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Pediatric Coding Alert

Reader Question:

State Laws Dictate Who the Doc Can Supervise

Question: Can a pediatrician bill as a supervising provider when the staff member (in our case, a credentialed teacher) is providing a cognitive therapy service for autistic or ADD kids, using computers as the therapy tool? The pediatrician is in the office while the service is being provided. We would like to report 97532 (Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact by the provider, each 15 minutes) or 96116. Florida Subscriber Answer: This issue concerns not only correct coding, but also state scope of practice laws. In many states, the therapy codes can only be billed when performed by a physician or a physical, occupational, or speech therapist. For instance, Aetna’s policy says that cognitive rehabilitation is only payable when performed by an OT, PT, SLP, neuropsychologist, or physician. Cigna, on the other hand, typically does not cover these services [...]