
And and that's just kind of like that
high level. Yeah. And
it's going to impact
also, you know, if you have different policies
within your organization
at state level. You have different rules and
regulations based on your licensure
depending on what state you're in, depending on
what billers your organization or your private pack
practice accepts where you're allowed to bill.
So
a lot of things impact
the end result of the code. So there's
a lot of rules for us to know,
and I wouldn't expect any one SLP to
be like, I know all of the rules.
But at least
my kind of expectation or kind of expectation
I bring forth to our team, I say,
you need to know where to look for
the rules,
and you need to know what rules impact
your area that you're facing. That was that
was gonna be my next question is,
Suzy Staff SLP. I'm making the absolute most
largest generalization ever in the world right now,
everyone. Okay. Don't come for me.
Susie Staff SLP
loves to just get her kids on the
bus in the morning, grab her coffee, get
to work, see eight patients a day, clock
out, go home. It's the most perfect life.
She loves it. She does not wanna know
this stuff. What is the minimum amount of
stuff that she
could know to still feel good about what
she's doing, know that she's ethically billing,
know that she's doing right by the facility
and bringing in the right reimbursements that need
to happen?
So kind of kind of bare minimum that
I and, again, this is my personal lived
experience because I I've been the SLP who
who shows up, and I enter the billing
codes that
are auto populated in my EMR
and,
you know, the whatever treatment was assigned, like,
I go and treat and I do. And
that that's fine and dandy, but you're putting
yourself at risk and you're doing a disservice
to yourself, our profession, and your patients if
you do that. So at a minimum, I
would say,
at the beginning of every year,
open up that new physician fee schedule. ASHA
does a great job of preparing one that
is very speech specific with amazing links and
resources within ASHA and outside of it. But
at a minimum,
have that position fee schedule for the current
year you're in,
go through,
highlight the codes
that are ones that you use in your
practice
and ones that you have questions about.
So, you know, we talk about 92507,
kind of that catch all code. Do you
do anything else that's not in that description,
or is that description broad enough for you?
And start breaking down what you do, really
understanding,
okay, if I am treating somebody for apraxia,
what does that mean? Does my documentation
support
I am treating apraxia? Here's what I'm doing.
Here's the skilled things.
Versus the next day, I see that person
and maybe I'm treating aphasia.
What am I treating? What is the skill?
And getting really good at breaking down and
documenting,
even though it's all within one code, perhaps,
This is the skill and this is the
clinical complexity
that I'm treating. And when you review your
documentation, I recommend that our SLPs
audit your own documentation. Like, look at your
last thirty days. If 90% of your billing
is $92.05 $0.07,
you should be able to tell that those
are different treatment sessions,
different diagnostics that you're treating, different deficits and
impairments.
It shouldn't read like everybody looks the same.
Right.
And I think,
you know, at a minimum as SLPs, we
need to know our physician fee schedule.
We need to know what codes are available,
whether you use them or not. Right. Right.
Know what's available, but know the definition of
what you're using. If you're using a code,
you need to be able to define that
code
and know what the rules are associated with
it. So so say someone's having trouble getting
this info from their DOR or their facility,
who can they contact to figure out what
exactly they're able to bill?
So kind of first start with that position
fee schedule. You can go on,
go online. You can search for it. If
you just search twenty twenty six position fee
schedule SLP,
generally, the first thing that pops up is
the PDF from ASHA that has all of
those physician fee schedules.
Next thing, just
ask your DOR
what insurances do we bill.
Start there. If you are seeing straight traditional
med a,
k, pull the CMS manual and the local
coverage determination for your area.
That'll give you the rules.
Those are also PDF files you can type
in in a search area what code, and
it'll tell you all the rules associated with
that code. I will also add the AI
is very helpful for doing this. Like, I've
typed in a few different codes
in this area. I'm in North Florida. In
Florida, we have North Florida. We have South
Florida. Those are the two different
two different MACs, but then there are geographic
things as well. And what's interesting is just
there's some codes that can be built a
few counties over. There's some that can't be
built. There's so
much variation, and that's just what I wanna
emphasize
to you guys is I'm just giving so
many blanket recommendations
online for people to research this stuff because
everybody is so different.
Yeah. And, usually,
it's interesting.
So
when I was, you know, when I was
a staff therapist,
my DOR was a PT.
So me coming up and saying, hey. How
do you build this? They'd be like,
Right. You have an end time code? That
like, it we're not even speaking the same
language.
So, you know, if you're in an area
or you're in an organization
where you have a biller,
maybe your health information person,
if you're in skilled nursing, your MDS person
Yep. They know a lot about coding and
billing.
So go to them and say, hey. Can
you just tell me you know, let's take
a look at my patient list. I have
these 10 patients that I have to see
that are on my schedule.
What are the rules?
What insurance are they?
Start there. Yep.
Because you could potentially have 10 patients on
your schedule. Every single one of them may
have a different rule.
Yep.
Generally,
kinda you know, this is really an overarching
broad statement, but generally, start with Medicare. What
does CMS say? What does CMS define it
as? Because that's generally the basis
of where you start. Yep.
Then you have some nitty gritty nuances or
restrictions put in, but that's where you start
and kind of go from there. Yep. Awesome.
Thank you, Lisa. Okay. Yeah. I wanna talk
about I wanna switch gears a tiny bit.
I wanna talk about where we are in
this entire process
today. So
Lisa and I are recording this podcast
March 5, and it is 10:38AM
right now. I do not know when this
is gonna hit the
Internet. Okay? Hopefully, in the next day or
two, I have a wonderful team that will
get this out. So say this hits March
6, March 7.
The AMA open comment period
opens March 6. So
tell the people how they can get involved
in that.
Alright. So
as Theresa said, the
open comment period
opens
for us tomorrow, March 6. So what that
also means is the public agenda for the
meeting is going to be available March 6.
Right now, there is no public agenda available.
There is basically what's called a lab agenda,
and there's not a lot of information in
it.
So
what you wanna be looking at is
get registered to be part of the AMA.
Whether that's you are going to register and
participate in the hybrid meeting or if you're
in Boston,
be there in person.
And that is our opportunity
to potentially
be able to state,
and
this is where the
editorial panel starts to solicit
input from practicing clinicians,
physicians,
advisories
from all of the different societies out there
and not just speech. Like, there's a litany
of codes that they are looking at every
time they meet, and we're just a small
part of that agenda.
Registration and getting any information is mandatory whether
you are attending in person or virtually. So
register.
That is my first to do. Register,
and then if it's March 6 or after
March 6, pull up the public agenda and
see what's being said.
Next kind of, like, action step you wanna
take,
register
for the AMA CPT editorial
updates.
That way you're getting the information directly from
the source.
Also register for the CMS
updates.
They will come to your email box sometimes
depending on what buttons you click. You might
get one email. You might get a dozen
a day. Depending on what setting you're in,
you can really customize what information you want.
But start getting the updates because I feel
like a lot of times we're very
reactive once information has gone through other organizations.
But if you can get that information directly
from the source sooner rather than later, you
can start preparing with what you wanna do.
Also,
take a look at
what some of the revision
recommendations
are.
So,
it's
a little hard to find,
but within
AMA,
there is a meeting minutes
PDF that's from this past fall. And, basically,
it goes through
what the CPT revision recommendations
are, and there's quite a few of them.
There's some different organizations that have submitted,
for those change code recommendations.
So take a look at those code recommendations.
And
whether or not you're able to
hop in on that AMA meeting, so the
meeting is April 30 through May 2, we
don't know where we are on the agenda.
We could be first, we could be last,
we could be somewhere in the middle. We
just don't know at this point.
But take a look at what's being proposed
and really look at, okay, which hits me,
which areas or things that I include in
my practice,
what are things that I am treating clinically
now,
and how do I define that, and how
do I define
kind of the time that is necessary to
do this part of our treatment?
Because,
you know, we've had this catch all code
where we've kinda just been lumping everything in,
and maybe Monday, you're treating one thing. Tuesday,
you're treating a different thing. Wednesday, you're treating
another,
but it's all under the same code. So
we have to be able to define
to the panel
this is the complexity of what we're doing,
but we also have to talk their language.
So why is it a complex code? Why
is clinical skill need? What diagnostics
does this address?
And getting
really intentional about what your treatments look like
and start writing them down.
So if you are called
to speak
during the meeting, you have talking point.
Another kind of action thing I would say
is
if you're not involved at your state level,
get involved at your state level. We should
be making phone calls to our state organization,
shooting them emails. However
form of communication you have with your state
organization
because those larger bodies that represent a larger
group of us, they have a louder voice
in these meetings. They are generally recognized before
an individual is.
So if we can get our voice out
to those organizations,
we have a better chance of what we
want being heard.
So that's kind of the the what do
we do immediately right now.
I
you know, I'm someone who I'm like, you
know what? This information has been out there
for a while. We've known since this summer
when they put in the editorial recommendations for
the September meeting. Like, this has been a
long time coming.
And now it's what do we do? How
do we prepare? How do we
make ourselves
have less of a risk when and if
changes are made?
Because we don't know. And what we've seen
is while,
yes, there's this January 1 date looming,
we've seen historically where AMA makes a recommendation
and CMS is like, yeah. No.
Go back to the drawing board. That might
happen.
So we wanna make sure that our voices
and
the skill that this code
encompasses and even all of the breakdowns that
are recommended in some of those revisions,
that we're able to talk about them. And
we're able to say, you know, as a
pediatric clinician, I do x y z, and
here's the skill involved. Here's the time involved.
Here's the complexity of the diagnoses that I'm
looking at
versus as
a
SLP who's in a geriatric setting. These are
the diagnostics I treat. These are the complexities.
This is the time that I spend on
these codes
and why it's so vastly different.
I think that's really important because it is
shocking when you realize,
oh my gosh. We're all using the same
code.
And should we be?
Right. No. I I don't think so. You
know? I I mean and I think that's
just the tough part right now. It's like,
we've all been saying this that we all
treat just such a wide variety of things,
and why are we all getting reimbursed
the same? And and, you know, it's like
we've been arguing for this. And now that
it's here,
we are freaking out about it. You know?
And there's, you know, it's, yeah, there's some
things that have been proposed that are not
okay, and that's why we use our voices
to to go ahead and speak up. So
okay. So that you explained the AMA,
the CPT,
and then my understanding also is that towards
is it the end of the summer when
they actually look at the values? Is that
right?
Yep. So once things go that through the
CPT o CPT editorial panel, once there's a
chance for kind of all of the collective
voices to be heard more or less,
Then
what comes out in the summer is the
AMA's recommendation.
So
mid summer,
I wanna say July is generally when it
comes out.
There's not a set date, but it's generally
July is when they put out the recommendation.
After that, there's another comment period, and then
that's when CMS reviews as well.
So we'll
depending on what they say, we know that
things have been recommended. We have
a set of codes.
So
I think it's 92X0X
through 92X9X
have been proposed.
Chances are that's what's gonna go through. Maybe
there'll be a few revisions, maybe an addition
here or there,
but highly likely that those codes in some
form or another are going to move forward.
So
be looking for what that code structure looks
like and those open comment periods. Like I
said, make sure you're registered
for those CMS updates, for those AMA updates.
That way you can get ahead of it
because there's a lot of
confidentiality that goes into these closed door meetings.
And
if you're not aware of when publications are
coming out and you're reading them, you might
miss those comment periods.
And there's also a very limited number of
individuals that can comment on these as well,
which is why it's so important, you know,
even after this April 30 meeting,
closes,
we wanna continue to have our voices heard.
So
getting in front of our national organizations, getting
in front of our state organizations, talking to
our physician groups, is this gonna impact them?
You know, if you're somebody who's in a
high managed care state, start asking those questions.
What are they doing? Your state boards, your
Medicaid boards, we've seen changes already on the
Medicaid side in some of the states that
I'm in where we already have coding that
is different and restrictions within our codes.
Making sure that you're aware of when those
changes happen and when the comment periods open
and being prepared to make a statement, make
a comment.
And while it's great, you know, social media
is a great way to get information out
very quickly to hit a wide
breadth of individuals and audience,
sometimes that's not where the action has to
happen.
It has to happen in front of these
panels. It has to happen through these
logistics
and through a lot of these closed door
communities.
So trying to get our voice in there
is is really important.
Yeah. Lisa, talk to me about because I
know there is this NDA involved with the
AMA, and I've heard so many different
crazy things that you can't even comment or
anything unless you sign this NDA. If you
sign this NDA, you can't speak about anything.
Share what you know. So within the AMA
process and they have different,
depending on where you're making comments and where
you're making suggestions.
Depends on the type of confidentiality,
statements, and agreements, and NDAs that have to
be signed.
So, essentially,
what it means is
if and while you are part of the
process. So, for example,
when
the cognitive codes were being reviewed,
kind of that 2018
to 2020 time frame,
there were board members presented on the
CPT editorial panel and then also on the
rock panel and individuals that were invited to
speak in those closed door meetings.
Until AMA came forward and published information,
either via through their meeting agenda notes,
through their public comment policy, or through their
general publications.
Individuals who are invited into those meetings could
not speak about them
without
legal repercussions happening.
It's one of those things where
if you're invited to speak in these committee
meetings,
you wanna get as much information as you
can, but also knowing that you can't speak
about it until somebody else says go.
Yeah.
Which we could look at as a positive
or a negative, but there's a process involved.
And part of the process is getting all
of those voices, making sure they're going through
the correct channels,
and speaking
when the option is available and being ready
to present as much information in a short
time frame as possible.
But, also,
it's frustrating
for
the frontline SLP to be like, how come
we didn't hear about this? Right. Well, we've
been hearing about it. We just haven't been
getting all the nitty gritty detail because
it's not published.
Yeah.
Yeah. So being prepared to react when the
information is presented to us
and also knowing what does reaction look like.
Is reaction advocacy
or is reaction
complaining
and saying, oh my gosh. What do I
do? Everything is a disaster, and it's not.
This is just part of the process as
an opportunity for us. Like you said, we've
been asking for this for a long time.
Yeah. Whether we
knew what that ask meant
Yep. Or not. We've been asking for a
long time. We've been trying to compare ourselves
in some areas to PT and OT, and
we're very different than PT and OT. Our
coding structure has been very different, but we've
been seeing this collective
shift throughout
reimbursement structuring
throughout the medical sector of trying to align
as much as possible
so we have kind of this systematic
consistency.
Yep.
And that's what we're moving towards.
That's what we should have been preparing for
for a long time. And,
unfortunately,
like you said, we don't get this information
in grad school. We get a trial by
fire,
and, generally, it's not until you either had
a denial thrown in your lap or you
attempt to pivot or maybe you go into
a different position that you start asking those
questions.
Yeah. Thank you. I think, you know, and
the complexity comes into play here too with
comparing ourselves to PT because there's a lot
of aspects of what we do that is
super, super similar. We diagnose.
We do treatments. We do exercises.
We help to improve muscle strength and coordination
and then,
you know, do some more updated testing and
then they graduate. You know? And that's very
much like PT. There's other parts of what
we do, like, I think about, you know,
trach management in the ICU. You know? That
is so far off and is, you know,
not considered,
you know, an exercise based
therapy that, you know, there's just so much
complexity. Right? So it's like, don't come for
me guys when I make these generalizations online
that
because I'm just trying to get us to
understand
why we need to all be speaking up
for our own lived experiences, patient populations,
settings that we work in because they are
just so vastly different. And to just say
that this one blanket code that we've all
been billing for fifteen years is the way
to go, we all know that's not the
way to go. So
this this is the time for us to
speak up as much as we can, and,
you know, I don't know what I don't
know. Lisa doesn't know what she doesn't know.
The only way that these people are gonna
change the system is if they hear from
you. So it's just really important to me
that people
channel their anger and their frustration
in the right
manner because just, you know, spreading this panic,
fear, doom, and gloom is not productive for
anybody. You know? If if you all of
a sudden close-up your private practice, you're not
helping anybody. Right? So we've
we've gotta get some
knowledge around this to be able to advocate
appropriately.
And I think and that's the the big
thing too is we can't just write in
and say, you know, this isn't fair. This
isn't our field is so much more complex.
You have to give patient specific examples of
your lived experiences and your patient settings and
your patient populations.
Yeah. And I think, you know, I think
when you ask, okay. What do I do
as, you know,
Susie SLP
on Lonely SLP Island out here in rural
Nebraska?
What can I do about it? So we've
talked about some tangible steps, like, within
kind of this revision process.
But let's say
the revisions go through,
you know, we're given whatever relative value we're
given.
What does that mean for you, for your
practice, for your business,
for where you're structured,
and are there things that you can do
about it now?
Yeah. We can prepare.
Knowing what we know, knowing the
potential
of what might happen.
You know, we don't know the exact numerics.
We don't know the exact value that's gonna
come forth yet. We don't know exactly
what MUE edits and NCCI edits are gonna
happen,
but we know something's going to happen.
So how do we kind of protect our
practices,
protect our profession,
and what are some tangible things that we
can do
individually and operationally?
Because there's a lot of things that we
can do. And
there's kind of you know, we talked about
this,
kind of on an organizational level. Like, what
are some of these
shifts that we're going to potentially see?
So kind of, like, one of the major
shifts is our therapy is no longer gonna
be a container.
That is a potential shift that's going to
happen. We're going to have to get
very clear about what we are treating and
what we are documenting.
What is the domain we're looking at? What
is the specificity
of what we're treating? So getting very clear
and granule
granular on that and starting to document that
way. Because if we start documenting that way,
we're, you know, we're helping protect us ourselves
from audits because we know those are coming.
But, also, we're getting ourselves prepared for if
and when a shift happens.
Looking at time, time is gonna matter more.
With the proposed codes that are in there
right now, it's a thirty minute and fifteen
minute code structure essentially with those add on
codes.
Very similar to
the 97129,
nine seven one three zero cognitive codes that
are in in kind of our our playbook
right now.
Those differ from the eight minute rule codes.
So, essentially, it's a minimum of sixteen minutes
in order to build that first code. Then
once you hit over the 30, you can
add on to that additional code into it.
So look at your time. What are your
sessions look like time based?
Knowing that
domain specificity is gonna matter more.
So are we clearly defined? Am I treating
voice? Am I treating
speech language? Am I treating
articulation?
What what am I treating? And documenting it
as such.
Making sure that if you do have that
overlap with cognition,
it needs to be very, very defensible. We
already have cognitive codes in place.
Are you using those appropriately right now?
So take a look at your documentation.
Take a look at those
three codes essentially. Are you using them appropriately
right now? Do you know your rules associated
with those codes?
And then making sure your documentation
and this is just a good general rule.
Does your documentation align with the diagnosis
you're treating?
I'm getting very, very clear. We're really moving
from this flexibility
within this giant code to precision.
And that's what we're gonna continue to see
mimic kind of throughout
the professions.
And we need to be really good about
getting very precise about what our coding is
and what we're treating. Yep. Awesome. Thank you.
And I do wanna share too, you guys.
I mean, this stuff is so as Lisa
explained, like, if you're not getting the updates
right from the source, this stuff is so
fluid right now. Things are moving quickly. Things
are changing quickly. There was even something that
I had written a few days ago that
was changed this morning, and so I had
to edit a post before it went up.
There's been a lot of documentation
that ASHA has pulled down in the last
few days. I'm not gonna speculate why they
did that, but my guess is that something's
changed
that they heard was coming down the pike
or that something was changed. So I I'm
asking for a little grace too and that
I'm trying to update everybody as quick as
I know with the information that I have
in my hand at the moment that I'm
presenting it.
But if you see a post a week
later, like, have some grace and and
know that this stuff is just so fluid.
And please dig into it. Please ask. I'm
not afraid to say if I, you know,
missed something or if something had changed in
the last few days. But plea you know,
do your own digging, do your own research.
But all I can really just say is
is please send in your comments about your
specific
situation and your own lived experiences because we
all know they are so vastly different. And
my comment may not touch
an ounce of what you do in your
setting. You know, somebody else's comment may be
totally different from what you do, and and
that is why this is all so important
that we all do
speak up and get our voices heard because
it is so different. And and I'm just
like I said, I said at the beginning
of this, and I'll I'll close out with
it too. I'm excited about this because we've
been asking for this.
The table is available for us to pull
up a seat and sit at and share
what we want to share. So let's do
that. Let's not cripple ourselves with fear, but
let's let's get together and speak up. And
and I'm I'm just hopeful that this is
what we've been asking for.
Yeah. And I think, you know, like you
said, there's a huge opportunity for us here.
And coming from a place of
knowledge and understanding,
knowing that everything is fluid, we don't have
concrete, but there are concrete things you can
do.
You can get involved. You can advocate. You
can audit proof your business and prepare for
those what if things. And it no matter
what the decision is in the end, doing
those steps is only gonna make your practice
stronger. It's only gonna make our profession stronger,
and it's only going to make us be
able to speak about these things
more proficiently
moving forward. Yep.
So
get involved. And and when we say comment
and get involved, we're we're not talking about
put a blast out on whatever pages you
have. We're talking about going to the sources,
going to AMA, going to ASHA, going to
your state organization,
making comments there where there is leverage that
they can take and make our voices louder
as a collective.
Yep. And that's what we need to be
doing. Yep. Awesome. Okay. I'm gonna leave that
there. Do you have any final thoughts, Lisa?
I think I think we did a really
good job explaining
things that are going on. I'm gonna put
as many links as I can in the
show notes to this, you guys,
because I want to make it easy for
you to comment.
I am not going to be sharing templates
and things like that because I I do
not wanna be influencing
what other people should say. I'm just going
to say,
please do get in the conversation,
and that is where I'm gonna leave that.
So any any final thoughts, Lisa? I asked
you any final thoughts, and then I kept
talking over myself. So any final thoughts, Lisa?
I think, you know, using those resources, getting
to know those links,
really get intentional about what you're doing and
what you're practicing.
And,
I mean, we could talk for hours about
the here's how you can do the next
steps within your business, within your practice,
but that's a different focus, different conversation. This
is really about how do we advocate about
what's happening right now and where are those
sources. Yep. So use the resources, use the
links,
Talk to your other SLP friends.
Talk to your PTs and OTs also. They've
gone through this
a lot.
Your physicians have gone through it. They may
have words of wisdom for you
that are amazing. Yep. So
Alright. Thanks, Lisa. Appreciate you so much. I
always I always love talking to someone that
actually loves coding because I don't know, like,
ninety nine percent of other speech pathologists that
do not like it. So awesome. Thank you
so much for your for your time and
your energy and your knowledge. And like I
said, we will share as much of this
stuff in the show notes as we can,
as many links as we can gather for
you all, and and I hope this has
been a helpful conversation. So thank you so
so much. Yeah. Thank you.
And that's a wrap for this episode.
As always, thank you so much for listening.
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