Answers to Your ICD-10-CM Coding Questions The new code set in place since Oct. 1 has some clinicians revisiting their coding practices. Here are answers to some of the most frequently asked questions. Bottom Line
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Bottom Line  |   January 2016
Answers to Your ICD-10-CM Coding Questions
Author Notes
  • Kate Ogden, MPH, is an ASHA health policy associate. kogden@asha.org
    Kate Ogden, MPH, is an ASHA health policy associate. kogden@asha.org×
  • 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×
  • © 2016 American Speech-Language-Hearing Association
Article Information
Hearing Disorders / Special Populations / Autism Spectrum / Early Identification & Intervention / Practice Management / Language Disorders / Social Communication & Pragmatics Disorders / Bottom Line
Bottom Line   |   January 2016
Answers to Your ICD-10-CM Coding Questions
The ASHA Leader, January 2016, Vol. 21, 30-32. doi:10.1044/leader.BML.21012016.30
The ASHA Leader, January 2016, Vol. 21, 30-32. doi:10.1044/leader.BML.21012016.30
New systems are bound to pose some challenges for users, and the new coding system for diseases and disorders, in place since Oct. 1, is no exception.
All health care providers—including audiologists and speech-language pathologists—must now use the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) to code diseases and disorders. ASHA members brought their questions about the new system to an online chat, “What Are Your ICD-10 Coding and Billing Challenges?” The following questions and answers are based on that chat.
How do I code central auditory processing disorder (CAPD)?
Coding for CAPD differs for audiologists and SLPs.
Audiologists who have diagnosed CAPD should assign H93.25.
SLPs who have a CAPD diagnosis from an audiologist could assign R48.8 (other symbolic dysfunction) after evaluating auditory processing abilities to capture the language deficits as the first-listed diagnosis. The second-listed diagnosis would be H93.25, which supports the use of R48.8. If an audiologist has not assigned H93.25, the SLP should code a language deficit using F80.2 (mixed receptive-expressive language disorder).
How do I appropriately assign ICD-10-CM codes when a patient has hearing loss in both ears?
Unilateral hearing loss codes that include “unrestricted hearing on the contralateral side” are creating a problem for coding different types of hearing loss in each ear. There is a proposal to the National Center for Health Statistics (NCHS) to add new codes for “restricted hearing on the contralateral side.” However, there will be no revisions until October 2016.
In the meantime, there are a couple of options to code different hearing loss in the ears of one patient.
The first option is to use the “unspecified” hearing loss codes (one code for each ear) according to the type:
  • H90.5, Unspecified sensorineural hearing loss

  • H90.8, Mixed conductive and sensorineural hearing loss, unspecified

  • H90.2, Conductive hearing loss, unspecified

There is concern that “unspecified” codes may not be readily accepted by payers, so another option is to use the H91.8X series of codes for “other specified hearing loss.”
Audiologists should use clinical judgment to decide which codes best describe the diagnosis for each circumstance.
Can you discuss the “Z” codes for audiology and when they are appropriate to report for newborn hearing screening? Are “Z” codes likely to get reimbursed?
“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 patient visits 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. Check with payers before submitting a claim. Some audiologists have used the following Z codes with varying success:
  • Z00.110, Newborn check under 8 days old

  • Z00.111, Newborn check 8 to 28 days old

  • Z00.121, Encounter for routine child health examination with abnormal findings

  • Z00.129, Encounter for routine child health examination without abnormal findings

  • Z01.10, Encounter for examination of ears and hearing without abnormal findings

  • Z01.110, Encounter for hearing examination following failed hearing screening

  • Z01.118, Encounter for examination of ears and hearing with other abnormal findings (use additional code to identify abnormal findings)

The official ICD-10-CM guidelines provide detailed information on the appropriate use of “Z” codes.
A more common option for reporting newborn hearing screening is to report the ICD-10-CM code that reflects the reason for the encounter—that is, code based on testing for hearing loss. Possible codes to use include H91.90 (unspecified hearing loss, unspecified ear) or the H91.8X series of codes for “other specified hearing loss,” since a final diagnosis has not been established.
Is there a common code for oral-motor weakness?
Oral-motor weakness is typically captured as part of a speech disorder diagnosis, such as R47.1 (dysarthria) or F80.0 (phonological disorder).
Should I code for all features of all disorders? For example, for a patient with Down syndrome, should I code for macroglossia and high-arched palate?
For Down syndrome in particular, you should code all features, because the Q90 series notes that additional codes are needed to identify associated physical conditions and intellectual disabilities.
For other diagnoses, ICD-10-CM guidelines state that you should include all relevant, coexisting conditions. Generally, clinicians should be as specific as possible, including all relevant diagnoses to provide a “big picture” view of the patient’s condition, as corroborated by the patient’s medical record.
When is it appropriate to use R48.8 (other symbolic dysfunctions)?
R48.8 captures language impairments that are caused by an underlying medical condition. This includes receptive and expressive language disorders, cognitive language disorders, and executive function impairment due to organic or neurological conditions.
Why is there an exclusion for autism under the R47 series of codes for speech disturbances? Can I code for autism and articulation disorder?
There is an Excludes1 note on the R47 family (dysarthria, for example), indicating that nothing in that family of codes should be used with F84.0 (autism). ASHA believes that this guidance contradicts other guidance from the NCHS, which tells clinicians, for example, to use the R48 series of codes with an autism diagnosis.
ASHA has contacted NCHS with these concerns, but any action on this discrepancy may take years. Until then, clinicians should use F80.0 (phonological disorder) along with the autism diagnosis. This advice contradicts ASHA’s usual guidance—to use F80 codes for disorders that have no underlying medical conditions and to use the R series of codes for disorders related to an organic medical condition. However, this work-around is the only option for clinicians until the problem is resolved.
What’s the code for social communication disorder?
Although the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), suggests using F80.89 for social pragmatic communication disorder, ASHA suggests using F80.2, because it is a more specific code and social communication falls under the umbrella of language deficits. If a related medical condition is involved, use R48.8 to capture the social pragmatic communication disorder, with autism as the secondary diagnosis.
The American Psychological Association has proposed a new social communication disorder code for ICD-10, but the issue has not yet been resolved. ASHA’s guidance on this matter differs from the DSM guidance, but it reflects an extensive internal and external analysis of the codes and coding principles. ASHA believes that F80.2 is the appropriate code.
ASHA provides additional information on ICD-10-CM coding. For specific questions, contact reimbursement@asha.org.
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