Incorporating CAPD in private practice: What you need to know to get started! Rupa Balachandran, Ph.D., CCC-A Department Chair Audiology, University of the Pacific Sharzad Cohen, Au.D., FAAA Auditory Processing Centers Corp.
Definition of CAPD ASHA (2005) Broadly stated, (Central) Auditory Processing as referring to the efficiency and effectiveness by which the central nervous system (CNS) utilizes auditory information. Narrowly defined, (C)AP refers to the perceptual processing of auditory information in the CNS and the neurobiologic activity that underlies that processing and gives ride to electrophysiologic potentials.
What is CAPD? Simply said; Resemblance of hearing loss in whom no hearing loss is present (Mykelbust, 1954). Deficit in processing of the information that is specific to the auditory modality (Jerger & Musiek,2000) What our brain does with what we hear (Katz) When the peripheral hearing sensitivity is normal, but the person does not hear normally.
Signs and Symptoms Parents, teachers, or the patient reports hearing normally, but not understanding the information. Having a hard time following aural instructions (auditory memory) Difficulty with reading, spelling, comprehension Lack of attention or interest Difficulty hearing in background of noise Slow rate of processing information Extreme listening effort and exhaustion
Set Up In office or Mobile Sound Booth Two channel audiometer Insert, noise cancellation, or circumaural headphones Recorded test material
Choosing test Battery No Single test can diagnose CAPD. Monaural Low Redundancy Tests Binaural Interaction Tests of Temporal Processing Dichotic Tests Electrophysiological Tests
Choosing your test Battery Auditory Figure Ground (Speech in Noise) Filtered Words Time Compressed Speech Dichotic Digits SSW Duration Pattern Frequency Pattern Masking Level Difference Gap Detection Phonemic Synthesis
Test battery APDQ MAPA LiSN ( in review) SCAN-A SCAN-C Staggered Spondaic Words (SSW) ARIA (Amblyaudia)
Diagnosis Criteria Failed two or more tests binaurally, based on ASHA(2005) and AAA (2010). Failed two or more tests at least monaurally, based on ASHA (2005) and AAA (2010). Failed one or more tests at least monaurally within one or more (C)AP domains.
Failed one or more tests binaurally within one or more (C)AP domains derived from the breakdown of(c)ap test types in ASHA (2005) and AAA (2010). This breakdown places LPFS in the monaural low-redundancy speech test domain, DD and CS in the dichotic speech test domain (therefore to qualify for a fail in this domain, a participant could fail the DD and/or the CS), FP in the auditory temporal processing and patterning test domain. On occasions when a participant failed only a single test, ASHA s (2005) recommendation that (C)APD be diagnosed only when the failure is accompanied by significant functional difficulty in auditory behaviors reliant on the failed process (rather than the failure needing to be at least 3 SDs below the mean
Recommendations (Accommodations) FM system (Increase signal to noise ratio) Extended time on tests Weekly homework submission Preferential seating (close to teacher and away from doors and windows) Breaks between classes Computer based Auditory training (Home or clinic) Auditory training with Speech Pathologist or Audiologist Reading and learning support (preview lessons, notes, visual input)
Diagnostic Coding (ICD-10) Getting paid for CAPD evaluation highly depends on the insurance carrier and your contract language Diagnostic code (ICD-10) H93.25 AUDIOLOGIST ONLY SLP code R48.8 (diagnosed by AuD) Language deficit SLP code F80.2 (no audiologist input), Mixed receptive-expressive language disorder
Billing (CPT, Procedure Codes) 92572 SSW 92620 Eval of central auditory function- One hour eval with report 92621 Each additional 15 minutes 92626 Eval of auditory rehab status, speech in noise- one hour 92627 Each additional 15 minutes 92700 Unspecified 99366 Medical team conference, pt and min 3 providers, 30+ mints 99368 Medical team conference, no pt, min 3 providers, 30+ mints
Pricing How to develop your pricing for CAPD Test time Report time Break even rate/hour Will fees cover follow up meetings, phone calls, email IEP presence by phone or in person( extra) Subject matter expertise Bundle vs. Unbundle pricing Evaluation with formal report or no report Meeting with parents, school, or other therapists
Further Learning Auditory Processing Disorder- Assessment; Management, and treatment. Donna Geffner and Deborah Ross-Swain Handbook of Clinical Audiology; Jack Katz, Larry Medwetsky, Robert Burkard, and Linda Hood Therapy for Auditory Processing Disorders; Jack Katz IGAPS Pathways Mentor
Questions Thank you for your attention, and GOOD LUCK