CPT code 92610 is used to describe the evaluation of a patient's swallowing function, helping healthcare providers assess and manage swallowing disorders.
CPT code 92610 is used to describe the evaluation of swallowing function. This code is typically utilized by healthcare professionals, such as speech-language pathologists, to assess a patient's ability to swallow safely and effectively. The evaluation involves a comprehensive assessment of the oral, pharyngeal, and esophageal phases of swallowing, which may include observing the patient's swallowing mechanics, identifying any difficulties or abnormalities, and determining the appropriate interventions or treatments needed to address any issues. This code is essential for documenting the service provided and ensuring proper billing and reimbursement for the evaluation conducted.
When evaluating the swallowing function using CPT code 92610, certain modifiers may be applicable depending on the specific circumstances of the service provided. Here is a list of potential modifiers that could be used with this code, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the evaluation of swallowing function required significantly more effort or time than typically necessary due to complications or unusual circumstances.
2. Modifier 52 - Reduced Services: Apply this modifier if the evaluation was partially completed or less comprehensive than usual, possibly due to patient intolerance or other limiting factors.
3. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is appropriate if the swallowing evaluation needs to be repeated on the same day by the same provider due to clinical necessity.
4. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Use this modifier if the evaluation is repeated on the same day by a different provider, perhaps for a second opinion or further assessment.
5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the evaluation of swallowing function was distinct or independent from other services performed on the same day, ensuring that it is not bundled with other procedures.
6. Modifier 95 - Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System: If the evaluation is conducted via telemedicine, this modifier indicates that the service was provided through a real-time interactive audio and video system.
7. Modifier GT - Via Interactive Audio and Video Telecommunications Systems: Similar to Modifier 95, this modifier is used for telehealth services, specifically indicating that the evaluation was conducted through interactive audio and video telecommunications.
8. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service: Use this modifier if a significant and separate evaluation and management service was provided on the same day as the swallowing evaluation.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered. Always verify payer-specific guidelines, as modifier usage can vary between insurance companies.
CPT code 92610 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates. However, the actual reimbursement for CPT code 92610 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and setting local coverage determinations, which can influence whether and how much Medicare reimburses for this particular code. Therefore, healthcare providers should consult their specific MAC for detailed information on coverage and reimbursement rates for CPT code 92610.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level and by individual payer. For instance, with RevFind, you can identify discrepancies related to CPT code 92610, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can optimize your financial performance.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
