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Aphasia is a communication disorder that affects an individual's ability to comprehend or produce speech, often resulting from neurological conditions or brain injuries. These conditions may include atherosclerotic disease leading to cerebral infarction or traumatic injuries such as skull fractures that cause intracranial bleeding. The assessment of aphasia is a comprehensive evaluation that examines various aspects of speech and language function. This includes spontaneous speech, the ability to repeat words, phrases, and sentences, comprehension of speech, recognition and naming of objects, as well as reading and writing skills. The assessment process utilizes standardized tools, such as the Boston Diagnostic Aphasia Examination, which is designed to systematically evaluate the different components of language function. The medical professional conducting the assessment must possess the necessary training, knowledge, and skills to administer the tests effectively, following established protocols. After the assessment, the professional analyzes the results and prepares a written interpretation that details the findings. This interpretation typically identifies the specific type of aphasia present, such as expressive aphasia, where the patient struggles to translate thoughts into spoken language, or receptive aphasia, characterized by difficulties in understanding spoken words. The report may also highlight specific deficits, such as pure word deafness or transcortical sensory aphasia. The CPT® Code 96105 is utilized to bill for this assessment, which is conducted on an hourly basis and includes the interpretation of results and the generation of a written report.
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The assessment of aphasia is indicated for individuals who exhibit signs of communication difficulties due to neurological conditions or brain injuries. The following conditions may warrant this assessment:
The procedure for assessing aphasia involves several key steps that ensure a thorough evaluation of the patient's speech and language capabilities. Each step is critical for obtaining accurate results and formulating an appropriate treatment plan.
Post-procedure care following the assessment of aphasia typically involves a review of the findings with the patient and their family. The medical professional discusses the results of the assessment, including the type of aphasia diagnosed and the implications for communication. Based on the assessment, a tailored treatment plan may be developed, which could include speech therapy or other interventions aimed at improving the patient's communication skills. Ongoing monitoring and follow-up assessments may also be recommended to track progress and adjust the treatment plan as necessary.
| Short Descr | ASSESSMENT OF APHASIA | Medium Descr | ASSESSMENT APHASIA W/INTERP & REPORT PER HOUR | Long Descr | Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, eg, by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 04 - Physician supervision policy does not apply when procedure is furnished by a qualified, independent psychologist... | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Service Paid under Fee Schedule or Payment System other than OPPS | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | M5D - Specialist - other | MUE | 3 | CCS Clinical Classification | 7 - Other diagnostic nervous system procedures |
| GN | Services delivered under an outpatient speech language pathology plan of care | KX | Requirements specified in the medical policy have been met | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | 97 | Rehabilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified health care professional may add modifier 97 to the service or procedure code to indicate that the service or procedure provided was a rehabilitative service. rehabilitative services help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabled. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GA | Waiver of liability statement issued as required by payer policy, individual case | GO | Services delivered under an outpatient occupational therapy plan of care | GW | Service not related to the hospice patient's terminal condition | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 1996-01-01 | Added | First appearance in code book in 1996. |
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