New codes in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), include important changes for speech-language pathology diagnoses related to fluency disorders and cognitive communication.
The changes appear in 2010 ICD-9-CM addenda that become effective Oct. 1, 2010.
The new fluency codes follow extensive lobbying by ASHA (The ASHA Leader, Nov. 25, 2008). The fluency proposal was first presented at the ICD-9-CM Coordination and Maintenance Committee meeting in September 2008 and a revised proposal was presented at the September 2009 meeting (details about the presentations are available at CMS's web site).
Following negotiations on the best placement of the fluency codes, the final revised proposal was presented in March 2010; it recommended additions and revisions to the ICD-9-CM to "better capture the nature and description of fluency disorders."
ASHA presented the final recommendations for the fluency coding revision in collaboration with the American Psychiatric Association. Nan Bernstein Ratner led the effort with support from the ASHA Health Care Economics Committee. The addenda include the following changes:
- 307.0—Under the new regulations, ICD-9-CM 307.0 will no longer be used as the default code for stuttering. Instead, 307.0 will be used to describe adult-onset fluency disorder not caused by stuttering that arises from other well-described organic conditions, such as stroke or Parkinson's disease. In effect, the 307.0 will be used to identify stuttering that may be "psychogenic" in origin.
- 315.35—A new code, 315.35, will be used to report childhood-onset fluency disorder, regardless of the current age of the client. The new code will become the default code for a disorder related to fluency. The addenda indicate that the code should be used for cluttering, fluency disorder, and stammering. ASHA will offer guidance to help providers and families seek coverage if carriers inappropriately exclude coverage in response to this code (as they sometimes respond to other conditions coded in the 315 series).
- 438.14—A revised code, 438.14, is already available for fluency disorder or stuttering due to late effect of cerebrovascular accident.
- 784.5—A new code, 784.5 (other speech disturbance), will be added to the "Ill-Defined Conditions" chapter under 784, symptoms involving head and neck.
- 784.52—A new code, 784.52, will be in place for "fluency disorder in conditions classified elsewhere" under "other speech disturbance." It will exclude 307.0, 315.35, and 438.14. This code should be used when stuttering appears as a symptom of another condition, such as following closed-head injury or as part of the symptoms of Parkinson's disease; the fluency disorder is not a pre-existing condition, but rather is a symptom of another condition also being coded as the major diagnosis.
For additional fluency revisions, see Table 1 [PDF].
As part of their continuing efforts to improve the coding of intracranial injuries and associated symptoms, the U.S. Departments of Defense (DoD) and Veterans Affairs (VA) proposed a new diagnostic subcategory for signs and symptoms involving cognitive state (799.5x). For the first time these codes capture a spectrum of cognitive disorders associated with conditions—such as traumatic brain injury (TBI)—classified elsewhere.
New codes include:
- 799.51, Attention or concentration deficit
- 799.52, Cognitive communication deficit
- 799.53, Visuospatial deficit
- 799.54, Psychomotor deficit
- 799.55, Frontal lobe and executive function deficit
- 799.59, Other signs and symptoms involving cognition
These codes may be used to identify cognitive deficits associated with any other condition. Certain exclusions apply (e.g., cognitive deficits associated with cerebrovascular disease).
The new subcategory does not include a new code for memory deficits because several codes already exist for this purpose. Rather than create confusion by creating a new memory code, the National Center for Health Statistics clarified that 780.93 will be used for memory deficits not elsewhere classified.
DoD and VA collaborated with ASHA on code proposals and supported ASHA's proposal on adult onset fluency disorders. Fluency disorders due to TBI will be included in the new adult-onset fluency disorder code. ASHA member Kyle Dennis was chiefly responsible for developing the TBI symptom proposals on behalf of DoD and VA.
The code changes, along with those activated last year for signs and symptoms involving emotional state, provide more accurate classification of symptoms associated with TBI without having to use mental disorder codes. These codes will be used to track TBI symptoms among military service members and veterans who have suffered TBI, which is widely regarded as the signature injury of the current wars in Iraq and Afghanistan.
Because large numbers of military service members and veterans are likely to seek care for cognitive, memory, and executive function deficits, ASHA members should become familiar with these code changes and implement them in their practices. These codes will be used by DoD, VA, the Centers for Disease Control and Prevention, the National Institutes of Health, and other agencies to track the prevalence of TBI-associated symptoms, identify previously unknown symptom clusters and syndromes, and track the long-term costs of TBI. For this tracking to be most effective, audiologists and speech-language pathologists need to code TBI symptoms accurately. Guidance is available at the reimbursement section of ASHA's web site.