Diving Into New ICD-10 Codes New codes address difficulties reporting some hearing, social communication and cognitive deficit conditions. Bottom Line
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Bottom Line  |   November 01, 2016
Diving Into New ICD-10 Codes
Author Notes
  • 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×
  • 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×
Article Information
Hearing & Speech Perception / Hearing Disorders / Practice Management / Language Disorders / Social Communication & Pragmatics Disorders / Attention, Memory & Executive Functions / Bottom Line
Bottom Line   |   November 01, 2016
Diving Into New ICD-10 Codes
The ASHA Leader, November 2016, Vol. 21, 28-30. doi:10.1044/leader.BML.21112016.28
The ASHA Leader, November 2016, Vol. 21, 28-30. doi:10.1044/leader.BML.21112016.28
New diagnosis codes for some hearing- and speech-related conditions are now available—the result of additions to ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification)—and Medicare coding “flexibilities” allowed during the transition from ICD-9 to ICD-10 are no longer permitted.
Flexibilities
The codes in ICD-10 are much more specific than in previous revisions. To help clinicians in the transition to ICD-10, which went into effect last year, Medicare allowed coding “flexibilities”—that is, Medicare would not deny claims solely because the reported codes were not specific. For example, a claim for a patient with bilateral sensorineural hearing loss (H90.3) may have been considered acceptable even if it was reported using H90.5, unspecified sensorineural hearing loss.
Although there are valid reasons to use unspecified codes, such as insufficient information in the medical record, clinicians should always use the most specific diagnosis code possible, especially now that Medicare is no longer being lenient and is scrutinizing codes more carefully.
New audiology codes
Hearing loss
The first iteration of ICD-10-CM posed a significant coding problem for audiologists reporting conductive, sensorineural or mixed conductive/sensorineural hearing loss in one ear when patients had a different type of loss in the other ear. Codes were available only for bilateral hearing loss or unilateral hearing loss with normal hearing in the other ear (for example, H90.11, conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side). Therefore, the only appropriate codes for patients with two different types of hearing loss were “other specified hearing loss” or “unspecified hearing loss.”
ASHA and other audiology stakeholders, including the Academy of Doctors of Audiology and the American Academy of Audiology, worked with the National Center for Health Statistics (NCHS) to add codes that reflect different types of hearing loss in each ear.
Now, in addition to codes for hearing loss with unrestricted hearing on the contralateral side, there are corresponding codes for hearing loss with restricted hearing on the contralateral side (H90.A series). Audiologists should use two codes to report the different types of hearing loss in each ear. For example, a patient could be coded with H90.A11 (conductive hearing loss, unilateral, right ear, with restricted hearing on the contralateral side) and H90.A22 (sensorineural hearing loss, unilateral, left ear, with restricted hearing on the contralateral side).
Pulsatile tinnitus
Reporting for tinnitus is also more specific in ICD-10 with new codes that describe pulsatile tinnitus (H93.A series). Other types of tinnitus can still be reported under the existing H93.1 series of codes.

In addition to codes for hearing loss with unrestricted hearing on the contralateral side, there are now corresponding codes for hearing loss with restricted hearing on the contralateral side.

New speech-language codes
Social pragmatic communication disorder
SLPs can report a specific code for social pragmatic communication disorder—F80.82—found in the section of codes that capture developmental and functional speech-language impairments with no related medical conditions. Previously, SLPs used F80.2—the general umbrella of mixed receptive-expressive language disorder—to capture social communication disorder.
Social pragmatic communication deficits related to medical conditions, such as autism spectrum disorder, should be coded R48.8 (other symbolic dysfunctions). This code is used for organic-based language disorders, including social pragmatic communication deficits.
Cognitive deficits following cerebrovascular disease
The original ICD-10 includes only general codes for cognitive deficits related to cerebrovascular disease (I69 series). Although cerebrovascular disease can cause varied cognitive-social deficits, no codes specifically delineated these deficits, despite the availability of deficit-specific codes related to other conditions.
The American Academy of Neurology (AAN) proposed—and NCHS accepted—additional ICD-10 codes for attention and concentration deficit, visuospatial deficit, psychomotor deficit, and frontal lobe and executive function deficit. AAN noted there was no need for a cognitive communication code, as that deficit is covered in the code for aphasia.
AAN also proposed new codes in this series to describe the following cognitive deficits affecting people who have had cerebrovascular disease:
  • “Memory deficit[s], involving difficulty with recall and memory retrieval of functional relevance, but not meeting criteria for vascular dementia.”

  • “Cognitive social or emotional deficit[s], involving the acquired inability to understand or behave appropriately in communicating or reinforcing social, emotional or other interpersonal relationships, including inability to produce or interpret appropriate facial expressions, body movements, prosodic speech, or nonverbal behavior, interfering with function in vocational and other contexts.”

Each category of cerebrovascular disease (nontraumatic subarachnoid hemorrhage, nontraumatic intracerebral hemorrhage, other nontraumatic intracranial hemorrhage, cerebral infarction, other cerebrovascular diseases, unspecified cerebrovascular diseases) now has its own codes for specific cognitive deficits, in much the same format as speech-language and dysphagia codes related to cerebrovascular disease.
With these new codes, SLPs can assign specific cognitive deficit codes for patients with cerebrovascular disease in addition to other appropriate diagnoses, such as dysarthria and aphasia.

SLPs can assign specific cognitive deficit codes for patients with cerebrovascular disease in addition to other appropriate diagnoses, such as dysarthria and aphasia.

Clinicians can also use the cognitive deficit codes related to cerebrovascular disease for patients with vascular dementia. The codes should be reported in conjunction with the code for vascular dementia without behavioral disturbance (F01.50) or vascular dementia with behavioral disturbance (F01.51).
ICD-10 instructs clinicians reporting the F01 series to “Code first the underlying physiological condition or sequelae of cerebrovascular disease.” For example, a patient with stroke-induced dementia would be reported as I69.014 (frontal lobe and executive function deficit following nontraumatic subarachnoid hemorrhage), if appropriate, and F01.50 (vascular dementia without behavioral disturbance).
SLPs providing treatment under billing code 97532 (development of cognitive skills to improve attention, memory and problem-solving) may find that these new, specific cognitive-deficit codes related to cerebrovascular disease may better support their patients’ goals and treatment. The ICD-10 codes also distinguish the treatment from services provided under billing code 92507 and captured under appropriate diagnostic codes—such as I69.020, aphasia following nontraumatic subarachnoid hemorrhage.
Send questions to reimbursement@asha.org.
2 Comments
November 3, 2016
Rhonda Friedlander
New ICD-10 Codes
Are there any on-site, or specific training workshops planned for the new coding procedures???
November 3, 2016
Carol Polovoy
workshops
You will find two sessions at the ASHA Convention on the new ICD-10 codes reported here, one for audiology and one for speech-language pathology. Session 1357, Boost Your SLP Coding Knowledge, is Friday at 10:30 a.m., and session 1454, Boost Your Audiology Coding Knowledge, is Friday at 3:30 p.m. Additional information on these codes is found in links in the article. You can always contact the authors (their emails are provided), or any reimbursement staff person at reimbursement@asha.org.
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November 2016
Volume 21, Issue 11