Coding Normal Results Frequently Asked Questions
Many third party payers will not reimburse for audiology or speech-language pathology services when the results of an evaluation are reported simply as within normal limits. These questions and answers describe how to use International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes when normal results are found and provides examples for major communication and related complaints that prompt the referral.
What if a speech-language pathologist or audiologist performs diagnostic testing that produces a normal result?
The signs and symptoms, chief complaint, or reason(s) for the encounter should be reported as the primary diagnosis. The audiologist or speech-language pathologist should also use additional codes that describe any co-existing or chronic conditions. Do not code conditions that were previously treated and no longer exist, although history codes may be used as secondary codes if the historical condition or family history has an impact on current care or influences treatment.
Are any instructions available on how to code when the results of an audiology or a speech-language assessment are normal?
The ICD-9-CM Official Guidelines for Coding and Reporting became effective on October 1, 2003. A description of how to report an uncertain diagnosis is found on page 48: "If the diagnosis documented at the time of discharge is qualified as 'probable', 'suspected', 'likely', 'questionable', 'possible', or 'still to be ruled out', code the condition as if it existed or was established. The bases for these guidelines are the diagnostic workup, arrangements for further workup or observation, and initial therapeutic approach that correspond most closely with the established diagnosis." The Official Guidelines are available on the Centers for Disease Control and Prevention Web site [PDF].
Has Medicare issued any instructions?
The Centers for Medicare & Medicaid Services (CMS) issued ICD-9-CM Coding Guidelines for Diagnostic Tests in a Program Memorandum dated September 26, 2001 (Transmittal AB-01-144, Change Request 1724). This PM (now §10.1 of Chapter 23 of Medicare Claims Manual) directs practitioners to report diagnoses based on test results. In Section B., Instructions to Determine the Reason for the Test, CMS states that the Balanced Budget Act (BBA) required referring physicians to provide diagnostic information to the testing entity at the time the test is ordered. All diagnostic tests paid by CMS must be ordered by the physician who is treating the beneficiary. If the physician does not provide diagnostic information, and is unavailable to provide such information, it is appropriate to obtain the information directly from the patient or the patient's medical record. However, an attempt should be made to confirm any information obtained by the patient by contacting the referring physician.
Can you provide examples of signs and symptoms for voice disorders?
| Complaint |
ICD-9-CM Code |
| Hoarse/breathy/harsh voice |
784.42 Dysphonia, hoarseness |
| High pitch; low pitch |
784.49 Other voice and resonance disorders, change in voice |
| Problems with voice production |
784.40 Voice and resonance disorder, unspecified OR
784.41 Aphonia, loss of voice |
| Nasal/denasal voice |
784.43 Hypernasality
784.44 Hyponasality |
Can you provide examples of signs and symptoms for swallowing disorders?
| Complaint |
ICD-9-CM Code |
| History of aspiration or aspiration pneumonia |
507.0 Pneumonitis due to inhalation of food or vomit |
| Problems with swallowing, oral phase |
787.21 Dysphagia, oral phase |
| Problems with swallowing, pharyngeal phase |
787.23 Dysphagia, pharyngeal phase |
| Cough |
786.2 Cough |
| Esophageal reflux |
530.81 |
| Facial weakness |
781.94 Facial weakness |
| Feeding difficulty |
783.3 Feeding difficulties and mismanagement |
Can you provide examples of signs or symptoms associated with aphasia of other expressive/receptive language disorders?
| Complaint |
ICD-9-CM Code |
| Difficulty speaking |
784.51 Dysarthria |
| Unintelligible speech |
784.51 |
| Difficulty understanding spoken language |
784.3 Aphasia |
| Difficulty understanding written language |
784.61 Alexia and dyslexia: Alexia (with agraphia) |
| Difficulty reading/writing |
784.61 |
| Difficulty remembering words |
784.3 or 310.8 Mild memory disturbance due to organic brain damage |
| Difficulty expressing thoughts |
784.3 or 310.8 |
| Difficulty processing information |
784.3 |
| Difficulty following directions |
784.3 |
| Difficulty remembering tasks |
310.1 or 310.8 |
| Cognitive deficits |
784.60 Symbolic dysfunction, unspecified |
| Word retrieval difficulties |
784.3 |
| Difficulty with word meaning |
784.3 |
Do you have other examples of signs and symptoms that will be useful to audiologists?
| Complaint |
ICD-9-CM Code |
| Unspecified hearing loss |
389.9 Unspecified hearing loss |
| Tinnitus |
388.30 Tinnitus |
| Vertigo |
780.4 Vertigo |
| Dizziness |
780.4 Dizziness and giddiness |
| Ear pain |
388.70 Otalgia, unspecified |
| Aural fullness |
388.8 Other disorders of the ear |
| Discharging ear |
388.60 Otorrhea, unspecified |
| Delayed speech and language development |
315.31 Expressive language disorder OR
783.42 Late talker |
| Articulation errors |
315.39 Developmental articulation disorder OR
783.42 |
| Unintelligible speech |
315. 39 or 783.42 |
| Difficulty hearing in noise |
389.9 |
| Acoustic trauma |
388.11 Acoustic trauma (explosive) to ear |
| Facial weakness |
781.94 Facial weakness, Facial droop |
| Facial numbness |
782.0 Disturbance of skin sensation |
| History of tympanic membrane perforation |
384.20 Perforation of the tympanic membrane, unspecified |
| History of noise exposure |
388.10 Noice effects on inner ear, unspecified |
Where can I obtain a list of the ICD-9-CM codes for audiologists and speech-language pathologists?
You may access a list of ICD-9-CM codes online [PDF]. For comprehensive speech and hearing related ICD-9 and CPT coding information, we recommend the Health Plan Coding and Claims Guide. The complete ICD-9-CM is available in medical libraries, medical center billing offices, or may be purchased online.
Questions about coding can be sent to reimbursement@asha.org.
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