New Cognitive Function CPT Codes in 2018

patient collections in physical therapy

In  a recent webinar our CEO John Wallace held for our clients, he reviewed changes made in 2018 to Cognitive Function codes. In this article we will review which code is in, which code is out, and what code to use to bill Medicare.

AMA CPT Code 97532 Replaced by 97127

If 97532 doesn’t look familiar to you it’s because most physical therapists do not use this code. It’s primarily use by speech therapists and therapists who treat pediatric and neurologic patients. 97532 has been replaced with code 97127 (Cognitive Function Intervention).

97532 (Cognitive Skills Development) Definition

Development of cognitive skills to improve attention, memory, problem solving. Direct (one-on-one) patient contact by provider each 15-minutes.

97127 (Cognitive Function Intervention) Definition

Therapeutic interventions that focus on cognitive function (e.g. attention, memory, reasoning, executive function, problem solving, and or programmatic functioning) and compensatory strategies to manage an activity (e.g. managing time or schedules, initiating, organizing and sequencing tasks) direct (one-on-one) patient contact.

See the Difference?

Unlike 97532 which was a 15-minute code, 97127 is an untimed code that is only reported once on each claim. The AMA RUC (RSV Update Committee) reviewed the data on 97532 and found that most providers reported 3-4 units of this code per claim. Based on their findings, 97127 is valued three times that of 97532 and the definition was greatly expanded beyond attention, memory, and problem solving. You should not report 97127 in conjunction with the behavioral assessment codes, or T-Codes (0364T, 0365T, 0368T, 0367T).

97127 not valid for Medicare

Although most commercial payers will recognize 97127 in 2018 Medicare will not. Just like for the electrical stimulation codes, CMS has its own code (G0515) which has the same descriptor and value as 97532 had in 2017.

G0515 Definition

Development of cognitive skills to improve attention, memory, problem solving. Direct (one-on-one) patient contact by provider each 15-minutes.

Recap for Cognitive Function Codes

  • 97532 is out
    • Do not use for any payer
  • 97127 is in
    • Use for all payers except Medicare
    • 97127 is an untimed code, use only once per claim
    • Do not use with any T-Codes (0364T, 0365T, 0368T, 0367T)
  • G0515 is the code used for Medicare
    • 15-minute timed code
    • Same descriptor as old 97532 code

So there you have it folks. What you need to know for code cognitive function codes in 2018. Still confused? Have more coding questions? Contact us today we’ll show you how using RevFlow EMR takes the guess work our of coding, and gets your claims paid faster.

 

 

 

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