Commonly Used Diagnostic Codes For SPD / SID Insurance Reimbursement

 

The first section of this information is available in the SENSORY INTEGRATION - SPECIAL INTEREST SECTION QUARTERLY Volume 22, number 1 March, 1999.  Published by the American Occupational Therapy Association, Inc.


"Insurance Reimbursement Survey Results"
Use of Codes for Diagnosis and Treatment

 

ICD-9 Diagnostic Codes:

299.0   Autism

299.8   Pervasive Developmental Disorder/Asperger's Syndrome

314.0   Attention Deficit Disorder

314.01  Attention Deficit Disorder with Hyperactivity

315.4   Developmental Coordination Disorder

315.8   Delay in Development (specified)

315.9   Delay in Development (unspecified)

343.9   Cerebral Palsy

759.83  Fragile X Syndrome

781.3   Lack of Coordination

784.69  Motor Apraxis

742.9   Unspecified Anomaly of the Brain, Spinal Cord and Nervous System

349.9   Unspecified Disorders of the Nervous System

782.0   Disturbance of Skin Sensation

781.0   Tremors Nervous system

348.3   Encephalopathy

382.9   Otitis Media



CPT Codes For Billing:

97110   Therapeutic Exercises (procedures)

97112   Neuromuscular Re-Education

97530   Therapeutic Exercises (activities)

97770   Self-Care/Home Management


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In a sample Private OT, these are the evaluation and treatment codes most frequently used...

Evaluation Codes:

96110   OT Eval- developmental assessment interpretation, report

96111   OT Eval- extended standardized developmental instruments

96115   Neurobehavioral status exam with interpretation report

96117   Neuropsychological testing with interpretation report

97003   Medicaid/CMS Evaluation


Treatment Codes:

97110   Therapeutic Procedure - develop strength/endurance. ROM/flex

97112   Neuro-muscular Re-Education - balance, coordination, proprioception

97250   Myofascial Release/Mobilization - hand, wrist

97265   Joint Mobilization - hand, wrist

97504   Orthotics Fitting - upper/lower extremity



 

(Michelle Morris   Reprinted With Permission.)

 

Michelle Morris is the mother of six, and parent of a child with a Sensory Processing Disorder. She is whole heartedly dedicated to promoting awareness and advocacy for families with SPD children.  She has published over 30 articles supporting and educating parents about SPD.  

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