Code Revisions Would Benefit Clinicians Recommended revisions and additions to diagnostic codes for stuttering and resonance would benefit clinicians by allowing them more precision in treating patients, say ASHA members Nan Bernstein Ratner and Dee Adams Nikjeh. The two presented recommendations on behalf of the association Sept. 25 to the International Classification of Diseases, 9th ... Policy Analysis
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Policy Analysis  |   November 01, 2008
Code Revisions Would Benefit Clinicians
Author Notes
  • Steven C White, PhD, CCC-A, director of health care economics and advocacy, can be reached at swhite@asha.org.
    Steven C White, PhD, CCC-A, director of health care economics and advocacy, can be reached at swhite@asha.org.×
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Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   November 01, 2008
Code Revisions Would Benefit Clinicians
The ASHA Leader, November 2008, Vol. 13, 1-45. doi:10.1044/leader.PA.13162008.1
The ASHA Leader, November 2008, Vol. 13, 1-45. doi:10.1044/leader.PA.13162008.1
Recommended revisions and additions to diagnostic codes for stuttering and resonance would benefit clinicians by allowing them more precision in treating patients, say ASHA members Nan Bernstein Ratner and Dee Adams Nikjeh. The two presented recommendations on behalf of the association Sept. 25 to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). The federal Health Insurance Portability and Accountability Act requires the use of ICD-9-CM codes in reporting diagnoses and disorders.
The ASHA Health Care Economics Committee coordinated the presentations developed by Special Interest Division 4, Fluency and Fluency Disorders, and Division 3, Voice and Voice Disorders. Nikjeh described how dysphonia, hoarseness, hypernasality, hyponasality, and change in voice are grouped together in code 784.49. However, dysphonia, hypernasality, and hyponasality are distinct manifestations and should not be included as voice disturbances, she explained. The ASHA divisions recommended revising 784.4 to read “voice and resonance disorders” rather than the current “voice disturbance.” New diagnostic codes would be created for dysphonia, hypernasality, and hyponasality.
The current ICD-9-CM includes one diagnostic code for stuttering. Ratner discussed the rationale for adding codes that clarify and augment the nature and description of a variety of fluency disorders, including stuttering. In an overview of the problems associated with an exclusive diagnosis for stuttering, she cited supporting references including one from the National Institutes of Health’s Web site.
The most typical presentation of stuttering is one of onset between the ages of 2 and 4, with a mix of disfluency behaviors that include sound and syllable repetitions, inappropriate prolongations of sound segments, and blocks, she said. Ratner noted that research has failed to find evidence of primary mental disorder in this population, although some individuals who stutter may develop maladaptive responses to their speech impairment and to listener reactions. The current placement of stuttering in section 307 of the mental disorders chapter has long created dissatisfaction among speech-language pathologists as well as individuals who stutter and their families, she said. The classification perpetuates long-held but unsubstantiated beliefs that stuttering is a manifestation of an underlying mental disorder.
The ASHA proposal recommends revising the current code descriptor to “psychogenic stuttering” in the mental disorders chapter, and adding two more codes. The first code would cover “stuttering with onset in childhood” in the chapter on signs, symptoms, and ill-defined conditions; the second code would cover fluency disorder as a late effect of cerebrovascular disease in the circulatory system chapter. The American Academy of Neurology previously reviewed this proposal and did not object. The Stuttering Foundation of America and the National Stuttering Association also endorsed the proposal.
Only the American Psychiatric Institute for Research and Education of the American Psychiatric Association opposed the change. Its concern seemed to be about research on stuttering that is consistent with its current ICD placement. SLPs, however, conduct the vast majority of research, and a revision would better partition the types of fluency disorders, Ratner said.
An American Academy of Pediatrics representative concurred with ASHA’s recommendation, saying that he believed AAP would strongly endorse the proposal. Moving the primary diagnosis to the chapter on signs, symptoms, and ill-defined conditions was appropriate, he said, because other diagnoses and disorders have been transferred without problem.
ASHA member Kyle Dennis also presented at the meeting on behalf of the U.S. Department of Veterans Affairs. He offered extensive proposals for six new codes related to traumatic brain injury and related topics. Among them was a new subcategory for “cognitive symptom codes including language or speech deficit.” He also recommended another relevant code proposal for the V Codes chapter—Supplementary Classification of Factors Influencing Health Status and Contact with Health Services. In the revision, V57.3 would refer to an “encounter with speech-language pathologist” rather than the current “encounter for speech therapy.”
The meeting took place at the Center for Medicaid and Medicare Services’ central office in Baltimore. The deadline for receipt of public comments on the proposed code revisions is Dec. 5. The final version of the revised ICD-9-CM codes will be implemented Oct. 1, 2009. Under a proposed rule by the U.S. Department of Health and Human Services, the entire ICD-9-CM will be replaced by two new code sets, effective Oct. 1, 2011 (see The ASHA Leader, Sept. 23).
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November 2008
Volume 13, Issue 16