Running a speech therapy clinic is both art and science. You must put patients at ease, motivate them to participate actively in their treatment, and ensure that staff are empowered to provide a positive patient experience. At the same time, you must stay at the top of your profession and ensure your business is profitable so you can continue to serve patients effectively. This balance isn’t easy, especially since accurate medical billing is part of running a profitable practice. You need to ensure your claims are accepted in a timely manner in order to keep cash flow where it should be.
Essential to increasing your claim acceptance rate is understanding ICD-10 codes for speech therapy. In this post, we look at what you need to know about ICD-10 codes and the codes you’ll use most often in your speech therapy practice.
What are ICD-10 Diagnosis Codes?
ICD-10 (International Classification of Diseases, Tenth Revision) is a set of codes published by the World Health Organization (WHO) that are used to represent medical diagnoses. An ICD-10 code is assigned to every disease, infection, injury, disorder, and symptom. These codes are used for a variety of purposes, from tracking epidemics across the world to medical billing. (Note that WHO recently released ICD-11, but it won’t go into effect until 2022.)
Most Common ICD-10 Diagnosis Codes for Speech Therapy
Due to the nature of ICD-10 codes, there are thousands of diagnosis codes — over 69,000. While it’s important for your medical biller to have a thorough knowledge of the codes that apply to speech therapy, you’ll want to become familiar with the most commonly-used codes. Here are ten codes most frequently used by speech therapists, including their descriptions.
1. F80.0 — Phonological disorder
Code F80.0 describes phonological disorder. Patients with this disorder have a problem making the correct sounds for a letter or a word. Examples include:
Leaving out a sound (saying “pay” instead of “play”)
Swapping one sound for another (saying “fog” instead of “dog”)
Adding a sound (saying “place” instead of “pace”)
Phonological disorder is diagnosed by reviewing symptoms and medical history and ruling out vision and hearing issues through testing.
2. F80.2 — Mixed receptive-expressive language disorder
Mixed Receptive-Expressive Language Disorder, described by code F80.2, is displayed when a patient has difficulty in expressing their feelings and thoughts and understanding what others are saying. Young children are typically most affected, though it can impact adults as a result of a stroke, seizures, or a traumatic brain injury. Symptoms may vary between patients and include:
Inability to communicate wants, needs, or thoughts
Confusion with spatial terms and abstract nouns
Ability to pronounce words clearly, but inability to use words appropriately in a sentence or use the correct tense or grammar
Inability to understand what is being said
Repeating a few key phrases or terms without varying from them
3. F80.81 — Childhood onset fluency disorder
Code F80.81 represents childhood onset fluency disorder, which is characterized by the patient cluttering and stuttering. Symptoms include but are not limited to:
Repetition of syllables or sounds
Pausing in the middle of a word
Prolonged pauses during speech
Vocalizing consonants and vowels in a prolonged manner
Broken words (e.g., pauses within a word)
Substituting words to avoid problematic words
Physical tension when pronouncing words (which as clenching fists)
4. R13.11 — Dysphagia, oral phase
Code R13.11 describes difficulty swallowing. Dysphagia is when a patient’s food or liquids take more time and effort to move from their mouth to their stomach. Swallowing may be associated with pain or may not be possible. Dysphagia is more common in older adults. Symptoms include:
Odynophagia (pain while swallowing)
Frequent heartburn and/or having stomach acid or food backing up into the throat
Inability to swallow
Unexpected weight loss
Gagging or coughing while swallowing
The sensation of food getting caught in the throat or chest
Note that this code should not be used as a primary diagnosis when a related definitive diagnosis was established.
5. R13.12 — Dysphagia, oropharyngeal phase
Oropharyngeal dysphagia is when a patient has trouble swallowing and the issue involves the patient’s mouth and pharynx (the part of the throat behind the mouth). Symptoms are generally similar to those for the oral phase of dysphagia and include:
Coughing, choking, and drooling
Reporting the feeling that food is stuck in the throat
Issues with starting to swallow to move food and liquid from the mouth to the back of the throat (liquid may be harder than food)
Problems getting enough nutrition or fluids
You may see the following causes of oropharyngeal dysphagia in the patient’s records:
Zenker’s diverticulum, or pharyngoesophageal diverticulum, where a small pouch forms and collects food particles in the throat
Neurological damage from a stroke, or brain or spinal cord injury
Neurological disorders like muscular dystrophy, Parkinson’s disease, and multiple sclerosis
Cancer including certain cancers centered in the mouth or throat and cancer treatments like radiation
6. R48.8 — Other symbolic dysfunctions
Code R48.8 is used to capture language deficits as the first-listed diagnosis. It should only be used if an Audiologist has assigned the H93.25 code (Central auditory processing disorder (CAPD)) to a patient. If a diagnosis of CAPD has not been established by an Audiologist, use code F80.2 (mixed receptive-expressive language disorder, developmental) for an auditory processing deficit.
7. R47.1 — Dysarthria and anarthria
Dysarthria, described by code R47.1, is a speech deficit caused by issues with controlling the muscles involved with speech production. Anarthria is the most severe form, which results in the inability to produce articulate and clear speech. Vowel sounds, in particular, may be distorted. Symptoms include slurred speech and:
Limited movement of the lip, jaw, and tongue
Abnormal vocal pitch
Slowed rate of speech
Abnormal rhythm to speech
Nasal or congested-sounding speech
Inability to speak loudly
Hoarseness or breathiness quality to speech
8. R48.2 — Apraxia
Apraxia of speech, identified by code R48.2, is a neurological condition where the patient finds it difficult or impossible to move their mouth and tongue to speak. It should not be confused with aphasia, where the person’s inability to speak is due to a problem with understanding or using the words. Instead, apraxia describes difficulty initiating and performing the movements needed to speak, despite no weakness in the required muscles. Common symptoms include:
Difficulty saying complex or long words
Speech inconsistencies (where the patient can say a word or make a sound at some times but not others)
Repetitive attempts at pronunciation
Stringing syllables together in the correct order to make words is difficult or impossible
Seeming to have challenges with making words
Distorting of vowel sounds
Incorrect stressing certain sounds or words or incorrect inflections
Excessive use of nonverbal forms of communication
Leaving off consonants at the beginnings and ends of words
9. R63.3 — Feeding difficulties
Code R63.3 is used for a diagnosis of feeding difficulties and may be used for difficulty clearing the mouth of residue, difficulty establishing feeding, dependency for feeding, chewing finding, and difficulty chewing. This code can be used for developmental delays and sensory food aversions. It excludes feeding problems for newborns and eating disorders.
10. F80.4 — Speech and language development delay due to hearing loss
Code F80.4 is used for a developmental delay caused by hearing loss in children. Common symptoms include:
Delays in vocabulary development, including a delay with abstract words and function words like “the” or “a”
Challenge in understanding words with multiple meanings
Tendency to use shorter and simpler sentences
Speech that is difficult to understand
Speaking too loudly or quietly or mumbling
Difficulty with academic achievement, particularly mathematics and reading
Falling behind in school by one to four grades on average for children
Appearing to isolate themselves, especially in social situations
While there are certainly more ICD-10 codes that you’ll use in your speech therapy practice, knowing the ten we’ve described here is a good start. Most speech therapists tend to encounter patients with these diagnoses frequently.
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