The following answers regarding ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) are based on general coding principles and best practices as well as guidance from the Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS). Audiologists and speech-language pathologists (SLPs) are responsible for verifying coding and billing policies with their specific payers.
There are no ICD-10-CM codes to reflect a normal result. Instead, the signs and symptoms, chief complaint, or reason for the encounter should be reported as the primary diagnosis. List any additional codes that describe coexisting conditions. An evaluation to "rule out" a condition is not recognized as a coding convention and should not be used.
Generally, audiologists and SLPs should use the ICD-10-CM diagnosis code for the speech, language, swallowing, vestibular, and/or hearing disorder that they are evaluating or treating (i.e., primary or treating diagnosis) as their first-listed diagnosis. The second-listed diagnosis—sometimes referred to as the secondary or medical diagnosis—is the medical diagnosis that is causing or contributing to the speech, language, swallowing, vestibular, and/or hearing disorder. Twelve slots are available on the CMS-1500 claim form [PDF] to accommodate the need for multiple diagnosis codes.
You need a secondary diagnosis for medically or neurologically based speech, language, swallowing, vestibular, and/or hearing disorders when you have medical evidence of a problem.
This is a coding convention, but if your payer or facility requests that you list the medical diagnosis as the first-listed diagnosis, and the speech, language, swallowing, vestibular, and/or hearing diagnosis as the second-listed diagnosis, then you should follow that payer’s or facility’s guidance.
Some codes may require different sequencing based on additional notes in the ICD-10-CM code list. These variations in sequencing will be identified very clearly at both the etiology ICD-10-CM code and the ICD-10-CM code that identifies the manifestation. For example, if an SLP assigns a diagnosis of dysphagia from the R13.1 series, the accompanying "code first" note directs the SLP to first list a separate code in the I69 series (in this case, dysphagia following cerebrovascular disease), when appropriate. Conversely, the I69 series is accompanied by a "use additional" note instructing the SLP to identify the type of dysphagia in the R13.1 series, if known.
Excludes1 indicates that the codes excluded should never be used at the same time as the code above the "Excludes1" notation. An "Excludes1" notation is used when two conditions cannot occur together, such as the congenital form of a condition versus an acquired form of the same condition.
For example, code H93.25 for central auditory processing disorder (CAPD) has an "Excludes1" note that prevents clinicians from coding it with F80.2 for mixed receptive-expressive language disorder.
Excludes2 indicates codes that may be listed together because the conditions may occur together, even if they are unrelated. When an "Excludes2" notation appears under a code, it is acceptable to use both the code and the excluded code together.
Codes designated as "unspecified" indicate that that there is insufficient information in the medical record to assign a more specific code. Codes designated as "other" indicate that sufficient documentation exists to assign a diagnosis, but no code exists for the specific condition.
Audiologists and speech-language pathologists should choose the code(s) that provide the greatest degree of accuracy and completeness (i.e., the highest degree of specificity) which means selecting the diagnosis to the full number of characters available for that category of codes. ICD-10-CM consists of codes with 3, 4, 5, 6, or 7 characters.
An ICD-10-CM code is considered invalid if it has not been coded to the highest degree of specificity. For example, audiologists coding bilateral tinnitus should choose H93.13 (tinnitus, bilateral) rather than H93.1 (tinnitus). Speech-language pathologists coding oral phase dysphagia should code R13.11 (dysphagia, oral phase) rather than R13.1 (dysphagia).
Generally, codes with 3 characters are listed in ICD-10-CM as headers for categories that are further subdivided into more specific codes. However, a 3-character code should be used if the the category is not further subdivided. For example, G35 (multiple sclerosis) should be coded with only 3 characters because there are not more specific codes available.
Use ICD-10-CM code H93.25 for the diagnosis of CAPD. CAPD coding for SLPs will differ.
Audiologists can report two of the following codes to show a different type of hearing loss in each ear, as appropriate:
The most commonly accepted option is to use a hearing loss code, such as H91.90 (unspecified hearing loss, unspecified ear) or one of the codes in the H91.8X series for "other specified hearing loss." Another option is to use P09.6 (abnormal findings on neonatal screening for neonatal hearing loss) for an initial neonatal screen on an infant 28 days old or younger.
Some audiologists have also been successful using "Z" codes."Z" codes represent "factors influencing health status and contact with health services" within the ICD-10-CM code set. They can be used to represent those times when a patient is seen for reasons other than a disease or injury, such as a hearing screening. However, acceptance of these codes varies widely across the health care industry. Some audiologists have reported that the following Z codes have been submitted on claims with varying success. Again, check with payers before submitting a claim.
The official ICD-10-CM guidelines provide detailed information on the appropriate use of "Z" codes.
Medically-based speech, language, or swallowing problems, such as those related to cleft palate and cerebral palsy, are coded typically in the R00–R99 series of codes. For example, the code for oral phase dysphagia is R13.11. The code for dysarthria of speech (not related to a cerebrovascular accident) is R47.1, which may be descriptive of the speech of a child who has cerebral palsy. For a child with language deficits related to an organic or medical condition, code R48.8 (other symbolic dysfunctions) is often used by SLPs to describe the deficit. When there is an underlying medical condition contributing to the speech or language deficit, this information should also be included on the claim.
For example, for a child with no related medical condition but who has speech-language deficits, use code F80.2, mixed receptive-expressive language disorder.
There are additional codes in each of these code series.
The diagnosis code for apraxia is R48.2. Generally, codes in the R00-R99 series are used for organic disorders. SLPs are able to diagnose apraxia, and, as such, R48.2 is one of the few codes in the "R" series of codes that can be assigned by an SLP without the patient having a secondary medical condition. However, neurological information supporting use of this code/diagnosis may be useful for obtaining health plan coverage. You should be able to answer the following question: How is this child's verbal apraxia different from an articulation disorder?
The SLP reports as the first-listed diagnosis what the SLP treats—that is, the speech-language disorder, such as R48.8 (other symbolic dysfunction), which captures organic-based language deficits, including pragmatic disorders. The autism diagnosis F84.0 is the secondary diagnosis.
The code for Asperger’s syndrome is F84.5.
If a diagnosis of CAPD has not been established by an audiologist, an SLP evaluating auditory processing abilities would code a language deficit using F80.2 (mixed receptive-expressive language disorder, developmental). If the patient has a CAPD evaluation performed by an audiologist who has assigned H93.25, the SLP evaluating AP skills might assign R48.8 to capture the language deficits as the first-listed diagnosis (i.e., primary or treating diagnosis) and H93.25 as the second-listed diagnosis (i.e., secondary or medical diagnosis) that supports R48.8.
There is an Excludes1 note on the R47 family (e.g, dysarthria) indicating that clinicians should not code anything in the R47 family with F84.0 (autism). ASHA believes that this guidance in incongruous with other guidance from the National Center for Health Statistics (NCHS), which tells us to use, for example, the R48 series of codes with an autism diagnosis.
We have reached out to NCHS with our concerns, but until we have gotten word on any correction, we advise clinicians to use F80.0 (phonological disorder), along with the autism diagnosis. Though this is contrary to ASHA's standard guidance, because of this coding issue, this is the only option for clinicians until the problem is fixed.