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Our Family Is Crazy
SLP Practice Council

SLP CPMS
By: Elizabeth Ebensteiner
Date: August 8, 2019

You Can Bill for That? SLP CPMS By the SLP Practice Council

We at the Practice Council have received questions regarding billing Clinical Process Measures (CPM), especially since dysphagia is not one of the listed CPMs.  Questions have also been raised regarding checking one of the CPMs such as memory or attention when billing only for dysphagia treatment. After discussion, we want to say, we heard you, we understand where your questions are coming from, and hopefully this article will help to clear things up.

When I was in school, dysphagia therapy and cognitive therapy were taught as two completely different subjects that only related in that people with dementia were more likely to need diet downgrades.  As a grad student, the idea of billing for cognitive therapy and using CPMs related to attention, memory, or visuospatial/executive functioning was a foreign concept. The reality is that as SLPs we frequently get patients who have cognitive-communication impairments as well as dysphagia and when we are providing cues during meals, we need to stop and ask: why do these patients need these cues?

  • Are you providing verbal cues for patients to attend to their meals? Those are cues for attention.
  • Are you providing verbal cues for patients to attend to the left side of their plates to compensate for neglect? That’s visuospatial/executive functions.
  • Are you using a visual aid to remind patients of their compensatory strategies during meals because they are unable to remember them on their own? That’s memory.

There are many more examples that I could give, but I am sure that you get the idea. Despite what we may have been taught, cognitive-communication treatment and dysphagia treatment do not live in entirely separate worlds. Therefore, we as SLPs need to see the “big picture” and identify the areas of deficit that would benefit from intervention.

Therefore, if we find our dysphagia patients would improve from cognitive-communication treatment (or perhaps we are already prompting for improved cognitive-communication responses within our dysphagia plan of care) and we recognize we should be checking CPMs to support these areas, then this must be justified through a cog-comm evaluation and an established POC. The same goes for a treatment plan for cognition and/or communication, and we notice reoccurring coughing with intake. We would then want to initiate a dysphagia evaluation to further assess these concerns as indicated.

Let’s clarify use of the CPMs and our clinical practices.

Currently the SLP CPMs are as follows:

1 – Intervention for visuospatial/executive functions

2 – Naming

3 – Attention

4 – Language

5 – Abstraction

6 – Memory, delayed recall

7 – Orientation

20 – None of these

  • When there is an established plan of care for dysphagia only, select the CPM “20 – None of these.”
  • If a plan of care has been created for dysphagia and cognition with patient goals, including recall of swallow strategies or possibly spaced retrieval to support memory and carryover of dysphagia components, you would choose the CPM memory and perhaps attention.
  • If you are working with a cognitive-communication plan of care, you may be checking more than one CPM to support goals and interventions.

Make sure to give yourself credit for the work you are doing within your evaluations, treatments, coding, goals, billing, and overall documentation. These components should all align and connect the plan of care, creating the story of your skilled services as an SLP.

It can be a challenge to adjust our thinking to be about the why behind our treatments instead of just how, but in October we are going to be entering the new world of PDPM and justifying our services is going to be more important than ever. Let’s take action together, capturing the skilled stories within our documentation to support optimal outcomes for our patients!

Elizabeth Ebensteiner, MS, CCC-SLP, SLP Practice Council Member


SLP Practice Council SLP CPMS

By: Elizabeth Ebensteiner
Date: August 8, 2019


You Can Bill for That? SLP CPMS By the SLP Practice Council

We at the Practice Council have received questions regarding billing Clinical Process Measures (CPM), especially since dysphagia is not one of the listed CPMs.  Questions have also been raised regarding checking one of the CPMs such as memory or attention when billing only for dysphagia treatment. After discussion, we want to say, we heard you, we understand where your questions are coming from, and hopefully this article will help to clear things up.

When I was in school, dysphagia therapy and cognitive therapy were taught as two completely different subjects that only related in that people with dementia were more likely to need diet downgrades.  As a grad student, the idea of billing for cognitive therapy and using CPMs related to attention, memory, or visuospatial/executive functioning was a foreign concept. The reality is that as SLPs we frequently get patients who have cognitive-communication impairments as well as dysphagia and when we are providing cues during meals, we need to stop and ask: why do these patients need these cues?

  • Are you providing verbal cues for patients to attend to their meals? Those are cues for attention.
  • Are you providing verbal cues for patients to attend to the left side of their plates to compensate for neglect? That’s visuospatial/executive functions.
  • Are you using a visual aid to remind patients of their compensatory strategies during meals because they are unable to remember them on their own? That’s memory.

There are many more examples that I could give, but I am sure that you get the idea. Despite what we may have been taught, cognitive-communication treatment and dysphagia treatment do not live in entirely separate worlds. Therefore, we as SLPs need to see the “big picture” and identify the areas of deficit that would benefit from intervention.

Therefore, if we find our dysphagia patients would improve from cognitive-communication treatment (or perhaps we are already prompting for improved cognitive-communication responses within our dysphagia plan of care) and we recognize we should be checking CPMs to support these areas, then this must be justified through a cog-comm evaluation and an established POC. The same goes for a treatment plan for cognition and/or communication, and we notice reoccurring coughing with intake. We would then want to initiate a dysphagia evaluation to further assess these concerns as indicated.

Let’s clarify use of the CPMs and our clinical practices.

Currently the SLP CPMs are as follows:

1 – Intervention for visuospatial/executive functions

2 – Naming

3 – Attention

4 – Language

5 – Abstraction

6 – Memory, delayed recall

7 – Orientation

20 – None of these

  • When there is an established plan of care for dysphagia only, select the CPM “20 – None of these.”
  • If a plan of care has been created for dysphagia and cognition with patient goals, including recall of swallow strategies or possibly spaced retrieval to support memory and carryover of dysphagia components, you would choose the CPM memory and perhaps attention.
  • If you are working with a cognitive-communication plan of care, you may be checking more than one CPM to support goals and interventions.

Make sure to give yourself credit for the work you are doing within your evaluations, treatments, coding, goals, billing, and overall documentation. These components should all align and connect the plan of care, creating the story of your skilled services as an SLP.

It can be a challenge to adjust our thinking to be about the why behind our treatments instead of just how, but in October we are going to be entering the new world of PDPM and justifying our services is going to be more important than ever. Let’s take action together, capturing the skilled stories within our documentation to support optimal outcomes for our patients!

Elizabeth Ebensteiner, MS, CCC-SLP, SLP Practice Council Member

© 2019 Avamere Family of Companies
© 2019 Avamere Family of Companies
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© 2019 Avamere Family of Companies