February 1, 2013 Departments

Policy Analysis: Autism and Cognitive Communication Codes Don’t Go Together

Speech-language pathologists providing treatment to patients with autism may not use the diagnosis code for cognitive communication deficit (799.52) in their documentation and billing, according to guidance from the American Hospital Association.

The AHA information comes in response to ASHA's request for clarification. After a series of cognitive deficit codes was added to the International Classification of Diseases-Ninth Revision in October 2010, ASHA asked the AHA—the official U.S. clearinghouse on medical coding for ICD-9—to clarify how SLPs should use code 799.52, cognitive communication deficit, for patients with autism.

The AHA, in a direct response to ASHA (see sidebar on p. 23) and in additional information (AHA Coding Clinic, Third Quarter 2012, pp. 19–21), indicated that SLPs may not use cognitive communication deficit as an additional code for patients with autism because the diagnosis is "integral to autism."

Therefore, SLPs providing speech-language treatment for patients with autism should continue to use the typical coding protocol—that is, list the speech-language disorder as the principal or primary diagnosis, and other known medical conditions as secondary diagnoses. For example, an SLP working with a child with autism might list 784.69 (symbolic dysfunction) as the primary diagnosis and 299.00 (autism) as the secondary diagnosis.

In earlier guidance (AHA Coding Clinic, Fourth Quarter 2010, pp. 95–97), the AHA stated that the 799.5x codes for cognitive impairment—such as problems with memory, concentration, attention, communication and executive function—are intended to be used as supplementary codes when the cause of the deficit is known and they are not integral to the condition in question.

However, if the cause of the deficit is unknown, the clinician may use a cognitive impairment code as the primary diagnosis. As an example, AHA cites a 2-year-old child who is a delayed talker with no definitive diagnosis and who has been referred to an SLP for evaluation. AHA advises the SLP to assign code 799.52 (cognitive communication deficit) as the primary diagnosis because the underlying condition is not known. If the child receives a diagnosis of autism and is seen for a speech-language disorder, then the appropriate speech-language diagnosis would be primary—such as 784.69, symbolic dysfunction—and 299.00 (autism) would be listed as the secondary diagnosis.

AHA gives a second example of cognitive communication coding: A 30-year-old patient is evaluated by an SLP for cognitive problems involving impaired executive functioning, communication difficulties, and concentration and attention impairments from a brain injury sustained during military combat several years previous. The speech-language session is for cognitive communicative deficits due to traumatic brain injury—but which diagnosis should be listed first?

According to AHA, the clinician should assign 799.52 (cognitive communication deficit), 799.51 (attention or concentration deficit) and 799.55 (frontal lobe and executive function deficit) to describe the cognitive disabilities responsible for the treatment. Codes 907.0 (late effect of intracranial injury without mention of skull fracture) and E999.0 (late effects of injury due to war operations and terrorism) should be assigned as additional codes. Acute TBI would not be coded because the cognitive deficits are the residual or late effects of the intracranial injury.

Janet McCarty, MEd, CCC-SLP, is ASHA private health plans advisor. jmccarty@asha.org

cite as: McCarty, J. (2013, February 01). Policy Analysis: Autism and Cognitive Communication Codes Don’t Go Together. The ASHA Leader.

The Verbatim Explanation

In asking the American Hospital Association for clarification on SLPs' use of cognitive deficit codes for a patient with autism, ASHA posed the following question and included the requested medical record for a real patient: 

A 3-year-old boy was seen on consultation by the early childhood development team at the medical center. The patient has a history of speech-language, cognitive and motor delays as well as difficulties with attention and behavior. He is currently receiving services to address his delays. The evaluation summary indicates autism and generalized developmental delays, and that his behavior and attention difficulties are related to his diagnosis of autism. Can a code in category 799.5x (signs and symptoms involving cognition) be the first listed as the reason for the consultation or should code 299.0x (autistic disorder) be the first listed diagnosis?

AHA responded:

Assign code 299.00, Autistic disorder, current or active state, as the first-listed diagnosis. Codes from category 799.5x, Signs and symptoms involving cognition, may be assigned as additional codes because they provide additional information regarding the type of cognitive impairment. The exception is code 799.52, Cognitive communication deficit, since this is integral to autism. As stated in Coding Clinic, Fourth Quarter 2010, pages 95–97, cognitive impairments, such as problems with memory, concentration, attention, communication and executive function are intended to be used as a supplementary code when the cause of the deficit is known and they are not integral to this condition. Please see Coding Clinic, Third Quarter 2012, pp. 19–21, for further examples.


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