Speech-language pathologists and audiologists have raised a number of questions with ASHA concerning the appropriate use of ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) codes when selecting a diagnosis for a child. The following two questions address common coding issues.
Q: I am seeing a 5-year-old boy who has delayed speech and language development. Which ICD-9-CM code should I use?
An SLP or audiologist may select the most appropriate diagnostic code from those provided here. A section of the ICD-9-CM manual in the Mental Disorders chapter is called "neurotic disorders, personality disorders, and other nonpsychotic mental disorders (300-316)." It may seem like a strange place to find the diagnostic code you need, but this is where it might be located.
ICD-9-CM 315.3 is for developmental speech or language disorders and requires a fifth digit code for reporting. That is, if one uses 315.3 it will be rejected because a more specific diagnosis is required. ICD-9-CM 315.31 is for an expressive language disorder and includes developmental aphasia and word deafness. It excludes acquired aphasia (784.3) and elective mutism (309.83, 313.0, and 313.23).
The next diagnostic code is 315.32 for mixed receptive-expressive language disorder. The revised text of the 2008 ICD-9-CM indicates that this code should be used for central auditory processing disorder, but it excludes an acquired central auditory processing disorder (388.45), a new code.
The third diagnostic code for consideration is 315.34, speech and language developmental delay due to hearing loss. This is a new code as of Oct. 1, 2007, and should be helpful in ensuring that health plans understand that the cause of the speech and language developmental delay is clearly related to a hearing loss.
The last code in the developmental speech or language section is 315.39, other. This general diagnosis includes developmental articulation disorders, dyslalia, and phonological disorders. It excludes lisping and lalling (307.9), and stammering and stuttering (307.0).
One other code of interest is found in the symptoms section of the "Symptoms, Signs and Ill-defined Conditions" chapter. The diagnoses in 785.4, "Lack of expected normal physiological development," all require the fifth digit for an appropriate diagnosis. The third diagnosis code in this category, 783.42, is specifically identified as a pediatric code (age 0–17) that includes late talker and late walker. One might need to consider 783.42 if the developmental codes are inappropriate.
Q: I am an SLP working in a pediatric facility. I notice that there is a V code (57.3) in the ICD-9-CM for "speech therapy." When do I use that code?
V codes are supplemental codes that should be used only when there is no active diagnosis, or when the patient is in rehabilitation for "aftercare." The V code is not appropriate for pediatrics. Insurance companies tend to deny the V code because it is non-specific and is a procedure without a diagnosis. The speech therapy V code is in the V57 area that includes codes for "care involving use of rehabilitation procedures."
According to the ICD-9-CM Official Guidelines for Coding and Reporting:
V codes are "supplementary" and "this classification deals with occasions when circumstances other than a disease or injury classifiable to categories 001-999 (the main part of the ICD) are recorded as 'diagnoses' or 'problems.'" Please note that in most, if not all pediatric practices, there is at least one active diagnosis and thus this would be the code to use in the main part of the ICD-9-CM.
"The V code should be used only as a supplementary code and should not be the one selected for use in primary, single cause tabulations." Again, pediatrics should have at least one other code that would be used.
The description of V57 codes says: "Care involving rehabilitation procedures." Rehabilitation is rarely used in pediatrics. Most of pediatrics is habilitation.
V57 in the "Aftercare" section of the manual also states that "the V code should not be used if treatment is directed at a current, acute disease or injury." An exception is the use of V57.3 as explained below. Virtually all pediatric patients have a current diagnosis. Pediatric facilities tend to provide very little "aftercare."
Based on these guidelines, a SLP in a pediatric practice would be coding incorrectly in most situations with the use of V57.3, because long-term "aftercare" is rarely performed in that setting.
The American Hospital Association Central Office on ICD-9-CM reported to ASHA that one should "sequence first the diagnosis, condition, problem, or other reason for encounter/visit. If the patient's encounter/visit is specifically for speech therapy, assign a code for the condition (i.e. aphasia) responsible for the outpatient services as the principal or first listed diagnosis." The only exception given by ASHA is when the patient is in a comprehensive rehabilitation program and receiving more than speech-language services. In that case, V57.3 would be used.