Ready to Code and Bill ICD-10? The new diagnosis codes go live in just two months. Use these hints to code correctly—and avoid claim denials. Make It Work
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Make It Work  |   August 01, 2015
Ready to Code and Bill ICD-10?
Author Notes
  • Neela Swanson is director of ASHA health care coding policy. nswanson@asha.org
    Neela Swanson is director of ASHA health care coding policy. nswanson@asha.org×
  • Janet McCarty, MEd, CCC-SLP, is director of ASHA private health plan reimbursement. jmccarty@asha.org
    Janet McCarty, MEd, CCC-SLP, is director of ASHA private health plan reimbursement. jmccarty@asha.org×
Article Information
Speech, Voice & Prosodic Disorders / Hearing Disorders / Swallowing, Dysphagia & Feeding Disorders / Special Populations / Genetic & Congenital Disorders / Early Identification & Intervention / Healthcare Settings / Practice Management / ASHA News & Member Stories / Language Disorders / Make It Work
Make It Work   |   August 01, 2015
Ready to Code and Bill ICD-10?
The ASHA Leader, August 2015, Vol. 20, 36-37. doi:10.1044/leader.MIW.20082015.36
The ASHA Leader, August 2015, Vol. 20, 36-37. doi:10.1044/leader.MIW.20082015.36
On Oct. 1, we switch from the ninth revision of the International Classification of Diseases (ICD-9) to the tenth revision (ICD-10). It’s time for clinicians in health care settings—and school-based clinicians with Medicaid-eligible students—to get familiar with how to use the new system.
Here are some practical reminders and tips to get you ready.
Understand the difference between ICD-10-CM and ICD-10-PCS. The new ICD-10 system includes the ICD-10-CM (clinical modification) and ICD-10-PCS (procedure coding system). ICD-10-CM is the diagnosis classification system used in all health care settings in the United States. ICD-10-PCS is the procedure coding system used in the U.S. for classifying procedures provided in hospital inpatient settings only.
ICD-10-PCS codes related to audiology and speech-language pathology are found in the “F” section and include categories such as “Physical Rehabilitation and Diagnostic Audiology, Rehabilitation, Speech Assessment” and “Physical Rehabilitation and Diagnostic Audiology, Rehabilitation, Hearing Treatment.”
Clinicians in outpatient settings will use only ICD-10-CM. Audiologists and speech-language pathologists in inpatient hospitals will also use ICD-10-CM for diagnosis coding, but should consult their administrators or billing staff for relevant ICD-10-PCS procedure codes. ASHA’s resources on ICD-10 focus mostly on the clinical modification, ICD-10-CM.
Note that ICD-10-PCS does not replace the Current Procedural Terminology (CPT ® American Medical Association) system to describe procedures and services.
Code to the highest degree of specificity. ICD-10 codes are often more specific than in ICD-9. The more specific the diagnosis, the more characters in the code—and you must use the code with the most characters available in that diagnosis.
For example, an SLP evaluating and treating a patient for dysphagia should not use R13.1 (dysphagia) because more descriptive codes are available, ranging from R13.10 to R13.19, to describe different types of dysphagia (oral phase, oropharyngeal phase), . If your code is not specific enough, your claim will be returned.

ICD-10 codes are often more specific than in ICD-9. The more specific the diagnosis, the more characters in the code—and you must use the code with the most characters available in that diagnosis.

Know how to code when results are within normal limits. If testing reveals normal results, clinicians should code the chief complaint or the sign(s) or symptom(s) that prompted the evaluation.
For instance, a newborn fails an infant hearing screening and is referred for follow-up testing, which results in normal findings. In this situation, one of the H91.9 codes for unspecified hearing loss may be appropriate.
Appropriately assign primary and secondary diagnosis codes. Your diagnosis—the disorder you are evaluating and/or treating—is considered the primary diagnosis and should be listed first on the claim form. Any other supporting or medical diagnoses are considered secondary and should be listed after your primary diagnosis.
For example, H90.0 would be an audiologist’s primary diagnosis for a child with bilateral conductive hearing loss. The secondary ICD-10-CM code would be H65.23, for the medical diagnosis of bilateral chronic serous otitis media.
Read the whole category, including the notes. Before you choose a code, review all the possibilities within the category. Some ICD-10-CM codes may include additional guidance notes for appropriate use.
For instance, if you are assigning a diagnosis of dysphagia from the R13.1 series, the accompanying “code first” note directs you to first list a separate code in the I69 series (dysphagia following cerebrovascular disease), when appropriate.
Some other important notes to be aware of: An “excludes1” note indicates codes that should never be listed together because the two conditions cannot occur together, and an “excludes2” note indicates codes that may be listed together because the conditions may occur together, even if they are unrelated.
For example, the H93.25 code for central auditory processing disorder has an “excludes1” note that prevents clinicians from coding it with F80.2 for mixed receptive-expressive language disorder.
Review medical diagnoses for existing patients. Assigning the ICD-10-CM code for the communication, swallowing or hearing disorder is your primary responsibility, but you should also be aware of longstanding ICD-9-CM medical diagnoses for your patients that may require additional information when transitioning to ICD-10.
For example, the ICD-9-CM code for Down syndrome (758.0) includes several more specific codes in ICD-10-CM:
  • Q90.0 (Down syndrome, Trisomy 21, nonmosaicism)

  • Q90.1 (Down syndrome, Trisomy 21, mosaicism)

  • Q90.2 (Down syndrome, Trisomy 21, translocation)

  • Q90.9 (Down syndrome, unspecified)

If the specific type is not stated in the medical record, you may need to coordinate with the patient’s physician to ensure the appropriate medical diagnosis is reported.
Make sure your documentation matches the diagnosis. Your documentation must support the ICD-10-CM assignment. CPT codes for the services provided should be consistent with and support the diagnosis you specified. This tip may sound simple, but it is key to your billing success.
Be prepared for hiccups. Remember, the switch to ICD-10 is a big change for the entire industry. Even with these practical tips and ASHA resources that should ease your transition, there will be bumps along the way. Be prepared, be patient and get help from ASHA if you need it.
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August 2015
Volume 20, Issue 8