Coding and Billing for AUDIOLOGY and SPEECH-LANGUAGE PATHOLOGY

Transcription

1 Coding and Billing for AUDIOLOGY and SPEECH-LANGUAGE PATHOLOGY

2 Coding and Billing for AUDIOLOGY and SPEECH-LANGUAGE PATHOLOGY Prepared by ASHA Health Care Economics & Advocacy Team

3 2016 Coding and Billing for Audiology and Speech-Language Pathology is published by the American Speech-Language-Hearing Association (ASHA). ASHA publications are designed to support practitioners in administrative and clinical areas. Opinions contained herein are views of contributors and do not reflect the official views of ASHA. ASHA Disclaimer Assigning codes to describe and bill for your services is a professional responsibility. The information contained in this book is designed as a resource for audiologists and speech-language pathologists and their staff in using various coding systems. Every effort has been made to ensure the accuracy of the information contained in this book. However, the service provider is ultimately responsible for correct coding. American Medical Association (AMA) CPT Codes CPT Copyright 2015 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. This presentation includes only CPT descriptive terms and numeric identifying codes and modifiers for reporting medical services and procedures that were selected by ASHA for inclusion in this publication. Copyright 2015, American Speech-Language-Hearing Association ISBN: Copies may be ordered from: ASHA Product Sales: ii 2016 Coding and Billing for Audiology and Speech-Language Pathology

4 Table of Contents Chapter 1: CPT Codes...1 General... 1 Use of Codes... 1 ASHA s Health Care Economics Committee... 1 CPT Procedure Codes... 1 Special Otorhinolaryngologic Services... 1 Additional CPT Codes... 4 Case Management Services... 5 Chapter 2: ICD-9-CM Diagnostic Codes...9 General... 9 Use of Codes... 9 Classification of Diseases and Injuries Related to Speech and Hearing Disorders (from Volume 1)... 9 Volume 2: V Codes Volume 3: Procedures Code to the Highest Degree of Specificity Chapter 3: ICD-10-CM Diagnostic Codes...33 General Use of Codes Overview Scope Purpose ICD-10-CM Guidelines Official ICD-10-CM Websites ASHA Resources ICD-10-CM Diagnostic Codes: Audiology ICD-10-CM Tabular List of Diseases and Injuries (Related to hearing and vestibular disorders) ICD-10-CM Diagnostic Codes: Speech-Language Pathology ICD-10-CM Tabular List of Diseases and Injuries (Related to speech, language, and swallowing disorders) Coding Normal Results Frequently Asked Questions ICD-10-PCS (Procedure Coding System) for Audiologist and SLPs Chapter 4: HCPCS General Use of codes Audiology Related HCPCS Codes Speech-Language Pathology Related HCPCS Codes Chapter 5: G-codes G-codes and Severity Modifiers for Speech-Language Pathology Claims-Based Outcomes Reporting for Medicare Part B Therapy Services Background Reporting Speech-Language Pathology Related G-codes Severity Modifiers Case Scenarios and Sample Claim Form Entries for Outcomes Reporting for Medicare Part B Therapy Services Chapter 6: Physician Quality Reporting System (PQRS) for Audiology Background Benchmark Requirements Reporting Requirements Chapter 7: Physician Quality Reporting System (PQRS) for Speech-Language Pathology Background Benchmark Requirements Reporting Requirements Chapter 8: National Correct Coding Initiative (NCCI) Edits Audiology Procedures Speech-Language Pathology Procedures Chapter 9: ASHA Model Superbills Model Superbill for Audiology Model Superbill for Speech- Language Pathology Chapter 10: 1500 Claim Form Chapter 11: Fee Data Determining Fees Medicare Fee Schedule Current Milliman Data Chapter 12: Documentation Guidance Documentation Tips Table of Contents 2016 Coding and Billing for Audiology and Speech-Language Pathology iii

5 Table of Contents Documentation for Audiology, Based on Medicare Requirements Documenting Audiological Tests Medicare Documentation for Speech- Language Pathology Electronic Health Records Appendix & Resources ICD-9-CM Conversion to ICD-10-CM Audiology Speech-Language Pathology Resources iv 2016 Coding and Billing for Audiology and Speech-Language Pathology

6 Chapter 1: CPT Codes General Current Procedural Terminology (CPT) is a listing of descriptive terms and identifying codes for reporting medical and health care services; CPT was developed by the American Medical Association (AMA) to provide health care professionals with a uniform language for communication. CPT is continually reviewed and revised to reflect changes in health care services. A number of procedures included in CPT are routinely performed by audiologists and speech-language pathologists. Use of Codes Select the name of the procedure that accurately identifies the service performed. Any service should be adequately documented in the medical record. AMA/CPT notes that, Throughout the CPT code set the use of terms such as physician, qualified health care professional, or individual is not intended to indicate that other entities may not report the service. Any procedure or service in any section may be used to designate the services provided by any qualified health care professional. AMA/ CPT indicates that a qualified health care professional is an individual who is qualified by education, training, licensure/regulation (when applicable), who performs a professional service within his/her scope of practice and independently reports that professional service. ASHA s Health Care Economics Committee ASHA s Health Care Economics Committee (HCEC) monitors current payment and coding concerns and works to ensure equitable coverage and reimbursement for audiology and speech-language pathology services. The Committee develops recommendations for coding and relative values of relevant codes. HCEC consists of six audiologists and six speech-language pathologists, three of whom serve as official representatives on the AMA Health Care Professional Advisory Committees to the CPT Editorial Panel and the Relative Value Update Committee. CPT Procedure Codes Special Otorhinolaryngologic Services The following language can be found in the AMA s Current Procedural Terminology CPT 2016 (CPT). Diagnostic or treatment procedures that are reported as evaluation and management services (e.g., otoscopy, anterior rhinoscopy, tuning fork test, removal of non-impacted cerumen) are not reported separately. Special otorhinolaryngologic services are those diagnostic and treatment services not included in an evaluation and management service, including office or other outpatient services ( ), or office or other outpatient consultations ( ). Codes 92507, 92508, 92520, 92521, 92522, 92523, 92524, and are used to report evaluation and treatment of speech sound production, receptive language, and expressive language abilities, voice and resonance production, speech fluency, and swallowing. Evaluations may include examination of speech sound production, articulatory movements of oral musculature, oral-pharyngeal swallowing function, qualitative analysis of voice and resonance, and measures of frequency, type, and duration of stuttering. Evaluations may also include the patient s ability to understand the meaning and intent of written and verbal expressions, as well as the appropriate formulation and utterance of expressive thought. In contrast, and are reported for an evaluation of auditory rehabilitation status determining the patient s ability to use residual hearing in order to identify the acoustic characteristics of sounds associated with speech communication Otolaryngologic examination under general anesthesia Binocular microscopy (separate diagnostic procedure) has been deleted. To report, see 92521, 92522, 92523, Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual group, two or more individuals Nasopharyngoscopy with endoscope (separate procedure) ASHA Note: Please see CPT codes and (p. 2) for additional information regarding supervision requirements Nasal function studies (e.g., rhinomanometry) Facial nerve function studies (e.g., electroneuronography) Laryngeal function studies (i.e., aerodynamic testing and acoustic testing) (For performance of a single test, use modifier 52) Evaluation of speech fluency (e.g., stuttering, cluttering) Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) with evaluation of language comprehension and expression (e.g., receptive and expressive language) Behavioral and qualitative analysis of voice and resonance has been deleted as of 2003; see Chapter 1: CPT Codes 2016 Coding and Billing for Audiology and Speech-Language Pathology 1

7 Chapter 1: CPT Codes Treatment of swallowing dysfunction and/or oral function for feeding Evaluation for use and/or fitting of voice prosthetic to supplement oral speech has been deleted as of Laryngoscopy, flexible fiberoptic; diagnostic Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy ASHA Note: There is no level of supervision designated in the Medicare Physician Fee Schedule for laryngoscopy (CPT 31575), videostrobscopy (CPT 31579), and nasopharyngoscopy (CPT 92511). However, state and/or Medicare Administrative Contractor (MAC) supervision requirements may supersede Medicare s requirement. Some states have endoscopy laws/regulations specific to speechlanguage pathologists, including California, New Jersey, Illinois, Michigan, and Tennessee. Other states such as Maryland, New York, and Virginia have policy statements and/ or guidance documents. In some cases, the licensure laws and regulations may refer only to fiberoptic endoscopic evaluation of swallowing (FEES) or to all forms of endoscopy. For further information, see; reimbursement/medicare/medicare-supervision- Requirements-for-Videostroboscopy-and- Nasopharyngoscopy-Procedures/. (See 92612, 92613, for endoscopic evaluation of swallowing.) Vestibular Function Tests, With Observation and Evaluation by Physician, Without Electrical Recording Spontaneous nystagmus, including gaze Positional nystagmus Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes four tests) Optokinetic nystagmus Vestibular Function Tests, With Recording (e.g., ENG, PENG), and Medical Diagnostic Evaluation Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one cool irrigation in each ear for a total of four irrigations) [new code in 2016] (Do not report in conjunction with 92270, 92538) (For three irrigations, use modifier 52) (For monothermal caloric vestibular testing, use 92538) monothermal (ie, one irrigation in each ear for a total of two irrigations) (Do not report in conjunction with 92270, 92537) [new code in 2016] (For one irrigation, use modifier 52) (For bilateral, bithermal caloric vestibular testing, use 92537) Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording. (Do not report in conjunction with 92270, 92451, 92542, 92544, 92545) Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording (Do not report in conjunction with 92270, or the set of 92542, 92544, 92545) Positional nystagmus test, minimum of 4 positions, with recording (Do not report in conjunction with 92270, or the set of 92541, 92544, 92545) (92543 has been deleted. To report, see or 92538) Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording (Do not report in conjunction with 92270, or the set of 92541, 92542, 92545) Oscillating tracking test, with recording (Do not report in conjunction with 92270, or the set of 92541, 92542, and 92544) Sinusoidal vertical axis rotational testing (Do not report in conjunction with 92270) Use of vertical electrodes in any or all of above tests counts as one additional test (Use in conjunction with 92537, 92538, ) (For unlisted vestibular tests, see 92700) (Do not report in conjunction with 92270) Computerized dynamic posturography (Do not report in conjunction with 92270) Audiologic Function Tests The audiometric tests listed below require the use of calibrated electronic equipment, recording of results and a report with interpretation. Hearing tests (such as whispered voice, tuning fork) that are otorhinolaryngologic Evaluation & Management services are not reported separately. All services include testing of both ears. Use modifier -52 if a test is applied to one ear instead of two ears. All codes (except 92559), apply to testing of individuals. For testing of groups, use and specify test(s) used Coding and Billing for Audiology and Speech-Language Pathology

8 92550 Tympanometry and reflex threshold measurements (Do not report in conjunction with 92567, 92568) Screening test, pure tone, air only Pure tone audiometry (threshold); air only air and bone Speech audiometry threshold with speech recognition Comprehensive audiometry threshold evaluation and speech recognition (92553 and combined) (For hearing aid evaluation and selection, see ) Audiometric testing of groups Bekesy audiometry; screening diagnostic Loudness balance test, alternate binaural or monaural Tone decay test Short increment sensitivity index (SISI) Stenger test, pure tone Tympanometry (impedance testing) Acoustic reflex testing; threshold has been deleted. For Acoustic reflex decay testing preformed in conjunction with tympanometry, use Acoustic immittance testing, includes tympanomtery (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing (Do not report in conjunction with 92567, 92568) Filtered speech test Staggered spondaic word test Sensorineural acuity level test Synthetic sentence identification test Stenger test, speech Visual reinforcement audiometry (VRA) Conditioning play audiometry Select picture audiometry Electrocochleography Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive limited Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report Hearing aid examination and selection; monaural binaural Hearing aid check; monaural binaural Electroacoustic evaluation for hearing aid; monaural binaural Ear protector attenuation measurements Evaluation of central auditory function, with report; initial 60 minutes each additional 15 minutes (List separately in addition to code for primary procedure) (Do not report 92620, in conjunction with 92521, 92522, 92523, 92524) Assessment of tinnitus (includes pitch, loudness matching, and masking) (Do not report in conjunction with 92562) For unilateral assessment, use modifier -52) Evaluation of auditory rehabilitation status; first hour each additional 15 minutes Auditory rehabilitation; pre-lingual hearing loss Auditory rehabilitation; post-lingual hearing loss Unlisted otorhinolaryngological service or procedure Special Diagnostic Procedures Diagnostic analysis with programming of auditory brainstem implant, per hour Cochlear Implant Related Codes Codes and describe post-operative analysis and fitting of previously placed external devices, connection to the cochlear implant, and programming of the stimulator. Codes and describe subsequent sessions for the measurements and adjustment of the external transmitter and re-programming of the internal stimulator Diagnostic analysis of cochlear implant, patient under 7 years of age; with programming Chapter 1: CPT Codes 2016 Coding and Billing for Audiology and Speech-Language Pathology 3

9 Chapter 1: CPT Codes subsequent reprogramming. (For aural rehab services following cochlear implant, including evaluation of rehabilitation status, use , ) Diagnostic analysis of cochlear implant, age 7 years of age or older; with programming subsequent reprogramming Augmentative/Alternative Communication Device Services Evaluation for prescription of non-speechgenerating augmentative and alternative communication device, first hour each additional 30 minutes Therapeutic service(s) for the use of non-speechgenerating device, including programming and modification Evaluation for prescription for speech-generating augmentative and alternative communication device; face-to-face with the patient; evaluation, first hour each additional 30 minutes (List separately in addition to code for primary procedure); (Use in conjunction with 92607) Therapeutic services for the use of speechgenerating device, including programming and modification Swallowing Evaluation Evaluation of oral and pharyngeal swallowing function Motion fluoroscopic evaluation of swallowing function by cine or video Flexible fiberoptic endoscopic evaluation of swallowing by cine or video interpretation and report only Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording interpretation and report only Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording interpretation and report only Additional CPT Codes Surgery: Respiratory System Unlisted procedure, larynx Surgery: Auditory System Removal of impacted cerumen, one or both ears Cochlear device implantation, with or without mastoidectomy Diagnostic Radiology Complex dynamic pharyngeal and speech evaluation by cine or video recording Swallowing function, with cineradiography and/ or video Ultrasound, soft tissues of head and neck, real time with image documentation ASHA Note: These are radiology codes included here for information purposes. The codes are not billed by speech-language pathologists. Nerve Conduction Tests Nerve conduction studies; 1-2 studies studies studies studies studies studies or more studies Intraoperative Neurophysiology Continuous intraoperative neurophysiology monitoring in the operating room, one-on-one monitoring requiring personal attendance. Each 15 minutes (List separately in addition to code for primary procedure) (Use in conjunction with the study performed 92585, 95822, , , 95925, 95926, 95927, 95928, 95929, , 95938, 95939) Continuous intraoperative neurophysiology monitoring from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (List separately in addition to code for primary procedure) (Use in conjunction with the study performed, 92585, 95822, , 95907,-95913, 95925, 95926, 95927, 95928, 95929, , 95938, 95939) (For time spent waiting on standby before monitoring, use 99360) (For electrocorticography, use 95829) (For intraoperative EEG during nonintracranial surgery, use 95955) Coding and Billing for Audiology and Speech-Language Pathology

10 G0453 (For intraoperative functional cortical or subcortical mapping, see ) (For intraoperative neurostimulator programming and analysis, see ) Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure) [HCPCS code] Evoked Potentials and Reflex Tests Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs (Do not report in conjunction with 95926) in lower limbs (Do not report in conjunction with 95925) in upper and lower limbs (Do not report in conjunction with 95925, 95926) in the trunk or head (To report a unilateral study, use modifier -52); (For auditory evoked potentials, use 92585) Central motor evoked potential study (transcranial motor stimulation); upper limbs (Do not report in conjunction with 95929) lower limbs (Do not report in conjunction with 95929) in upper and lower limbs (Do not report in conjunction with 95928, 95929) Visual evoked potential (VEP) testing central nervous system, checkerboard or flash Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any 1 method Other Procedures Canalith repositioning procedure(s) (e.g., Epley maneuver, Semont maneuver), per day Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, e.g., by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour Developmental screening (eg. developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument G0451 Developmental testing, with interpretation and report, per standardized instrument form ASHA Note: Medicare no longer covers because its policy is to not cover screens. However, CMS did allow a way for Medicare to pay for developmental screening by also proposing to add a temporary code, a supplemental HCPCS Level II G code G0451 Developmental testing with interpretation and report, per standardized instrument, which is valued on the previously-published values of CPT code Medicare is required to pay G codes. Medicaid and private payers often, but not always, follow suit. There is no guarantee of continued reimbursement, but G0451 may be an alternative to Because of the potential for confusion with these codes, documentation should be very clear Developmental testing, (includes assessment of motor, language, social, adaptive and/ or cognitive functioning by standardized developmental instruments) with interpretation and report Standardized cognitive performance testing (e.g., Ross Information Processing Assessment) per hour of a qualified health professional s time, both face-to face time administering tests to the patient and time interpreting these test results and preparing the report Physical Medicine and Rehabilitation Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training) direct one-on-one patient contact by the provider, each 15 minutes Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct one-on-one patient contact by the provider, each 15 minutes Unlisted physical medicine/rehabilitation service or procedure Case Management Services (The Center for Medicare & Medicaid Services (CMS) does not cover Case Management Codes.) Medical Team Conferences Medical team conferences include face-to face participation by a minimum of three qualified health care professionals from different specialties or disciplines (each of whom provide direct care to the patient) with or without presence for the patient, family member(s), community agencies, surrogate decision maker(s) (e.g., legal guardian), and/or caregiver(s). The participants are actively involved in the development, revision, coordination, and implementation of health services needed by the patient. Chapter 1: CPT Codes 2016 Coding and Billing for Audiology and Speech-Language Pathology 5

11 Chapter 1: CPT Codes Reporting participants shall have performed face-to face evaluations or treatments of the patient, independent of any team conference, within the previous 60 days. Physicians may report their time spent in a team conference with the patient and/or family present using evaluation and management (E/M) codes (and times as the key controlling factor for code selection when counseling and/or coordination of care dominates the service). These introductory guidelines do not apply to services reported using E/M codes (see E/M services guideline). However, the physician must be directly involved with the patient, providing face-to-face services outside of the conference visit with other providers or agencies. Reporting participants shall document their participation in the team conference as well as their contributed information and subsequent treatment recommendations. No more than one individual from the same specialty may report at the same encounter. Individuals should not report when their participation in the medical team conference is part of a facility or organizational service contractually provided by the organizational or facility provider. The team conference starts at the beginning of the review of an individual patient and ends at the conclusion of the review. Time related to record keeping and report generation is not reported. The reporting participant shall be present for all time reported. The time reported is not limited to the time that the participant is communicating to the other team members or patient and/or family. Time reported for medical team conferences may not be used in the determination of time for other services such as care plan oversight ( ), home, domiciliary, or rest home care plan oversight ( ), prolonged services ( ), psychotherapy, or any E/M service. For team conferences where the patient is present for any part of the duration of the conference, non-physician qualified health care professionals (e.g., speech-language pathologists, physical therapists, occupational therapists, social workers, dieticians) report the team conference face-to face code Medical Team Conference, Direct (Face-To- Face) Contact with Patient and/or Family Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more, participation by non-physician qualified health care professional (Team conference services of less than 30 minutes duration are not reported separately) (For team conference services by a physician with patient and/or family present, see Evaluation and Management services) Medical Team Conference, Without Direct (Face-to-Face) Contact with Patient and/or Family Medical team conference with interdisciplinary team of health care professionals, patient and/ or family not present, 30 minutes or more, participation by physician participation by non-physician qualified health care professional (Team conference services of less than 30 minutes duration are not reported separately) Prolonged Service With Direct Patient Contact These codes are used when a physician or other qualified health care professional provides prolonged service involving direct patient contact that is beyond the usual service Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour each additional 30 minutes Prolonged Service Without Direct Patient Contact This prolonged service beyond the usual may be reported on a different date than the primary service to which it is related. For example, extensive record review may relate to a previous evaluation and management service performed earlier. It must relate to a service or patient where (face-to-face) patient care has occurred or will occur and relate to ongoing patient management Prolonged evaluation and management service before and/or after direct patient care; first hour each additional 30 minutes Codes are not covered by Medicare. Check with your payer for coverage. Special Services and Reports Supplies and materials provided by physician or clinician over and above those usually included with the office visit or other services rendered Educational supplies, such as books, tapes, and pamphlets, provided by physician or clinician for the patient s education at cost to physician/ clinician Coding and Billing for Audiology and Speech-Language Pathology

12 Education and Training for Patient Self- Management Education and training for patient selfmanagement by qualified, non-physician health care professional using a standardized curriculum, face-to face with the patient (could include the caregiver/family); each 30 minutes; individual patient patients patients Telephone Services Audiologists and speech-language pathologists have three additional codes to report including three procedures for telephone services. They are described as non-faceto-face assessment and management services provided by a qualified health care professional to a patient using the telephone. These codes are used to report episodes of care by the qualified health care professional initiated by an established patient or guardian of an established patient. Of course, there are caveats for using these codes, such as not using the codes if the patient is seen within 24 hours of the phone call or are seen during the next available urgent visit appointment. Similarly, the codes cannot be used if the patient was seen within the previous seven days. The Centers for Medicare & Medicaid Services (CMS) decided not to cover the telephone services codes under Medicare saying (1) These services are non-face-toface; and (2) the code descriptor includes language that recognizes the provision of services to parties other than the beneficiary and for whom Medicare does not provide coverage (for example, guardian). Other health plans are not bound by the CMS decision. At least one private health plan, Blue Cross and Blue Shield of North Carolina, added the codes to its policy under a Telemedicine heading. The codes are: Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure with the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion minutes of medical discussion minutes of medical discussion Online Medical Evaluation Online assessment and management service provided by a qualified non-physician health care professional to an established patient, guardian, or health care provider not originating from a related assessment and management service provided within the previous 7 days, using the Internet or similar electronic communications network. Modifiers Listed services and procedures may be modified under certain circumstances. The modifiers listed below are those typically used by audiologists and speech-language pathologists to describe special circumstances. The twodigit modifier is placed after the usual procedure number and separated by a hyphen. -22 Unusual Services: When the service(s) provided is greater than that usually required for the listed procedures, it may be identified by adding modifier -22 to the usual procedure. A report may also be appropriate. -33 When the primary purpose of the service is the delivery of an evidence-based service in accordance with a U.S. Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by appending modifier -33, Preventive Service, to the service. For separately reported services specifically identified as preventive, the modifier should not be used. -52 Reduced Services: Under certain circumstances a service or procedure is partially reduced or eliminated at the physician s election. Under these circumstances the service provided can be identified by its usual procedure number and the addition of the modifier -52, signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service. -59 Distinct Procedural Service: Physician/provider may need to indicate that a procedure/service was distinct and independent from other services performed on same day. Modifier -59 identifies services not normally reported together, but are appropriate under the circumstances. Chapter 1: CPT Codes 2016 Coding and Billing for Audiology and Speech-Language Pathology 7

13 Chapter 1: CPT Codes Time Components There are no time components associated with most audiology and speech-language pathology CPT codes. ASHA proposed the inclusion of a time component (e.g., adding each 15 minutes to 92506) in several treatment and assessment codes. The AMA CPT Editorial Panel, however, rejected the proposal because they believed time components to be highly variable with no conclusive information or data available to substantiate them. The panel also noted that the Centers for Medicare & Medicaid Services (CMS), which administers the Medicare program, includes a time component in their resource-based relative value process. Insurers and health plans may assign time components to codes. Check with health plans that you deal with to determine if they have established time components for CPT codes. For more information on using timed versus untimed CPT codes, go to coding/servicebased/ Coding and Billing for Audiology and Speech-Language Pathology

14 Chapter 2: ICD-9-CM Diagnostic Codes ICD-9-CM is only valid for services provided on or before September 30, 2015 General The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) is based on the World Health Organization s Ninth Revision, International Classification of Diseases (ICD-9). The intent of ICD-9-CM is to standardize disease and procedure classification throughout the United States and to gather data about basic health statistics. The National Center for Health Statistics (NCHS) and the Centers for Medicare & Medicaid Services (CMS) are the U.S. governmental agencies responsible for overseeing all changes and modifications to the ICD-9-CM. Use of Codes Audiologists and speech-language pathologists use ICD- 9-CM codes to describe and bill for services. The Health Insurance Portability and Accountability Act (HIPAA) requires that the ICD-9-CM be used for health services billing and recordkeeping. This section contains information from ASHA about coding normal results and coding to the highest degree of specificity. Note: This is not a comprehensive list of ICD-9-CM codes and a number of codes are included for informational purposes only. Entries with only three or four digits may require coding to a higher degree of specificity than indicated here. However, in general, audiology and speech-language pathology related diagnoses will be listed to the highest level of specificity. Classification of Diseases and Injuries Related to Speech and Hearing Disorders (from Volume 1) Ch. 1 Infectious and Parasitic Diseases ( ) 042 AIDS Ch. 2 Neoplasms ( ) Malignant Neoplasm of Lip, Oral Cavity, and Pharynx ( ) 140 Malignant neoplasm of lip 141 Malignant neoplasm of tongue 143 Malignant neoplasm of gum 144 Malignant neoplasm of floor of mouth 145 Malignant neoplasm of other and unspecified parts of mouth Cheek mucosa Vestibule of mouth Hard palate Soft palate Uvula Palate, unspecified Retromolar area Other specified parts of mouth Mouth, unspecified 146 Malignant neoplasm of oropharynx 147 Malignant neoplasm of nasopharynx 148 Malignant neoplasm of hypopharynx 149 Malignant neoplasm of other and illdefined sites within lip, oral cavity, and pharynx 150 Malignant neoplasm of esophagus Upper third of esophagus Middle third of esophagus Lower third of esophagus Malignant Neoplasm of Respiratory and Intrathoracic Organs ( ) 160 Malignant neoplasm of nasal cavities, middle ear, and accessory sinuses Auditory tube, middle ear and mastoid air cells 161 Malignant neoplasm of larynx Malignant Neoplasm of Bone, Connective Tissue, Skin, and Breast ( ) 170 Malignant neoplasm of bone and articular cartilage Malignant neoplasm of mandible Malignant Neoplasm of Other and Unspecified Sites ( ) 191 Malignant neoplasm of brain Cerebrum, except lobes and ventricles Frontal lobe Temporal lobe Parietal lobe Occipital lobe Ventricles Cerebellum NOS Brain stem Other parts of brain Brain, unspecified Chapter 2: ICD-9-CM Diagnostic Codes 2016 Coding and Billing for Audiology and Speech-Language Pathology 9

15 Chapter 2: ICD-9-CM Diagnostic Codes 195 Malignant neoplasm of other and ill-defined sites Head, face, and neck 196 Secondary and unspecified malignant neoplasm of lymph nodes Lymph nodes of head, face, and neck 197 Secondary malignant neoplasm of respiratory and digestive systems 198 Secondary malignant neoplasm of other specified sites Brain and spinal cord Other parts of nervous system Meninges (cerebral) (spinal) Benign Neoplasms ( ) 210 Benign neoplasm of lip, oral cavity, and pharynx Lip Tongue Major salivary glands Floor of mouth Other and unspecified parts of mouth Palate (hard) (soft) Oral mucosa Gum (upper) (lower) Oral cavity NOS Other parts of oropharynx Nasopharynx Hypopharynx Pharynx, unspecified 212 Benign neoplasm of respiratory and intrathoracic organs Nasal cavities, middle ear, and accessory sinuses Larynx Trachea 213 Benign neoplasm of bone and articular cartilage Bones of skull and face Lower jaw bone 225 Benign neoplasm of brain and other parts of nervous system Brain Cranial nerves Cerebral meninges Carcinoma in Situ ( ) 230 Carcinoma in situ of digestive organs Lip, oral cavity, and pharynx Esophagus 231 Carcinoma in situ of respiratory system Larynx Trachea 232 Carcinoma in situ of skin Skin of lip Ear and external auditory canal Neoplasms of Uncertain Behavior ( ) 237 Neoplasm of endocrine glands and nervous system Neoplasm of paraganglia Brain and spinal cord Meninges Neurofibromatosis Neurofibromatosis, type 2 [acoustic neurofibromatosis] 239 Neoplasms of unspecified nature Brain Ch. 3 Endocrine, Nutritional and Metabolic Diseases, and Immunity Disorders ( ) Other Metabolic and Immunity Disorders ( ) 279 Disorders involving the immune mechanism Autoimmune disease, not elsewhere classified Ch. 4 Diseases of the Blood and Blood-Forming Organs ( ) Ch. 5 Mental Disorders ( ) Psychoses ( ) 290 Dementias Senile dementia, uncomplicated Excludes: mild memory disturbances, not amounting to dementia, associated with senile brain disease (310.89) Presenile dementia Brain syndrome with presenile brain disease Vascular dementia Multi-infarct dementia or psychosis Coding and Billing for Audiology and Speech-Language Pathology

16 Use additional code to identify cerebral atherosclerosis (437.0) Other specified senile psychotic conditions Presbyophrenic psychosis 291 Alcohol-induced mental disorders Alcohol-induced persisting amnestic disorder Korsakoff s psychosis, alcoholic Wenicke-Korsakoff syndrome (alcoholic) Alcohol-induced persisting dementia 293 Transient mental disorders due to conditions classified elsewhere Delirium due to conditions classified elsewhere Subacute delirium 294 Persistent mental disorders due to conditions classified elsewhere Amnestic disorder in conditions classified elsewhere Korsakoff s psychosis or syndrome (nonalcoholic) Dementia in conditions classified elsewhere Code first: Any underlying physical condition, as: For example: Alzheimer s disease (331.0) Epilepsy ( ) Multiple Sclerosis (340) Parkinson s disease (332.0) Dementia in conditions classified elsewhere without behavioral disturbance Dementia in conditions classified elsewhere with behavioral disturbance Dementia, unspecified Excludes: mild memory disturbances, not amounting to dementia (310.89) Dementia, unspecified, without behavioral disturbance Dementia NOS Dementia, unspecified, behavioral disturbance Aggressive behavior Combative behavior Violent behavior Other persistent mental disorders due to conditions classified elsewhere Excludes: mild memory disturbances, not amounting to dementia (310.89) Unspecified persistent mental disorders due to conditions classified elsewhere 295 Schizophrenic disorders Excludes: childhood type schizophrenia (299.9) infantile autism (299.0) 296 Episodic mood disorders 299 Pervasive developmental disorder The following fifth-digit subclassification is for use with category 299: 0 current or active state 1 residual state Autistic disorder [0-1] Childhood autism Infantile psychosis Kanner s syndrome Excludes: disintegrative psychosis (299.1) Heller s syndrome (299.1) Schizophrenic syndrome of childhood (299.9) Childhood disintegrative psychosis [0-1] Heller s syndrome Use additional code to identify any associated neurological disorder Excludes: infantile autism (299.0) schizophrenic syndrome of childhood (299.9) Chapter 2: ICD-9-CM Diagnostic Codes 2016 Coding and Billing for Audiology and Speech-Language Pathology 11

17 Chapter 2: ICD-9-CM Diagnostic Codes Other specified pervasive developmental disorders [0-1] Asperger s disorder Atypical childhood psychosis Borderline psychosis of childhood Excludes: simple stereotypes without psychotic disturbance (307.3) Unspecified pervasive developmental disorder [0-1] Child psychosis NOS Pervasive developmental disorder NOS Schizophrenia, childhood type NOS Schizophrenic syndrome of childhood NOS Excludes: schizophrenia of adult type occurring in childhood ( ) Neurotic Disorders, Personality Disorders, and Other Nonpsychotic Mental Disorders ( ) 300 Anxiety, dissociative and somatoform disorders Dissociative, conversion and factitious disorders Conversion disorder Hysterical: blindness deafness paralysis 307 Special symptoms or syndromes, not elsewhere classified Note: This category is intended for use if the psychopathology is manifested by a single specific symptom or groups of symptoms which is not part of an organic illness or other mental disorder classifiable elsewhere Adult onset fluency disorder Excludes: childhood onset fluency disorder (315.35) fluency disorder due to late effect of CVA (438.14) fluency disorder in conditions classified elsewhere (784.52) Other and unspecified special symptoms or syndromes, not elsewhere classified Communication disorder NOS Hair plucking Lalling Lisping Masturbation Nail-biting Thumb-sucking 310 Specific nonpsychotic mental disorders due to brain damage Excludes: neuroses, personality disorders, or other nonpsychotic conditions occurring in a form similar to that seen with functional disorders but in association with a physical condition ( , ) Frontal lobe syndrome Lobotomy syndrome Postleucotomy syndrome [state] Excludes: postcontusion syndrome (310.2) Personality change due to conditions classified elsewhere Cognitive or personality change of other type, of nonpsychotic severity Organic psychosyndrome of nonpsychotic severity Presbyophrenia NOS Senility with mental changes of nonpsychotic severity Excludes: mild cognitive impairment (331.83) postconcussion syndrome (310.2) signs and symptoms involving emotional state ( ) Postconcussion syndrome Postcontusion syndrome or encephalopathy Posttraumatic brain syndrome, nonpsychotic Status postcommotio cerebri Coding and Billing for Audiology and Speech-Language Pathology

18 Excludes: any organic psychotic conditions following head injury ( ) frontal lobe syndrome (310.0) postencephalitic syndrome (310.89) Other specified nonpsychotic mental disorders following organic brain damage Pseudobulbar affect Involuntary emotional expression disorder Code first underlying cause, if known, such as: amyotrophic lateral sclerosis (335.20) late effect of cerebrovascular accident (438.89) late effect of traumatic brain injury (907.0) multiple sclerosis (340) Other specified nonpsychotic mental disorders following organic brain damage Mild memory disturbance Other focal (partial) organic psychosyndromes Postencephalitic syndrome Excludes: memory loss of unknown cause (780.93) 313 Disturbance of emotions specific to childhood and adolescence Sensitivity, shyness, and social withdrawal disorder Selective mutism Excludes: elective mutism as adjustment reaction (309.83) 314 Hyperkinetic syndrome of childhood Attention deficit disorder Without mention of hyperactivity With hyperactivity Hyperkinesis with developmental delay Developmental disorder of hyperkinesis Use additional code to identify any associated neurological disorder 315 Specific delays in development Excludes: that due to a neurological disorder ( ) Specific reading disorder Reading disorder, unspecified Alexia Developmental dyslexia Other specific spelling difficulty Mathematics disorder Dyscalculia Other specific learning difficulties Disorder of written expression Excludes: specific arithmetical disorder (315.1) specific reading disorder ( ) Developmental speech or language disorder Expressive language disorder Developmental aphasia Word deafness Excludes: Acquired aphasia (784.3) Elective mutism (309.83, 313.0, ) Mixed receptiveexpressive language disorder Central auditory processing disorder Excludes: acquired auditory processing disorder (388.45) Chapter 2: ICD-9-CM Diagnostic Codes 2016 Coding and Billing for Audiology and Speech-Language Pathology 13

19 Chapter 2: ICD-9-CM Diagnostic Codes Speech and language developmental delay due to hearing loss Childhood onset fluency disorder Cluttering NOS Stuttering NOS Excludes: adult onset fluency disorder (307.0) fluency disorder due to late effect of CVA (438.14) fluency disorder in conditions classified elsewhere (784.52) Other Developmental articulation disorder Dyslalia Phonological disorder Excludes: Lisping and lalling (307.9) Developmental coordination disorder Clumsiness syndrome Dyspraxia syndrome Specific motor development disorder Mixed developmental disorder Other specific delays in development Unspecified delay in development Developmental disorder NOS Learning disorder NOS Intellectual Disabilities ( ) 317 Mild intellectual disabilities 318 Other specific intellectual disabilities Moderate intellectual disabilities Severe intellectual disabilities Profound intellectual disabilities 319 Unspecified intellectual disabilities Ch. 6 Diseases of the Nervous System and Sense Organs ( ) Inflammatory Diseases of the Central Nervous System ( ) 320 Bacterial meningitis 321 Meningitis due to unspecified bacterium 322 Meningitis of unspecified cause 323 Encephalitis, myelitis, and encephalomyelitis Hereditary and Degenerative Diseases of the Central Nervous System ( ) 330 Cerebral degenerations usually manifest in childhood 331 Other cerebral degenerations Alzheimer s disease Frontotemporal dementia Pick s Disease Senile degeneration of brain Other cerebral degeneration Mild cognitive impairment, so stated Excludes: altered mental status (780.97) cerebral degeneration ( ) change in mental status (780.97) cognitive deficits following (late effects of) cerebral hemorrhage or infarction (438.0) cognitive impairment due to intracranial or head injury ( , ) cognitive impairment due to late effect of intracranial injury (907.0) cognitive impairment due to skull fracture ( , ) dementia ( , 294.8) mild memory disturbance (310.8) neurologic neglect syndrome (781.8) personality change, nonpsychotic (310.1) 332 Parkinson s disease Paralysis agitans Secondary parkinsonism Coding and Billing for Audiology and Speech-Language Pathology

20 333 Other extrapyramidal disease and abnormal movement disorders Other degenerative diseases of the basal ganglia Essential and other specified forms of tremor Myoclonus Tics of organic origin Huntington s chorea Other choreas Genetic torsion dystonia Acquired torsion dystonia Athetoid cerebral palsy 334 Spinocerebellar disease Friedreich s ataxia Primary cerebellar degeneration Other cerebellar ataxia Cerebellar ataxia in diseases classified elsewhere 335 Anterior horn cell disease Motor neuron disease Amyotrophic lateral sclerosis Motor neuron disease (bulbar) (mixed type) Progressive muscular atrophy Progressive bulbar palsy Pseudobulbar palsy Primary lateral sclerosis Other Other Disorders of the Central Nervous System ( ) 340 Multiple sclerosis 343 Infantile cerebral palsy Diplegic Hemiplegic Quadriplegic Monoplegic Infantile hemiplegia Other specified infantile cerebral palsy Infantile cerebral palsy, unspecified 345 Epilepsy and recurrent seizures 348 Other conditions of brain Cerebral cysts Anoxic brain damage Benign intracranial hypertension Encephalopathy, unspecified Compression of brain Cerebral edema Other conditions of brain Unspecified condition of brain 349 Other and unspecified disorders of the nervous system Disorders of the Peripheral Nervous System ( ) 358 Myoneural disorders Myasthenia gravis 359 Muscular dystrophies and other myopathies Congenital hereditary muscular dystrophy Hereditary progressive muscular dystrophy Diseases of the Ear and Mastoid Process ( ) 380 Disorders of external ear Perichondritis and chondritis of pinna Chondritis of auricle Perichondritis of auricle Perichondritis of pinna, unspecified Acute perichondritis of pinna Chronic perichondritis of pinna Chondritis of pinna Infective otitis externa Infective otitis externa Acute infection of pinna Acute swimmers ear Other acute infections of external ear Code first underlying disease, as: erysipelas (035) impetigo (684) seborrheic dermatitis ( ) see Excludes next page Chapter 2: ICD-9-CM Diagnostic Codes 2016 Coding and Billing for Audiology and Speech-Language Pathology 15

21 Chapter 2: ICD-9-CM Diagnostic Codes Excludes: herpes simplex (054.73) herpes zoster (053.71) Malignant otitis externa Chronic myotic otitis externa Code first underlying disease, as: aspergillosis (117.3) otomycosis NOS (111.9) Excludes: candida otitis externa (112.82) Other chronic infective otitis externa Chronic infective otitis externa NOS Impacted cerumen Wax in ear 381 Nonsuppurative otitis media and Eustachian tube disorders Acute nonsuppurative otitis media Acute tubotympanic catarrh Otitis media, acute or subacute catarrhal exudative transudative with effusion Excludes: otitic barotrauma (993.0) Acute nonsuppurative otitis media, unspecified Acute serous otitis media Acute or subacute secretory otitis media Acute mucoid otitis media Acute or subacute seromucinous otitis media; Blue drum syndrome Acute sanguinous otitis media Acute allergic serous otitis media Acute allergic mucoid otitis media Acute allergic sanguinous otitis media Chronic serous otitis media Chronic serous otitis media, simple or unspecified Other Serosanguinous chronic otitis media Chronic mucoid otitis media Glue ear Chronic mucoid otitis media, simple or unspecified Other Mucosanguinous chronic otitis media Other and unspecified chronic nonsuppurative otitis media Nonsuppurative otitis media, not specified as acute or chronic 382 Suppurative and unspecified otitis media Acute suppurative otitis media Otitis media, acute: necrotizing NOS purulent Acute suppurative otitis media without spontaneous rupture of ear drum Acute suppurative otitis media with spontaneous rupture of ear drum Acute suppurative otitis media in diseases classified elsewhere Code first underlying disease, as: influenza (487.8) scarlet fever (034.1) Chronic tubotympanic supprative otitis media Coding and Billing for Audiology and Speech-Language Pathology

22 Benign chronic suppurative otitis media (with anterior perforation of ear drum) Chronic tubotympanic disease (with anterior perforation of ear drum) Chronic atticoantral suppurative otitis media Chronic atticoantral disease (with posterior or superior marginal perforation of ear drum) Persistent mucosal disease (with posterior or superior marginal perforation of ear drum) Unspecified chronic suppurative otitis media Chronic purulent otitis media Excludes: tuberculous otitis media (017.4) Unspecified suppurative otitis media Purulent otitis media NOS Unspecified otitis media Otitis media: NOS acute NOS chronic NOS 384 Other disorders of tympanic membrane Acute myringitis without mention of otitis media Acute myringitis, unspecified Acute tympanitis NOS Bullous myringitis Myringitis bullosa hemorrhagica Other Chronic myringitis without mention of otitis media Chronic tympanitis Perforation of tympanic membrane Perforation of ear drum: NOS persistent posttraumatic postinflammatory Excludes: otitis media with perforation of tympanic membrane ( ) traumatic perforation (current injury) (872.61) Perforation of tympanic membrane, unspecified Central perforation of tympanic membrane Attic perforation of tympanic membrane Pars flaccida Other marginal perforation of tympanic membrane Multiple perforations of tympanic membrane Total perforation of tympanic membrane Other specified disorders of tympanic membrane Atrophic faccid tympanic membrane Healed perforation of ear drum Atrophic nonflaccid tympanic membrane Unspecified disorder of tympanic membrane 385 Other disorders of middle ear and mastoid Excludes: mastoiditis ( ) Tympanosclerosis Tympanosclerosis, unspecified as to involvement Tympanosclerosis involving tympanic membrane only Tympanosclerosis involving tympanic membrane and ear ossicles Tympanosclerosis involving tympanic membrane, ear ossicles, and middle ear Chapter 2: ICD-9-CM Diagnostic Codes 2016 Coding and Billing for Audiology and Speech-Language Pathology 17

23 Chapter 2: ICD-9-CM Diagnostic Codes Tympanosclerosis involving other combination of structures Adhesive middle ear disease Adhesive otitis Otitis media: Otitis media: chronic adhesive fibrotic Excludes: glue ear ( ) Adhesive middle ear disease, unspecified as to involvement Adhesions of drum head to incus Adhesions of drum head to stapes Adhesions of drum head to promontorium Other adhesions and combinations Other acquired abnormality of ear ossicles Impaired mobility of malleus; Ankylosis of malleus Impaired mobility of other ear ossicles; Ankylosis of ear ossicles, except malleus Discontinuity or dislocation of ear ossicles Partial loss or necrosis of ear ossicles Cholesteatoma of middle ear and mastoid Cholesterosis Epidermosis }of (middle) ear Keratosis Polyp Excludes: cholesteatoma: external ear canal (380.21) recurrent of postmastoidectomy cavity (383.32) Cholesteatoma, unspecified Cholesteatoma of attic Cholesteatoma of middle ear Cholesteatoma of middle ear and mastoid Diffuse cholesteatosis Other disorders of middle ear and mastoid Cholesterin granuloma Retained foreign body of middle ear Other Unspecified disorder of middle ear and mastoid 386 Vertiginous syndromes and other disorders of vestibular system Excludes: vertigo NOS (780.4) Ménière s disease Endolymphatic hydrops Lermoyez s syndrome Ménière s syndrome or vertigo Ménière s disease, unspecified Ménière s disease (active) Active Ménière s disease, cochleovestibular Active Ménière s disease, cochlear Active Ménière s disease, vestibular Inactive Ménière s disease, Ménière s disease in remission Other and unspecified peripheral vertigo Excludes: epidemic vertigo (078.81) Peripheral vertigo, unspecified Benign paroxysmal positional vertigo Benign paroxysmal positional nystagmus Vestibular neuronitis Acute (and recurrent) peripheral vestibulopathy Coding and Billing for Audiology and Speech-Language Pathology

24 Other Aural vertigo Otogenic vertigo Vertigo of central origin Central positional nystagmus Malignant positional vertigo Labyrinthitis Labyrinthitis, unspecified Serous labyrinthitis Diffuse labyrinthitis Circumscribed labyrinthitis Focal labyrinthitis Suppurative labyrinthitis Toxic labyrinthitis Viral labyrinthitis Labyrinthine fistula Labyrinthine fistula, unspecified Round window fistula Oval window fistula Semicircular canal fistula Labyrinthine fistula of combined sites Labyrinthine dysfunction Labyrinthine dysfunction, unspecified Hyperactive labyrinth, unilateral Hyperactive labyrinth, bilateral Hypoactive labyrinth, unilateral Hypoactive labyrinth, bilateral Loss of labyrinthine reactivity, unilateral Loss of labyrinthine reactivity, bilateral Other forms and combinations Other disorders of labyrinth Unspecified vertiginous syndromes and labyrinthine disorders 387 Otosclerosis 388 Other disorders of ear Degenerative and vascular disorders of ear Degenerative and vascular disorders, unspecified Presbyacusis Transient ischemic deafness Noise effects on inner ear Noise effects on inner ear, unspecified Acoustic trauma (explosive) to ear Otitic blast injury Noise-induced hearing loss Sudden hearing loss, unspecified Tinnitus Tinnitus, unspecified Subjective tinnitus Objective tinnitus Other abnormal auditory perception Abnormal auditory perception, unspecified Diplacusis Hyperacusis Impairment of auditory discrimination Recruitment Acquired auditory processing disorder Disorders of acoustic nerve Acoustic neuritis Degeneration of acoustic or eighth nerve Disorder of acoustic or eighth nerve Excludes: acoustic neuroma (225.1) syphilitic acoustic neuritis (094.86) Otorrhea Otorrhea, unspecified Discharging ear, NOS Chapter 2: ICD-9-CM Diagnostic Codes 2016 Coding and Billing for Audiology and Speech-Language Pathology 19

25 Chapter 2: ICD-9-CM Diagnostic Codes Cerebrospinal fluid otorrhea Other Otorrhagia Otalgia Otalgia, unspecified Earache NOS Otogenic pain Referred pain Other disorders of ear Unspecified disorder of ear 389 Hearing Loss Conductive hearing loss Conductive hearing loss, unspecified Conductive hearing loss, external ear Conductive hearing loss, tympanic membrane Conductive hearing loss, middle ear Conductive hearing loss, inner ear Conductive hearing loss, unilateral Conductive hearing loss, bilateral Conductive hearing loss of combined types Sensorineural hearing loss Perceptive hearing loss or deafness Excludes: abnormal auditory perception ( ) mixed conductive and sensorineural hearing loss ( ) psychogenic deafness (306.7) Sensorineural hearing loss, unspecified Sensory hearing loss, bilateral Neural hearing loss, bilateral Neural hearing loss, unilateral Central hearing loss Sensorineural hearing loss, unilateral Sensorineural hearing loss, asymmetrical Sensory hearing loss, unilateral Sensorineural hearing loss, bilateral Mixed conductive and sensorineural hearing loss Deafness or hearing loss of type classifiable to with type classifiable to Mixed hearing loss, unspecified Mixed hearing loss, unilateral Mixed hearing loss, bilateral Deaf, non-speaking, not elsewhere classifiable Other specified forms of hearing loss Unspecified hearing loss Deafness NOS Ch. 7 Diseases of the Circulatory System ( ) Cerebrovascular Disease ( ) 430 Subarachnoid hemorrhage 431 Intracerebral hemorrhage 432 Other and unspecified intracranial hemorrhage 434 Occlusion of cerebral arteries 435 Transient cerebral ischemia Unspecified transient cerebral ischemia Impending CVA Intermittent cerebral ischemia Transient ischemic attack (TIA) 436 Acute, but ill-defined, cerebrovascular disease 437 Other and ill-defined cerebrovascular disease Cerebral atherosclerosis Other generalized ischemic cerebrovascular disease Hypertensive encephalopathy Coding and Billing for Audiology and Speech-Language Pathology

26 437.3 Cerebral aneurysm, nonruptured Unspecified Cerebrovascular disease or lesion NOS 438 Late effects of cerebrovascular disease Note: This category is to be used to indicate conditions in as the cause of late effects. The late effects include conditions specified as such, or as sequelae, which may occur at any time after the onset of the causal condition Cognitive deficits Speech and language deficits Speech and language deficits, unspecified Aphasia Dysphasia Dysarthria Fluency disorder Stuttering due to late effect of CVA Other speech and language deficits Other late effects of cerebrovascular disease Apraxia Dysphagia Use additional code to identify the type of dysphagia, if known ( ) Facial weakness Facial droop Ataxia Vertigo Other late effects of cerebrovascular disease Use additional code to identify the late effect Unspecified late effects of cerebrovascular disease Ch. 8 Diseases of the Respiratory System ( ) Acute Respiratory Infections ( ) 462 Acute pharyngitis 463 Acute tonsillitis 464 Acute laryngitis and tracheitis Acute laryngitis Without mention of obstruction With obstruction Acute tracheitis Without mention of obstruction With obstruction Acute laryngotracheitis Without mention of obstruction With obstruction Acute epiglottitis Viral epiglottitis Without mention of obstruction With obstruction Croup Croup syndrome Supraglottitis, unspecified Without mention of obstruction With obstruction Other Diseases of the Upper Respiratory Tract ( ) 474 Chronic disease of tonsils and adenoids Hypertrophy of tonsils adenoids Tonsils with adenoids` Tonsils alone Adenoids alone 476 Chronic laryngitis and laryngotracheitis Chronic laryngitis Chronic laryngotracheitis 477 Allergic rhinitis 478 Other diseases of the upper respiratory tract Paralysis of vocal cords or larynx Paralysis, unspecified Unilateral, partial Unilateral, complete Bilateral, partial Bilateral, complete Polyp of vocal cord or larynx Other diseases of vocal cords Edema of larynx Chapter 2: ICD-9-CM Diagnostic Codes 2016 Coding and Billing for Audiology and Speech-Language Pathology 21

27 Chapter 2: ICD-9-CM Diagnostic Codes Other diseases of larynx, not elsewhere classified Unspecified disease of larynx Cellulitis and perichondritis of larynx Stenosis of larynx Laryngeal spasm Other Upper respiratory tract hypersensitivity reaction, site unspecified Excludes: hypersensitivity reaction of lower respiratory tract, as: Extrinsic allergic alveolitis ( ) Pneumoconiosis ( ) Pneumoconioses and Other Lung Diseases Due to External Agents ( ) 507 Pneumonitis due to solids and liquids Due to inhalation of food or vomitus Aspiration pneumonia due to: NOS milk food (regurgitated) saliva gastric secretions vomitus Ch. 9 Diseases of the Digestive System ( ) Diseases of Oral Cavity, Salivary Glands, and Jaws ( ) 524 Dentofacial anomalies, including malocclusion Major anomalies of jaw size Unspecified anomaly Maxillary hyperplasia Mandibular hyperplasia Maxillary hypoplasia Mandibular hypoplasia Macrogenia Microgenia Excessive tuberosity of jaw Other specified anomaly Anomalies of relationship of jaw to cranial base Unspecified anomaly Prognathism Retrognathism Maxillary asymmetry Other jaw asymmetry Other specified anomaly Anomalies of dental arch relationship Anomaly of dental arch Unspecified anomaly of dental arch relationship Malocclusion, Angle s class I Neutro-occlusion Malocclusion, Angle s class II Disto-occlusion Division I Disto-occlusion Division II Malocclusion, Angle s class III Mesio-occlusion Open anterior occlusal relationship Anterior open bit Open posterior occlusal relationship Posterior open bite Excessive horizontal overlap Excessive horizontal overjet Reverse articulation Anterior articulation Crossbite Posterior articulation Anomalies of interarch distance Excessive interarch distance Inadequate interarch distance Other anomalies of dental arch relationship Other anomalies of dental arch Malocclusion, unspecified Dentofacial functional abnormalities Dentofacial function abnormality, unspecified Coding and Billing for Audiology and Speech-Language Pathology

28 Abnormal jaw closure Limited mandibular range of motion Deviation in opening and closing of the mandible Insufficient anterior guidance Centric occlusion maximum intercuspation discrepancy Non-working side interference Lack of posterior occlusal support Other dentofacial functional abnormalities Abnormal swallowing Mouth breathing Sleep postures Tongue, lip, or finger habits Temporomandibular joint disorders Temporomandibular joint sounds on opening and/or closing the jaw Dental alveolar anomalies Vertical displacement of alveolus and teeth Occlusal plane deviation Other specified dentofacial anomalies Anterior soft tissue impingement Posterior soft tissue impingement Other specified dentofacial anomalies Unspecified dentofacial anomalies 528 Diseases of the oral soft tissues, excluding lesions specific for gingiva and tongue Other and unspecified diseases of the oral soft tissues ASHA Note: Such as velopharyngeal incompetence 529 Diseases and other conditions of the tongue Other specified conditions of the tongue Atrophy (of) tongue Crenated (of) tongue Enlargement (of) tongue Hypertrophy (of) tongue Glossocele Excludes: erythroplasia of tongue (528.79) leukoplakia of tongue (528.6) macroglossia (congenital) (750.15) microglossia (congenital) (750.16) oral submucosal fibrosis (528.8) Diseases of Esophagus, Stomach, and Duodenum ( ) 530 Diseases of esophagus Other specified disorders of esophagus Esophageal reflux Ch. 10 Diseases of the Genitourinary System ( ) Ch. 11 Complications of Pregnancy, Childbirth and the Puerperium ( ) Ch. 12 Diseases of the Skin and Subcutaneous Tissue ( ) Ch. 13 Diseases of the Musculoskeletal System and Connective Tissue ( ) Ch. 14 Congenital Anomalies ( ) 741 Spina bifida With hydrocephalus Without mention of hydrocephalus 742 Other congenital anomalies of nervous system Encephalocele Microcephalus Reduction deformities of brain Congenital hydrocephalus Other specified anomalies of brain Other specified anomalies of spinal cord Other specified anomalies of nervous system Chapter 2: ICD-9-CM Diagnostic Codes 2016 Coding and Billing for Audiology and Speech-Language Pathology 23

29 Chapter 2: ICD-9-CM Diagnostic Codes Unspecified anomaly of brain, spinal cord, and nervous system 744 Congenital anomalies of ear, face, and neck Anomaly of ear causing impairment of hearing Excludes: congenital deafness without mention of cause ( ) Unspecified anomaly of ear with impairment of hearing Absence of external ear Other anomalies of external ear with impairment of hearing Anomalies of middle ear, except ossicles Anomalies of ear ossicles Anomalies of inner ear Other Absence of ear, congenital Accessory auricle Accessory tragus Polyotia Preauricular appendage Supernumerary ear lobule Other specified anomalies of ear Excludes: that with impairment of hearing ( ) Absence of ear lobe, congenital Macrotia Microtia Specified anomalies of Eustachian tube Absence of Eustachian tube Other Bat ear Darwin s tubercle Pointed ear Prominence of auricle Ridge ear Excludes: preauricular sinus (744.46) Unspecified anomaly of ear Congenital: anomaly NOS of ear, NEC deformity NOS of ear, NEC Other specified anomalies of face and neck 748 Congenital anomalies of respiratory system Web of larynx Other anomalies of larynx, trachea and bronchus 749 Cleft palate and cleft lip Cleft palate Cleft palate, unspecified Unilateral, complete Unilateral, incomplete Cleft uvula Bilateral, complete Bilateral, incomplete Cleft lip Cleft lip, unspecified Unilateral, complete Unilateral, incomplete Bilateral, complete Bilateral, incomplete Cleft palate with cleft lip Cleft palate with cleft lip, unspecified Unilateral, complete Unilateral, incomplete Bilateral, complete Bilateral, incomplete Other combinations 750 Other congenital anomalies of upper alimentary tract Excludes: dentofacial anomalies ( ) Tongue tie Ankyloglossia Other anomalies of tongue Anomalies of tongue, unspecified Coding and Billing for Audiology and Speech-Language Pathology

30 Aglossia Congenital adhesions of tongue Fissure of tongue Macroglossia Microglossia Hypoplasia of tongue Other Other specified anomalies of mouth and pharynx Other specified anomalies of pharynx 754 Certain congenital musculoskeletal deformities Of skull, face, and jaw 758 Chromosomal anomalies Includes: syndromes associated with anomalies in the number and form of chromosomes Use additional codes for conditions associated with the chromosomal anomalies Down s syndrome Mongolism Translocation Down s syndrome Trisomy: 21 or 22 G Edward s syndrome Trisomy: 18 E Autosomal deletion syndromes Cri-du-chat syndrome Velo-cardio-facial syndrome Other microdeletions Miller-Dieker syndrome Smith-Magenis syndrome Other conditions due to autosomal anomalies Klinefelter s syndrome (males only) XXY syndrome Other conditions due to chromosome anomalies Conditions due to anomaly of unspecified chromosome Ch. 15 Certain Conditions Originating in the Perinatal Period ( ) Other Conditions Originating in the Perinatal Period ( ) 779 Other and ill-defined conditions originating in the perinatal period Disorder of stomach function and feeding problems in newborn Feeding problems in newborn Slow feeding in newborn Excludes: feeding problem in child over 28 days old (783.3) Failure to thrive in newborn Excludes: failure to thrive in child over 28 days old (783.41) Ch. 16 Symptoms, Signs, and Ill-defined Conditions ( ) Symptoms ( ) 780 General symptoms Dizziness and giddiness Light-headedness Vertigo NOS Excludes: Ménière s disease and other specified vertiginous syndromes ( ) Other general symptoms Memory loss Amnesia (retrograde) Memory loss NOS Excludes: memory loss due to: intercranial injuries ( ) skull fractures ( , ) Chapter 2: ICD-9-CM Diagnostic Codes 2016 Coding and Billing for Audiology and Speech-Language Pathology 25

31 Chapter 2: ICD-9-CM Diagnostic Codes mild memory disturbance due to organic brain damage (310.8) 781 Symptoms involving nervous and musculoskeletal systems Lack of coordination Ataxia NOS Muscular incoordination Neurological neglect syndrome Asomatognosia Left-sided neglect Hemi-akinesia Sensory extinction Hemi-inattention Sensory neglect Hemispatial Visuospatial neglect neglect Other symptoms involving nervous and musculoskeletal systems Facial weakness Facial droop Excludes: facial weakness due to late effect of CVA (438.83) 783 Symptoms concerning nutrition, metabolism, and development Feeding difficulties and mismanagement Feeding problem (elderly) (infant) Excludes: feeding disturbance or problems: in newborn ( ) of nonorganic origin ( ) Lack of expected normal physiological development in childhood Lack of normal physiological development, unspecified Inadequate development Lack of development Failure to thrive Failure to gain weight Excludes: failure to thrive in newborn (779.34) Delayed milestones Late talker Late walker 784 Symptoms involving head and neck Aphasia Excludes: aphasia due to late effects of cerebrovascular disease (483.11) developmental aphasia (315.31) Voice and resonance disorders Voice and resonance disorder, unspecified Aphonia Loss of voice Dysphonia Hoarseness Hypernasality Hyponasality Other voice and resonance disorders Change in voice Other speech disturbance Excludes: speech disorder due to late effect of CVA ( ) stuttering (315.35) Dysarthria Excludes: Dysarthria due to late effect of CVA (438.13) Fluency disorder in conditions classified elsewhere Stuttering in conditions classified elsewhere Code first underlying disease or condition, such as Parkinson s disease (332.0) Excludes: adult onset fluency disorder (307.0) Coding and Billing for Audiology and Speech-Language Pathology

32 childhood onset fluency disorder (315.35) fluency disorder due to late effect of CVA (438.14) Other speech disturbance Dysphasia Slurred speech Speech disturbance NOS Other symbolic dysfunction Excludes: developmental learning delays ( ) Symbolic dysfunction, unspecified Alexia and dyslexia Alexia (with agraphia) Other Acalculia Difficulty performing simple mathematical tasks Agnosia Loss of ability to recognize objects, persons, sounds, shapes, or smells Agraphia NOS Apraxia Loss of the ability to execute or carry out movements 786 Symptoms involving respiratory system and other chest symptoms Dyspnea and respiratory abnormalities Other Respiratory: distress insufficiency Excludes: respiratory distress: following trauma and surgery (518.52) newborn (770.89) respiratory failure (518.81, ) newborn (770.84) syndrome (newborn) (769) adult (518.52) Cough Excludes: cough: psychogenic (306.1) smokers (491.0) with hemorrhage (786.39) 787 Symptoms involving digestive system Dysphagia Code first, if applicable, dysphagia due to late effect of CVA (438.82) Dysphagia, unspecified Dysphagia, oral phase Dysphagia, oropharyngeal phase Dysphagia, pharyngeal phase Dysphagia, pharyngoesophageal phase Other dysphagia Cervical dysphagia Neurogenic dysphagia Nonspecific Abnormal Findings ( ) 794 Nonspecific abnormal results of function studies Brain and central nervous system Abnormal function study, unspecified Other Abnormal brain scan Peripheral nervous system and special senses Abnormal visually evoked potential Abnormal auditory function studies Abnormal vestibular function studies Ill-Defined and Unknown Causes of Morbidity and Mortality ( ) Chapter 2: ICD-9-CM Diagnostic Codes 2016 Coding and Billing for Audiology and Speech-Language Pathology 27

33 Chapter 2: ICD-9-CM Diagnostic Codes 797 Senility without mention of psychosis Frailty Old age Senescence Senile asthenia Senile: debility exhaustion Excludes: senile psychoses ( ) 799 Other ill-defined and unknown causes of morbidity and mortality Signs and symptoms involving cognition Excludes: amnesia (780.93) amnestic syndrome (294.0) attention deficit disorder ( ) late effects of cerebrovascular disease (438) memory loss (780.93) mild cognitive impairment, so stated (331.83) specific problems in developmental delay ( ) transient global amnesia (437.7) visuospatial neglect (781.8) Attention or concentration deficit Cognitive communication deficit Visuospatial deficit Psychomotor deficit Frontal lobe and executive function deficit Other signs and symptoms involving cognition Ch. 17 Injury and Poisoning ( ) Fracture of Skull ( ) 800 Fracture of vault skull 801 Fracture of base skull 802 Fracture of face bones 803 Other and unqualified skull fractures 804 Multiple fractures involving skull or face with other bones Fracture of Neck and Trunk ( ) 805 Fracture of vertebral column without mention of spinal cord injury 807 Fracture of rib(s), sternum, larynx, and trachea Larynx and trachea, closed Hyoid bone Thyroid cartilage Trachea Larynx and trachea, open Intracranial Injury, Excluding Those with Skull Fractures ( ) 850 Concussion 851 Cerebral laceration and contusion 852 Subarachnoid, subdural, and extradural hemorrhage, following injury 853 Other and unspecified intracranial hemorrhage following injury 854 Intracranial injury of other and unspecified nature Includes injury: brain NOS cavernous sinus intracranial traumatic brain NOS Excludes: any condition classifiable to head injury NOS (959.01) Open Wound of Head, Neck, and Trunk ( ) 872 Open wound of ear 873 Other open wound of head 874 Open wound of neck Late Effects of Injuries, Poisonings, Toxic Effects, and Other External Causes ( ) 905 Late effects of musculoskeletal and connective tissue injuries Late effect of fracture of skull and face bones Late effect of injury classifiable to Late effects of injuries to nervous system Late effect of intracranial injury without mention of skull fracture Late effect of injury classifiable to Coding and Billing for Audiology and Speech-Language Pathology

34 Effects of Foreign Body Entering Through Orifice ( ) 931 Foreign body in ear 932 Foreign body in nose 933 Foreign body in pharynx and larynx 934 Foreign body in trachea, bronchus, and lung 935 Foreign body in mouth, esophagus, and stomach Injury to Nerves and Spinal Cord ( ) 951 Injury to other cranial nerve(s) Injury to oculomotor nerve (3rd cranial nerve) Injury to trochlear nerve (4th) Injury to trigeminal nerve (5th) Injury to abducens nerve (6th) Injury to facial nerve (7th) Injury to acoustic nerve (8th) Auditory nerve Traumatic deafness NOS Injury to accessory nerve (11th) Injury to hypoglossal nerve (12th) Injury to other specified cranial nerves Glossopharyngeal (9th) Olfactory (1st) Pneumogastric (10th) Traumatic anosmia NOS Vagus (10th) Injury to unspecified cranial nerve Certain Traumatic Complications and Unspecified Injuries ( ) 959 Certain early complications of trauma Head, face, and neck Head injury, unspecified Excludes: concussion ( ) with head injury NOS ( ) head injury NOS with loss of consciousness ( ) specified head injuries ( ) Unspecified site Complications of Surgical and Medical Care, Not Elsewhere Classified ( ) 997 Complications affecting specified body systems, not elsewhere classifiable Respiratory complications New Code Postprocedural aspiration pneumonia Chemical pneumonitis resulting from a procedure Mendelson s syndrome resulting from a procedure Excludes: aspiration pneumonia during labor and delivery (668.0) Volume 2: V Codes Supplementary Classification of Factors Influencing Health Status and Contact with Health Services (V01-V82) The V codes are provided to deal with occasions when circumstances other than a disease or injury classifiable to categories (the main part of ICD), or to the E codes (supplementary classification of external causes of injury and poisoning), are recorded as diagnoses or problems. This can arise mainly in three ways: a. When a person who is not currently sick encounters the health services for some specific purpose, such as a donor of an organ or tissue, to receive prophylactic vaccination, or to discuss a problem which is in itself not a disease or injury. This will be a fairly rare occurrence among hospital inpatients, but will be relatively more common among hospital outpatients and patients of family practitioners, health clinics, etc. b. When a person with a known disease or injury, whether it is current or resolving, encounters the health care system for a specific treatment of that disease or injury (e.g., dialysis for renal disease; chemotherapy for malignancy; cast change). c. When some circumstance or problem is present which influences the person s health status but is not in itself a current illness or injury. Such factors may be elicited during population surveys, when the person may or may not be currently sick, or be recorded as an additional factor to be borne in mind when the person is receiving care for some current illness or injury classifiable to categories In the latter circumstances, the V code should be used only as a supplementary code and should not be the one selected for use in primary, single cause tabulations. Chapter 2: ICD-9-CM Diagnostic Codes 2016 Coding and Billing for Audiology and Speech-Language Pathology 29

35 Chapter 2: ICD-9-CM Diagnostic Codes Examples of these circumstances are a personal history of certain diseases or a person with an artificial heart valve in situ. Persons with Potential Health Hazards Related to Personal and Family History (V10-V19) V13 Personal history of other diseases V13.6 Congenital (corrected) malformations V13.64 Personal history of (corrected) congenital malformation of eye, ear, face and neck Corrected cleft lip and palate V13.69 Personal history of other (corrected) congenital malformations V15 Other personal history presenting hazards to health V15.5 Injury V15.52 History of traumatic brain injury Persons with a Condition Influencing Their Health Status (V40-V49) Note: These categories are intended for use when these conditions are recorded as diagnoses or problems. V40 Mental and behavioral problems V40.0 Problems with learning V40.1 Problems with communication (including speech) V40.2 Other mental problems V40.3 Other behavioral problems V40.9 Unspecified mental or behavioral problems V41 Problems with special senses and other special functions V41.0 Problems with sight V41.0 Other eye problems V41.2 Problems with hearing V41.3 Other ear problems V41.4 Problems with voice production V41.6 Problems with swallowing and mastication V44 Artificial opening status Excludes artificial openings requiring attention or management (V55.0-V55.9) V44.0 Tracheostomy V44.8 Other artificial opening status V49 Other conditions influencing health status V49.8 Other specified conditions influencing health status V49.85 Dual-sensory impairment Blindness with deafness Combined visual hearing impairment Code first: hearing impairment ( ) visual impairment ( ) Persons Encountering Health Services for Specific Procedures and Aftercare (V50-V59) Note: Categories V51-V58 are intended for use to indicate a reason for care in patients who may have already been treated for some disease or injury not now present or who are receiving care to consolidate the treatment, to deal with residual states, or to prevent recurrence. V52 Fitting and adjustment of prosthetic device and implant V52.8 Other specified prosthetic device V52.9 Unspecified prosthetic device V53 Fitting and adjustment of other device Includes: removal of device replacement of device Excludes: status only, without need for care (V45.0-V45.8) V53.2 Hearing aid V55 Attention to artificial openings Excludes: complications of external stoma ( , , , , 997.5) V55.0 Tracheostomy V55.9 Unspecified artificial opening V57 Care involving use of rehabilitation procedures V57.0 Breathing exercises V57.3 Speech-language therapy V57.8 Other specified rehabilitation procedure V57.9 Unspecified rehabilitation procedure V58 Encounter for other and unspecified procedures V58.1 Chemotherapy Persons Encountering Health Services in Other Circumstances (V60-V69) V67 Follow-up examination Includes: surveillance only following treatment V68 Encounters for administrative purposes V68.0 Issue of medical certificates V68.01 Disability examination V68.2 Request for expert evidence Coding and Billing for Audiology and Speech-Language Pathology

36 V68.8 Other specified administrative purpose V68.81 Referral of patient without examination or treatment V68.89 Other Persons without Reported Diagnosis Encountered During Examination and Investigation of Individuals and Populations (V70-V82) V72 Special investigations and examinations Includes: routine examination of specific system V72.1 Examination of ears and hearing V72.11 Encounter for hearing exam following failed hearing screening V72.12 Encounter for hearing conservation and treatment V72.19 Other exam of ears and hearing V72.83 Other specified preoperative examination ASHA Note: V79 V80 One Medicare Local Coverage Determination (LCD) guides SLPs to use V72.83 to report prelaryngectomy examinations. Check with payers regarding appropriate use of this code. Special screening for mental disorders and other developmental handicaps V79.2 Mental retardation V79.3 Developmental handicaps in early childhood V79.8 Other specified mental disorders and developmental handicaps V79.9 Unspecified mental disorder and developmental handicap Special screening for neurological, eye, and ear diseases V80.1 Neurological conditions V80.01 Traumatic brain injury V80.09 Other neurological conditions V80.3 Ear diseases Excludes: general hearing exam (V72.1) Volume 3: Procedures Volume 3 contains tabular lists of 16 categories of operations or procedures that have been adopted for inpatient procedures reported by hospitals. (4) Operations on the Ear (18-20) 20 Other operations on middle and inner ear 20.3 Diagnostic procedures on middle and inner ear Electrocochleography (6) Operations on the Respiratory System (30-34) 31 Other operations on larynx and trachea 31.4 Diagnostic procedures on larynx and trachea Laryngoscopy and other tracheoscopy Other diagnostic procedure on larynx 31.9 Other operation on larynx and trachea Tracheoesophageal fistulization (16) Miscellaneous. Diagnostic and Therapeutic Procedures (87-99) 87 Diagnostic Radiology 87.6 Other X-ray of digestive system Barium swallow 93 Physical therapy, respiration therapy, rehabilitation, and related procedures 93.7 Speech and reading rehabilitation and rehabilitation of the blind Dyslexia training Dysphasia training Esophageal speech training Speech defect training Other speech training and therapy Other rehabilitation for the blind 93.8 Other rehabilitation therapy Rehabilitation, not elsewhere classified 94 Procedures related to the psyche 94.0 Psychologic evaluation and testing Administration of intelligence test Administration of psychologic test 94.5 Referral for psychologic rehabilitation 95 Ophthalmologic and otologic diagnosis and treatment 95.4 Nonoperative procedures related to hearing Audiometry Bekesy 5-tone audiometry Chapter 2: ICD-9-CM Diagnostic Codes 2016 Coding and Billing for Audiology and Speech-Language Pathology 31

37 Chapter 2: ICD-9-CM Diagnostic Codes Impedance audiometry Stapedial reflex response Subjective audiometry Tympanogram Clinical test of hearing Tuning fork test Whispered speech test Audiological evaluation Audiological evaluation by: Barany noise machine Blindfold test Delayed feedback Masking Weber lateralization Clinical vestibular function tests Thermal test of vestibular function Other auditory and vestibular function tests Hearing examination, not otherwise specified Fitting of hearing aid Excludes: implantation of electromagnetic hearing aid (20.95) Other nonoperative procedures related to hearing Adjustments (external components) of cochlear prosthetic device 97 Replacement and removal of therapeutic appliances 97.3 Nonoperative removal of therapeutic device from head and neck Removal of tracheostomy tube Code to the Highest Degree of Specificity Clinicians who must select ICD-9-CM diagnosis codes should use codes that provide the highest degree of accuracy and completeness or the greatest specificity. That usually means providing an ICD-9-CM code carried to the 5th digit. The Centers for Medicare & Medicaid Services (CMS) require all Medicare practitioners (as do most private payers) to use ICD-9-CM diagnosis codes with the highest specificity as requested by the Health Insurance Portability and Accountability Act (HIPAA). For example, clinicians using code (symbolic dysfunction) to describe language/cognitive impairments of an organic nature may have this code rejected. Because this code category has 5th digit subclassifications, the most appropriate subclassifications should be selected. This might be (symbolic dysfunction, unspecified), (alexia and dyslexia), or (other; acalculia, agnosia, agraphia, apraxia). Code is intended to include multiple diagnoses, some of which may differ significantly, according to David Berglund, MD, MPH, at the National Center for Health Statistics/Centers for Disease Control, but it provides the highest level of specificity in that category and, therefore, should be used instead of Keep in mind that , , and are subclassifications of 784.6; so, when you use those codes you are not excluding Following the specificity rule, therefore, assign 3-digit codes when there are no 4-digit codes within the category. (So far, only one 3-digit code relevant for ASHA members has been found, 931 foreign body in ear.) Assign 4-digit codes if there is no 5th digit subclassification for that category. Assign the 5th digit subclassification code for those categories where it exists. Providers should also be aware that codes marked NOS (not otherwise specified) or unspecified indicate that there is insufficient information in the medical record to assign a more specific code. NEC (not elsewhere classifiable) means that ICD-9-CM does not have a code that describes the condition Coding and Billing for Audiology and Speech-Language Pathology

38 Chapter 3: ICD-10-CM Diagnostic Codes General On October 1, 2015, a new diagnoses code system, the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), replaced the ICD-9-CM set of diagnostic codes currently in place. ICD-9-CM is a set of codes used by physicians, hospitals, and health care professionals to indicate diagnoses for all patient encounters. ASHA prepared this document of ICD- 10-CM codes for speech-language and hearing disorders. The new classification system provides significant changes that all health care providers, including ASHA members, must understand. The ICD-10-CM codes are very different from the current ICD-9-CM codes; for example, ICD-10-CM codes are based on an alpha-numeric system. There may be up to seven alpha-numeric characters, requiring billing software program changes to accommodate the additional digits, as well as extensive coder training. There will be little change in what the physician documents in the medical record; it is how the information is translated into ICD-10 coding that will change. ICD-10-CM codes will be able to provide more in-depth information about the patient s condition that can be more easily captured in an electronic medical record. Physician (CMS 1500) and hospital or facility (UB-04) billing forms have been updated to accommodate the changes. ICD-10-CM is based on the World Health Organization s Tenth Revision, International Classification of Diseases (ICD-10). The intent of ICD-10-CM is to standardize disease and procedure classification throughout the United States and to gather data about basic health statistics. The National Center for Health Statistics (NCHS) and the Centers for Medicare & Medicaid Services (CMS) are the U.S. governmental agencies responsible for overseeing all changes and modifications to the ICD-10-CM. Use of Codes Audiologists and speech-language pathologists use ICD-10-CM codes to describe and bill for services. The Health Insurance Portability and Accountability Act (HIPAA) requires that the ICD-10-CM be used for health services billing and recordkeeping. As was the case with the ICD-9-CM codes, clinicians should use the ICD-10-CM to code to the highest degree of specificity. Note: This is not a comprehensive list of ICD-10-CM codes. A number of codes, such as those for hearing diseases, are included for informational purposes only and may not represent the entire category of codes. Such categories may actually be more extensive. However, in general, the audiology and speech-language pathology diagnoses codes found in this publication are the most specific available for hearing, speech-language, and swallowing problems. Chapter 3: ICD-10-CM Diagnostic Codes Overview The ICD-10 is owned by the World Health Organization (WHO). The clinical modification (ICD-10-CM) was developed by the Centers for Disease Control and Prevention for use in all U.S. health care treatment settings. The procedure coding system (i.e., ICD-9-PCS and ICD-10-PCS) was developed by the Centers for Medicare & Medicaid Services (CMS) for use in the U.S. for inpatient hospital settings only. Scope The intent of ICD-10-CM is to standardize disease and procedure classification throughout the United States and to gather data about basic health statistics. Purpose HIPAA legislation requires the ICD-10-CM to be used for health services billing and record keeping. As noted above, the effective implementation date for ICD-10-CM (and ICD-10-PCS) is October 1, Updates to this version of ICD-10-CM are anticipated prior to its implementation. Relation to Professional Scope of Practice The audiologist and the speech-language pathologist practicing in a health care setting, especially a hospital, may have to code delivery of services according to the ICD-10-CM. ICD-10-CM Guidelines The instructional notations from the published ICD-10-CM Tabular List of Diseases and Injuries can be found at: ( Coding and Billing for Audiology and Speech-Language Pathology 33

39 Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) Includes The word Includes appears immediately under certain categories to further define, or give examples of, the content of the category. Excludes Notes The ICD-10-CM has two types of excludes notes. Each note has a different definition for use but they are both similar in that they indicate that codes excluded from each other are independent of each other. Excludes1 (Never use the listed codes together) A type 1 Excludes note is a pure excludes. It means NOT CODED HERE! An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. Excludes2 (Can use the listed codes together) A type 2 excludes note represents Not included here. An Excludes2 note indicates that the condition excluded is not part of the condition it is excluded from but a patient may have both conditions at the same time. When an Excludes2 note appears under a code it is acceptable to use both the code and the excluded code together. Code First/Use Additional Code Notes (etiology/manifestation paired codes) Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists there is a use additional code note at the etiology code and a code first note at the manifestation code. These instructional notes indicate the proper sequencing order of the code etiology followed by manifestation. In most cases the manifestation codes will have in the code title, in diseases classified elsewhere. Codes with this title are a component of the etiology/manifestation convention. The code title indicates that it is a manifestation code. In diseases classified elsewhere codes are never permitted to be used as first listed or principal diagnosis codes. They must be used in conjunction with an underlying condition code and they must be listed following the underlying condition. Code Also A code also note instructs that 2 codes may be required to fully describe a condition, but the sequencing of the two codes is discretionary, depending on the severity of the conditions and the reason for the encounter. 7th Characters and Placeholder X For codes less than 6 characters that require a 7th character a placeholder X should be assigned for all characters less than 6. The 7th character must always be the 7th character of a code. ASHA Note: Certain ICD-10-CM categories have applicable 7th characters. The seventh character of ICD-10 is often a required character in codes involving, for example, injuries and poisonings (Chapter 19, S00-T88). The purpose of the 7th character is to communicate to the payer the type of encounter such as initial (A), subsequent (D), or sequela (S). Official ICD-10-CM Websites National Center for Health Statistics: Centers for Medicare & Medicaid Services: ICD-10-CM Official Guidelines for Coding and Reporting: ASHA Resources ICD-9 to ICD-10 Mapping Tool for Audiologists and Speech-Language Pathologists: ICD-10-CM Diagnosis Codes for Audiology and Speech-Language Pathology: Coding and Billing for Audiology and Speech-Language Pathology

40 ICD-9-CM Diagnosis Codes for Audiology: ICD-9-CM Diagnosis Codes for SLP: Coding Normal Results: Coding to the Highest Degree of Specificity: ICD-10-CM Diagnostic Codes: Audiology ICD-10-CM Tabular List of Diseases and Injuries Related to hearing and vestibular disorders Note: This is not a comprehensive list and a number of codes are included for information purposes only. Some categories of codes (e.g., specific ear diseases) may be more extensive, contain additional instructional notes, and may also require coding to a higher degree of specificity than indicated here. However, in general, audiology related diagnoses will be listed to their highest level of specificity. For a full list of ICD-10-CM codes, descriptors, and instructions, see the official ICD-10-CM publication at Code typically used by audiologists Additional digits not listed here Ch. 6 Diseases of the nervous system (G00-G99) Other disorders of the nervous system (G89-G99) G96 Other disorders of central nervous system G96.0 Cerebrospinal fluid leak Excludes1: cerebrospinal fluid leak from spinal puncture (G97.0) Ch. 8 Diseases of the ear and mastoid process (H60-H95) Note: Use an external cause code following the code for the ear condition, if applicable, to identify the cause of the ear condition Excludes2: certain conditions originating in the perinatal period (P04-P96) certain infectious and parasitic diseases (A00-B99) complications of pregnancy, childbirth and the puerperium (O00-O9A) congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) endocrine, nutritional and metabolic diseases (E00-E88) injury, poisoning and certain other consequences of external causes (S00-T88) neoplasms (C00-D49) symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94) This chapter contains the following blocks: H60-H62: Diseases of external ear H65-H75: Diseases of middle ear and mastoid H80-H83: Diseases of inner ear H90-H94: Other disorders of ear H95: Intraoperative and postprocedural complications and disorders of ear and mastoid process, not elsewhere classified Diseases of external ear (H60-H62) H60 Otitis externa Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) 2016 Coding and Billing for Audiology and Speech-Language Pathology 35

41 Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) H60.0 Abscess of external ear Boil of external ear Carbuncle of auricle or external auditory canal Furuncle of external ear H60.00 Abscess of external ear, unspecified ear H60.01 Abscess of right external ear H60.02 Abscess of left external ear H60.03 Abscess of external ear, bilateral H60.1 Cellulitis of external ear Cellulitis of auricle Cellulitis of external auditory canal H60.10 Cellulitis of external ear, unspecified ear H60.11 Cellulitis of right external ear H60.12 Cellulitis of left external ear H60.13 Cellulitis of external ear, bilateral H60.2 Malignant otitis externa H60.20 Malignant otitis externa, unspecified ear H60.21 Malignant otitis externa, right ear H60.22 Malignant otitis externa, left ear H60.23 Malignant otitis externa, bilateral H60.3 Other infective otitis externa H60.31 Diffuse otitis externa H Diffuse otitis externa, right ear H Diffuse otitis externa, left ear H Diffuse otitis externa, bilateral H Diffuse otitis externa, unspecified ear H60.32 Hemorrhagic otitis externa H Hemorrhagic otitis externa, right ear H Hemorrhagic otitis externa, left ear H Hemorrhagic otitis externa, bilateral H Hemorrhagic otitis externa, unspecified ear H60.33 Swimmer s ear H Swimmer s ear, right ear H Swimmer s ear, left ear H Swimmer s ear, bilateral H Swimmer s ear, unspecified ear H60.39 Other infective otitis externa H Other infective otitis externa, right ear H Other infective otitis externa, left ear H Other infective otitis externa, bilateral H Other infective otitis externa, unspecified ear H60.4 Cholesteatoma of external ear Keratosis obturans of external ear (canal) Coding and Billing for Audiology and Speech-Language Pathology

42 Excludes2: cholesteatoma of middle ear (H71.-) recurrent cholesteatoma of postmastoidectomy cavity (H95.0-) H60.40 Cholesteatoma of external ear, unspecified ear H60.41 Cholesteatoma of right external ear H60.42 Cholesteatoma of left external ear H60.43 Cholesteatoma of external ear, bilateral H60.5 Acute noninfective otitis externa H60.6 Unspecified chronic otitis externa H60.8 Other otitis externa H60.9 Unspecified otitis externa H61 Other disorders of external ear H61.0 Chondritis and perichondritis of external ear Chondrodermatitis nodularis chronica helicis Perichondritis of auricle Perichondritis of pinna H61.00 Unspecified perichondritis of external ear H Unspecified perichondritis of right external ear H Unspecified perichondritis of left external ear H Unspecified perichondritis of external ear, bilateral H Unspecified perichondritis of external ear, unspecified ear H61.01 Acute perichondritis of external ear H Acute perichondritis of right external ear H Acute perichondritis of left external ear H Acute perichondritis of external ear, bilateral H Acute perichondritis of external ear, unspecified ear H61.02 Chronic perichondritis of external ear H Chronic perichondritis of right external ear H Chronic perichondritis of left external ear H Chronic perichondritis of external ear, bilateral H Chronic perichondritis of external ear, unspecified ear H61.03 Chondritis of external ear Chondritis of auricle Chondritis of pinna H Chondritis of right external ear H Chondritis of left external ear H Chondritis of external ear, bilateral H Chondritis of external ear, unspecified ear H61.1 Noninfective disorders of pinna Excludes2: cauliflower ear (M95.1-) gouty tophi of ear ( M1A-, M10.-) H61.10 Unspecified noninfective disorders of pinna Disorder of pinna NOS H Unspecified noninfective disorders of pinna, right ear Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) 2016 Coding and Billing for Audiology and Speech-Language Pathology 37

43 Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) H Unspecified noninfective disorders of pinna, left ear H Unspecified noninfective disorders of pinna, bilateral H Unspecified noninfective disorders of pinna, unspecified ear H61.11 Acquired deformity of pinna Acquired deformity of auricle Excludes2: cauliflower ear (M95.1-) H Acquired deformity of pinna, right ear H Acquired deformity of pinna, left ear H Acquired deformity of pinna, bilateral H Acquired deformity of pinna, unspecified ear H61.12 Hematoma of pinna Hematoma of auricle H Hematoma of pinna, right ear H Hematoma of pinna, left ear H Hematoma of pinna, bilateral H Hematoma of pinna, unspecified ear H61.19 Other noninfective disorders of pinna H Noninfective disorders of pinna, right ear H Noninfective disorders of pinna, left ear H Noninfective disorders of pinna, bilateral H Noninfective disorders of pinna, unspecified ear H61.2 Impacted cerumen Wax in ear H61.20 Impacted cerumen, unspecified ear H61.21 Impacted cerumen, right ear H61.22 Impacted cerumen, left ear H61.23 Impacted cerumen, bilateral H61.3 Acquired stenosis of external ear canal Collapse of external ear canal Excludes1: postprocedural stenosis of external ear canal (H95.81-) H61.30 Acquired stenosis of external ear canal, unspecified H Acquired stenosis of right external ear canal, unspecified H Acquired stenosis of left external ear canal, unspecified H Acquired stenosis of external ear canal, unspecified, bilateral H Acquired stenosis of external ear canal, unspecified, unspecified ear H61.31 Acquired stenosis of external ear canal secondary to trauma H Acquired stenosis of right external ear canal secondary to trauma H Acquired stenosis of left external ear canal secondary to trauma H Acquired stenosis of external ear canal secondary to trauma, bilateral Coding and Billing for Audiology and Speech-Language Pathology

44 H Acquired stenosis of external ear canal secondary to trauma, unspecified ear H61.32 Acquired stenosis of external ear canal secondary to inflammation and infection H Acquired stenosis of right external ear canal secondary to inflammation and infection H Acquired stenosis of left external ear canal secondary to inflammation and infection H Acquired stenosis of external ear canal secondary to inflammation and infection, bilateral H Acquired stenosis of external ear canal secondary to inflammation and infection, unspecified ear H61.39 Other acquired stenosis of external ear canal H Other acquired stenosis of right external ear canal H Other acquired stenosis of left external ear canal H Other acquired stenosis of external ear canal, bilateral H Other acquired stenosis of external ear canal, unspecified ear H61.8 Other specified disorders of external ear H61.81 Exostosis of external canal H Exostosis of right external canal H Exostosis of left external canal H Exostosis of external canal, bilateral H Exostosis of external canal, unspecified ear H61.89 Other specified disorders of external ear H Other specified disorders of right external ear H Other specified disorders of left external ear H Other specified disorders of external ear, bilateral H Other specified disorders of external ear, unspecified ear H61.9 Disorder of external ear, unspecified H61.90 Disorder of external ear, unspecified, unspecified ear H61.91 Disorder of right external ear, unspecified H61.92 Disorder of left external ear, unspecified H61.93 Disorder of external ear, unspecified, bilateral H62 Disorders of external ear in diseases classified elsewhere Diseases of middle ear and mastoid (H65-H75) H65 Nonsuppurative otitis media Includes: nonsuppurative otitis media with myringitis Use additional code for any associated perforated tympanic membrane (H72.-) Use additional code to identify: exposure to environmental tobacco smoke (Z77.22) exposure to tobacco smoke in the perinatal period (P96.81) history of tobacco use (Z87.891) occupational exposure to environmental tobacco smoke (Z57.31) Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) 2016 Coding and Billing for Audiology and Speech-Language Pathology 39

45 Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) tobacco dependence (F17.-) tobacco use (Z72.0) H65.0 Acute serous otitis media Acute and subacute secretory otitis H65.00 Acute serous otitis media, unspecified ear H65.01 Acute serous otitis media, right ear H65.02 Acute serous otitis media, left ear H65.03 Acute serous otitis media, bilateral H65.04 Acute serous otitis media, recurrent, right ear H65.05 Acute serous otitis media, recurrent, left ear H65.06 Acute serous otitis media, recurrent, bilateral H65.07 Acute serous otitis media, recurrent, unspecified ear H65.1 Other acute nonsuppurative otitis media Excludes1: otitic barotrauma (T70.0) otitis media (acute) NOS (H66.9) H65.11 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous) H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), left ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), bilateral H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, right ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, left ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, bilateral H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, unspecified ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), unspecified ear H65.19 Other acute nonsuppurative otitis media Acute and subacute mucoid otitis media Acute and subacute nonsuppurative otitis media NOS Acute and subacute sanguinous otitis media Acute and subacute seromucinous otitis media H Other acute nonsuppura-tive otitis media, right ear H Other acute nonsuppura-tive otitis media, left ear H Other acute nonsuppura-tive otitis media, bilateral H Other acute nonsuppura-tive otitis media, recurrent, right ear H Other acute nonsuppura-tive otitis media, recurrent, left ear H Other acute nonsuppura-tive otitis media, recurrent, bilateral Coding and Billing for Audiology and Speech-Language Pathology

46 H Other acute nonsuppura-tive otitis media recurrent, unspecified ear H Other acute nonsuppura-tive otitis media, unspecified ear H65.2 Chronic serous otitis media Chronic tubotympanal catarrh H65.20 Chronic serous otitis media, unspecified ear H65.21 Chronic serous otitis media, right ear H65.22 Chronic serous otitis media, left ear H65.23 Chronic serous otitis media, bilateral H65.3 Chronic mucoid otitis media Chronic mucinous otitis media Chronic secretory otitis media Chronic transudative otitis media Glue ear Excludes1: adhesive middle ear disease (H74.1) H65.30 Chronic mucoid otitis media, unspecified ear H65.31 Chronic mucoid otitis media, right ear H65.32 Chronic mucoid otitis media, left ear H65.33 Chronic mucoid otitis media, bilateral H65.4 Other chronic nonsuppurative otitis media H65.41 Chronic allergic otitis media H Chronic allergic otitis media, right ear H Chronic allergic otitis media, left ear H Chronic allergic otitis media, bilateral H Chronic allergic otitis media, unspecified ear H65.49 Other chronic nonsuppurative otitis media Chronic exudative otitis media Chronic nonsuppurative otitis media NOS Chronic otitis media with effusion (nonpurulent) Chronic seromucinous otitis media H Other chronic nonsuppura-tive otitis media, right ear H Other chronic nonsuppura-tive otitis media, left ear H Other chronic nonsuppura-tive otitis media, bilateral H Other chronic nonsuppura-tive otitis media, unspecified ear H65.9 Unspecified nonsuppurative otitis media Allergic otitis media NOS Catarrhal otitis media NOS Exudative otitis media NOS Mucoid otitis media NOS Otitis media with effusion (nonpurulent) NOS Secretory otitis media NOS Seromucinous otitis media NOS Serous otitis media NOS Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) 2016 Coding and Billing for Audiology and Speech-Language Pathology 41

47 Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) Transudative otitis media NOS H65.90 Unspecified nonsuppurative otitis media, unspecified ear H65.91 Unspecified nonsuppurative otitis media, right ear H65.92 Unspecified nonsuppurative otitis media, left ear H65.93 Unspecified nonsuppurative otitis media, bilateral H66 Suppurative and unspecified otitis media Includes: suppurative and unspecified otitis media with myringitis Use additional code for any associated perforated tympanic membrane (H72.-) Use additional code to identify: exposure to environmental tobacco smoke (Z77.22) exposure to tobacco smoke in the perinatal period (P96.81) history of tobacco use (Z87.891) occupational exposure to environmental tobacco smoke (Z57.31) tobacco dependence (F17.-) tobacco use (Z72.0) H66.0 Acute suppurative otitis media H66.00 Acute suppurative otitis media without spontaneous rupture of ear drum H Acute suppurative otitis media without spontaneous rupture of ear drum, right ear H Acute suppurative otitis media without spontaneous rupture of ear drum, left ear H Acute suppurative otitis media without spontaneous rupture of ear drum, bilateral H Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear H Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left ear H Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, bilateral H Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, unspecified ear H Acute suppurative otitis media without spontaneous rupture of ear drum, unspecified ear H66.01 Acute suppurative otitis media with spontaneous rupture of ear drum H Acute suppurative otitis media with spontaneous rupture of ear drum, right ear H Acute suppurative otitis media with spontaneous rupture of ear drum, left ear H Acute suppurative otitis media with spontaneous rupture of ear drum, bilateral H Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, right ear H Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, left ear H Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, bilateral Coding and Billing for Audiology and Speech-Language Pathology

48 H Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, unspecified ear H Acute suppurative otitis media with spontaneous rupture of ear drum, unspecified ear H66.1 Chronic tubotympanic suppurative otitis media Benign chronic suppurative otitis media Chronic tubotympanic disease H66.10 Chronic tubotympanic suppurative otitis media, unspecified H66.11 Chronic tubotympanic suppurative otitis media, right ear H66.12 Chronic tubotympanic suppurative otitis media, left ear H66.13 Chronic tubotympanic suppurative otitis media, bilateral H66.2 Chronic atticoantral suppurative otitis media Chronic atticoantral disease H66.20 Chronic atticoantral suppurative otitis media, unspecified ear H66.21 Chronic atticoantral suppurative otitis media, right ear H66.22 Chronic atticoantral suppurative otitis media, left ear H66.23 Chronic atticoantral suppurative otitis media, bilateral H66.3 Other chronic suppurative otitis media Chronic suppurative otitis media NOS Excludes1: tuberculous otitis media (A18.6) H66.3X Other chronic suppurative otitis media H66.3X1 Other chronic suppurative otitis media, right ear H66.3X2 Other chronic suppurative otitis media, left ear H66.3X3 Other chronic suppurative otitis media, bilateral H66.3X9 Other chronic suppurative otitis media, unspecified ear H66.4 Suppurative otitis media, unspecified Purulent otitis media NOS H66.40 Suppurative otitis media, unspecified, unspecified ear H66.41 Suppurative otitis media, unspecified, right ear H66.42 Suppurative otitis media, unspecified, left ear H66.43 Suppurative otitis media, unspecified, bilateral H66.9 Otitis media, unspecified Otitis media NOS Acute otitis media NOS Chronic otitis media NOS H66.90 Otitis media, unspecified, unspecified ear H66.91 Otitis media, unspecified, right ear H66.92 Otitis media, unspecified, left ear H66.93 Otitis media, unspecified, bilateral H67 Otitis media in diseases classified elsewhere Code first underlying disease, such as: viral disease NEC (B00-B34) Use additional code for any associated perforated tympanic membrane (H72.-) Excludes1: otitis media in: influenza (J09.X9, J10.83, J11.83) Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) 2016 Coding and Billing for Audiology and Speech-Language Pathology 43

49 Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) measles (B05.3) scarlet fever (A38.0) tuberculosis (A18.6) H67.1 Otitis media in diseases classified elsewhere, right ear H67.2 Otitis media in diseases classified elsewhere, left ear H67.3 Otitis media in diseases classified elsewhere, bilateral H67.9 Otitis media in diseases classified elsewhere, unspecified ear H68 Eustachian salpingitis and obstruction H68.0 Eustachian salpingitis H68.00 Unspecified Eustachian salpingitis H Unspecified Eustachian salpingitis, right ear H Unspecified Eustachian salpingitis, left ear H Unspecified Eustachian salpingitis, bilateral H Unspecified Eustachian salpingitis, unspecified ear H68.01 Acute Eustachian salpingitis H Acute Eustachian salpingitis, right ear H Acute Eustachian salpingitis, left ear H Acute Eustachian salpingitis, bilateral H Acute Eustachian salpingitis, unspecified ear H68.02 Chronic Eustachian salpingitis H Chronic Eustachian salpingitis, right ear H Chronic Eustachian salpingitis, left ear H Chronic Eustachian salpingitis, bilateral H Chronic Eustachian salpingitis, unspecified ear H68.1 Obstruction of Eustachian tube Stenosis of Eustachian tube Stricture of Eustachian tube H68.10 Unspecified obstruction of Eustachian tube H Unspecified obstruction of Eustachian tube, right ear H Unspecified obstruction of Eustachian tube, left ear H Unspecified obstruction of Eustachian tube, bilateral H Unspecified obstruction of Eustachian tube, unspecified ear H68.11 Osseous obstruction of Eustachian tube H Osseous obstruction of Eustachian tube, right ear H Osseous obstruction of Eustachian tube, left ear H Osseous obstruction of Eustachian tube, bilateral H Osseous obstruction of Eustachian tube, unspecified ear H68.12 Intrinsic cartilagenous obstruction of Eustachian tube H Intrinsic cartilagenous obstruction of Eustachian tube, right ear H Intrinsic cartilagenous obstruction of Eustachian tube, left ear H Intrinsic cartilagenous obstruction of Eustachian tube, bilateral Coding and Billing for Audiology and Speech-Language Pathology

50 H Intrinsic cartilagenous obstruction of Eustachian tube, unspecified ear H68.13 Extrinsic cartilagenous obstruction of Eustachian tube Compression of Eustachian tube H Extrinsic cartilagenous obstruction of Eustachian tube, right ear H Extrinsic cartilagenous obstruction of Eustachian tube, left ear H Extrinsic cartilagenous obstruction of Eustachian tube, bilateral H Extrinsic cartilagenous obstruction of Eustachian tube, unspecified ear H69 Other and unspecified disorders of Eustachian tube H69.0 Patulous Eustachian tube H69.00 Patulous Eustachian tube, unspecified ear H69.01 Patulous Eustachian tube, right ear H69.02 Patulous Eustachian tube, left ear H69.03 Patulous Eustachian tube, bilateral H69.8 Other specified disorders of Eustachian tube H69.80 Other specified disorders of Eustachian tube, unspecified ear H69.81 Other specified disorders of Eustachian tube, right ear H69.82 Other specified disorders of Eustachian tube, left ear H69.83 Other specified disorders of Eustachian tube, bilateral H69.9 Unspecified Eustachian tube disorder H69.90 Unspecified Eustachian tube disorder, unspecified ear H69.91 Unspecified Eustachian tube disorder, right ear H69.92 Unspecified Eustachian tube disorder, left ear H69.93 Unspecified Eustachian tube disorder, bilateral H70 Mastoiditis and related conditions H70.0 Acute mastoiditis Abscess of mastoid Empyema of mastoid H70.00 Acute mastoiditis without complications H Acute mastoiditis without complications, right ear H Acute mastoiditis without complications, left ear H Acute mastoiditis without complications, bilateral H Acute mastoiditis without complications, unspecified ear H70.01 Subperiosteal abscess of mastoid H Subperiosteal abscess of mastoid, right ear H Subperiosteal abscess of mastoid, left ear H Subperiosteal abscess of mastoid, bilateral H Subperiosteal abscess of mastoid, unspecified ear H70.09 Acute mastoiditis with other complications H Acute mastoiditis with other complications, right ear H Acute mastoiditis with other complications, left ear Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) 2016 Coding and Billing for Audiology and Speech-Language Pathology 45

51 Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) H Acute mastoiditis with other complications, bilateral H Acute mastoiditis with other complications, unspecified ear H70.1 Chronic mastoiditis Caries of mastoid Fistula of mastoid Excludes1: tuberculous mastoiditis (A18.03) H70.10 Chronic mastoiditis, unspecified ear H70.11 Chronic mastoiditis, right ear H70.12 Chronic mastoiditis, left ear H70.13 Chronic mastoiditis, bilateral H70.2 Petrositis Inflammation of petrous bone H70.20 Unspecified petrositis H Unspecified petrositis, right ear H Unspecified petrositis, left ear H Unspecified petrositis, bilateral H Unspecified petrositis, unspecified ear H70.21 Acute petrositis H Acute petrositis, right ear H Acute petrositis, left ear H Acute petrositis, bilateral H Acute petrositis, unspecified ear H70.22 Chronic petrositis H Chronic petrositis, right ear H Chronic petrositis, left ear H Chronic petrositis, bilateral H Chronic petrositis, unspecified ear H70.8 Other mastoiditis and related conditions Excludes1: preauricular sinus and cyst (Q18.1) sinus, fistula, and cyst of branchial cleft (Q18.0) H70.81 Postauricular fistula H Postauricular fistula, right ear H Postauricular fistula, left ear H Postauricular fistula, bilateral H Postauricular fistula, unspecified ear H70.89 Other mastoiditis and related conditions H Other mastoiditis and related conditions, right ear H Other mastoiditis and related conditions, left ear H Other mastoiditis and related conditions, bilateral H Other mastoiditis and related conditions, unspecified ear H70.9 Unspecified mastoiditis H70.90 Unspecified mastoiditis, unspecified ear Coding and Billing for Audiology and Speech-Language Pathology

52 H70.91 Unspecified mastoiditis, right ear H70.92 Unspecified mastoiditis, left ear H70.93 Unspecified mastoiditis, bilateral H71.2 Cholesteatoma of mastoid H71.20 Cholesteatoma of mastoid, unspecified ear H71.21 Cholesteatoma of mastoid, right ear H71.22 Cholesteatoma of mastoid, left ear H71.23 Cholesteatoma of mastoid, bilateral H71.3 Diffuse cholesteatosis H71.30 Diffuse cholesteatosis, unspecified ear H71.31 Diffuse cholesteatosis, right ear H71.32 Diffuse cholesteatosis, left ear H71.33 Diffuse cholesteatosis, bilateral H71.9 Unspecified cholesteatoma H71.90 Unspecified cholesteatoma, unspecified ear H71.91 Unspecified cholesteatoma, right ear H71.92 Unspecified cholesteatoma, left ear H71.93 Unspecified cholesteatoma, bilateral H72 Perforation of tympanic membrane Includes: persistent post-traumatic perforation of ear drum postinflammatory perforation of ear drum Code first any associated otitis media (H65.-, H66.1-, H66.2-, H66.3-, H66.4-, H66.9-, H67.-) Excludes1: acute suppurative otitis media with rupture of the tympanic membrane (H66.01-) traumatic rupture of ear drum (S09.2-) H72.0 Central perforation of tympanic membrane H72.00 Central perforation of tympanic membrane, unspecified ear H72.01 Central perforation of tympanic membrane, right ear H72.02 Central perforation of tympanic membrane, left ear H72.03 Central perforation of tympanic membrane, bilateral H72.1 Attic perforation of tympanic membrane Perforation of pars flaccida H72.10 Attic perforation of tympanic membrane, unspecified ear H72.11 Attic perforation of tympanic membrane, right ear H72.12 Attic perforation of tympanic membrane, left ear H72.13 Attic perforation of tympanic membrane, bilateral H72.2 Other marginal perforations of tympanic membrane H72.2X Other marginal perforations of tympanic membrane H72.2X1 Other marginal perforations of tympanic membrane, right ear H72.2X2 Other marginal perforations of tympanic membrane, left ear H72.2X3 Other marginal perforations of tympanic membrane, bilateral Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) 2016 Coding and Billing for Audiology and Speech-Language Pathology 47

53 Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) H72.2X9 Other marginal perforations of tympanic membrane, unspecified ear H72.8 Other perforations of tympanic membrane H72.81 Multiple perforations of tympanic membrane H Multiple perforations of tympanic membrane, right ear H Multiple perforations of tympanic membrane, left ear H Multiple perforations of tympanic membrane, bilateral H Multiple perforations of tympanic membrane, unspecified ear H72.82 Total perforations of tympanic membrane H Total perforations of tympanic membrane, right ear H Total perforations of tympanic membrane, left ear H Total perforations of tympanic membrane, bilateral H Total perforations of tympanic membrane, unspecified ear H72.9 Unspecified perforation of tympanic membrane H72.90 Unspecified perforation of tympanic membrane, unspecified ear H72.91 Unspecified perforation of tympanic membrane, right ear H72.92 Unspecified perforation of tympanic membrane, left ear H72.93 Unspecified perforation of tympanic membrane, bilateral H73 Other disorders of tympanic membrane H73.0 Acute myringitis Excludes1: acute myringitis with otitis media (H65, H66) H73.00 Unspecified acute myringitis Acute tympanitis NOS H Acute myringitis, right ear H Acute myringitis, left ear H Acute myringitis, bilateral H Acute myringitis, unspecified ear H73.01 Bullous myringitis H Bullous myringitis, right ear H Bullous myringitis, left ear H Bullous myringitis, bilateral H Bullous myringitis, unspecified ear H73.09 Other acute myringitis H Other acute myringitis, right ear H Other acute myringitis, left ear H Other acute myringitis, bilateral H Other acute myringitis, unspecified ear H73.1 Chronic myringitis Chronic tympanitis Excludes1: chronic myringitis with otitis media (H65, H66) H73.10 Chronic myringitis, unspecified ear H73.11 Chronic myringitis, right ear Coding and Billing for Audiology and Speech-Language Pathology

54 H73.12 Chronic myringitis, left ear H73.13 Chronic myringitis, bilateral H73.2 Unspecified myringitis H73.20 Unspecified myringitis, unspecified ear H73.21 Unspecified myringitis, right ear H73.22 Unspecified myringitis, left ear H73.23 Unspecified myringitis, bilateral H73.8 Other specified disorders of tympanic membrane H73.81 Atrophic flaccid tympanic membrane H Atrophic flaccid tympanic membrane, right ear H Atrophic flaccid tympanic membrane, left ear H Atrophic flaccid tympanic membrane, bilateral H Atrophic flaccid tympanic membrane, unspecified ear H73.82 Atrophic nonflaccid tympanic membrane H Atrophic nonflaccid tympanic membrane, right ear H Atrophic nonflaccid tympanic membrane, left ear H Atrophic nonflaccid tympanic membrane, bilateral H Atrophic nonflaccid tympanic membrane, unspecified ear H73.89 Other specified disorders of tympanic membrane H Other specified disorders of tympanic membrane, right ear H Other specified disorders of tympanic membrane, left ear H Other specified disorders of tympanic membrane, bilateral H Other specified disorders of tympanic membrane, unspecified ear H73.9 Unspecified disorder of tympanic membrane H73.90 Unspecified disorder of tympanic membrane, unspecified ear H73.91 Unspecified disorder of tympanic membrane, right ear H73.92 Unspecified disorder of tympanic membrane, left ear H73.93 Unspecified disorder of tympanic membrane, bilateral H74 Other disorders of middle ear mastoid Excludes2: mastoiditis (H70.-) H74.0 Tympanosclerosis H74.01 Tympanosclerosis, right ear H74.02 Tympanosclerosis, left ear H74.03 Tympanosclerosis, bilateral H74.09 Tympanosclerosis, unspecified ear H74.1 Adhesive middle ear disease Adhesive otitis Excludes1: glue ear (H65.3-) H74.11 Adhesive right middle ear disease H74.12 Adhesive left middle ear disease H74.13 Adhesive middle ear disease, bilateral Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) 2016 Coding and Billing for Audiology and Speech-Language Pathology 49

55 Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) H74.19 Adhesive middle ear disease, unspecified ear H74.2 Discontinuity and dislocation of ear ossicles H74.20 Discontinuity and dislocation of ear ossicles, unspecified ear H74.21 Discontinuity and dislocation of right ear ossicles H74.22 Discontinuity and dislocation of left ear ossicles H74.23 Discontinuity and dislocation of ear ossicles, bilateral H74.3 Other acquired abnormalities of ear ossicles H74.31 Ankylosis of ear ossicles H Ankylosis of ear ossicles, right ear H Ankylosis of ear ossicles, left ear H Ankylosis of ear ossicles, bilateral H Ankylosis of ear ossicles, unspecified ear H74.32 Partial loss of ear ossicles H Partial loss of ear ossicles, right ear H Partial loss of ear ossicles, left ear H Partial loss of ear ossicles, bilateral H Partial loss of ear ossicles, unspecified ear H74.39 Other acquired abnormalities of ear ossicles H Other acquired abnormalities of right ear ossicles H Other acquired abnormalities of left ear ossicles H Other acquired abnormalities of ear ossicles, bilateral H Other acquired abnormalities of ear ossicles, unspecified ear H74.4 Polyp of middle ear H74.40 Polyp of middle ear, unspecified ear H74.41 Polyp of right middle ear H74.42 Polyp of left middle ear H74.43 Polyp of middle ear, bilateral H74.8 Other specified disorders of middle ear and mastoid H74.8X Other specified disorders of middle ear and mastoid H74.8X1 Other specified disorders of right middle ear and mastoid H74.8X2 Other specified disorders of left middle ear and mastoid H74.8X3 Other specified disorders of middle ear and mastoid, bilateral H74.8X9 Other specified disorders of middle ear and mastoid, unspecified ear H74.9 Unspecified disorder of middle ear and mastoid H74.90 Unspecified disorder of middle ear and mastoid, unspecified ear H74.91 Unspecified disorder of right middle ear and mastoid H74.92 Unspecified disorder of left middle ear and mastoid H74.93 Unspecified disorder of middle ear and mastoid, bilateral H75 Other disorders of middle ear and mastoid in diseases classified elsewhere Diseases of inner ear (H80-H83) H80 Otosclerosis Coding and Billing for Audiology and Speech-Language Pathology

56 Includes: Otospongiosis H80.0 Otosclerosis involving oval window, nonobliterative H80.00 Otosclerosis involving oval window, nonobliterative, unspecified ear H80.01 Otosclerosis involving oval window, nonobliterative, right ear H80.02 Otosclerosis involving oval window, nonobliterative, left ear H80.03 Otosclerosis involving oval window, nonobliterative, bilateral H80.1 Otosclerosis involving oval window, obliterative H80.10 Otosclerosis involving oval window, obliterative, unspecified ear H80.11 Otosclerosis involving oval window, obliterative, right ear H80.12 Otosclerosis involving oval window, obliterative, left ear H80.13 Otosclerosis involving oval window, obliterative, bilateral H80.2 Cochlear otosclerosis Otosclerosis involving otic capsule Otosclerosis involving round window H80.20 Cochlear otosclerosis, unspecified ear H80.21 Cochlear otosclerosis, right ear H80.22 Cochlear otosclerosis, left ear H80.23 Cochlear otosclerosis, bilateral H80.8 Other otosclerosis H80.80 Other otosclerosis, unspecified ear H80.81 Other otosclerosis, right ear H80.82 Other otosclerosis, left ear H80.83 Other otosclerosis, bilateral H80.9 Unspecified otosclerosis H80.90 Unspecified otosclerosis, unspecified ear H80.91 Unspecified otosclerosis, right ear H80.92 Unspecified otosclerosis, left ear H80.93 Unspecified otosclerosis, bilateral H81 Disorders of vestibular function Excludes1: epidemic vertigo (A88.1) vertigo NOS (R42) H81.0 Ménière s disease Labyrinthine hydrops Ménière s syndrome or vertigo H81.01 Ménière s disease, right ear H81.02 Ménière s disease, left ear H81.03 Ménière s disease, bilateral H81.09 Ménière s disease, unspecified ear H81.1 Benign paroxysmal vertigo H81.10 Benign paroxysmal vertigo, unspecified ear H81.11 Benign paroxysmal vertigo, right ear H81.12 Benign paroxysmal vertigo, left ear H81.13 Benign paroxysmal vertigo, bilateral Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) 2016 Coding and Billing for Audiology and Speech-Language Pathology 51

57 Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) H81.2 Vestibular neuronitis H81.20 Vestibular neuronitis, unspecified ear H81.21 Vestibular neuronitis, right ear H81.22 Vestibular neuronitis, left ear H81.23 Vestibular neuronitis, bilateral H81.3 Other peripheral vertigo H81.31 Aural vertigo H Aural vertigo, right ear H Aural vertigo, left ear H Aural vertigo, bilateral H Aural vertigo, unspecified ear H81.39 Other peripheral vertigo Lermoyez syndrome Otogenic vertigo Peripheral vertigo NOS H Other peripheral vertigo, right ear H Other peripheral vertigo, left ear H Other peripheral vertigo, bilateral H Other peripheral vertigo, unspecified ear H81.4 Vertigo of central origin Central positional nystagmus H81.41 Vertigo of central origin, right ear H81.42 Vertigo of central origin, left ear H81.43 Vertigo of central origin, bilateral H81.49 Vertigo of central origin, unspecified ear H81.8 Other disorders of vestibular function H81.8X Other disorders of vestibular function H81.8X1 Other disorders of vestibular function, right ear H81.8X2 Other disorders of vestibular function, left ear H81.8X3 Other disorders of vestibular function, bilateral H81.8X9 Other disorders of vestibular function, unspecified ear H81.9 Unspecified disorder of vestibular function Vertiginous syndrome NOS H81.90 Unspecified disorder of vestibular function, unspecified ear H81.91 Unspecified disorder of vestibular function, right ear H81.92 Unspecified disorder of vestibular function, left ear H81.93 Unspecified disorder of vestibular function, bilateral H82 Vertiginous syndromes in diseases classified elsewhere Code first underlying disease Excludes1: epidemic vertigo (A88.1) H82.1 Vertiginous syndromes in diseases classified elsewhere, right ear H82.2 Vertiginous syndromes in diseases classified elsewhere, left ear H82.3 Vertiginous syndromes in diseases classified elsewhere, bilateral Coding and Billing for Audiology and Speech-Language Pathology

58 H82.9 Vertiginous syndromes in diseases classified elsewhere, unspecified ear H83 Other diseases of inner ear H83.0 Labyrinthitis H83.01 Labyrinthitis, right ear H83.02 Labyrinthitis, left ear H83.03 Labyrinthitis, bilateral H83.09 Labyrinthitis, unspecified ear H83.1 Labyrinthine fistula H83.11 Labyrinthine fistula, right ear H83.12 Labyrinthine fistula, left ear H83.13 Labyrinthine fistula, bilateral H83.19 Labyrinthine fistula, unspecified ear H83.2 Labyrinthine dysfunction Labyrinthine hypersensitivity Labyrinthine hypofunction Labyrinthine loss of function H83.2X Labyrinthine dysfunction H83.2X1 Labyrinthine dysfunction, right ear H83.2X2 Labyrinthine dysfunction, left ear H83.2X3 Labyrinthine dysfunction, bilateral H83.2X9 Labyrinthine dysfunction, unspecified ear H83.3 Noise effects on inner ear Acoustic trauma of inner ear Noise-induced hearing loss of inner ear H83.3X Noise effects on inner ear H83.3X1 Noise effects on right inner ear H83.3X2 Noise effects on left inner ear H83.3X3 Noise effects on inner ear, bilateral H83.3X9 Noise effects on inner ear, unspecified ear H83.8 Other specified diseases of inner ear H83.8X Other specified diseases of inner ear H83.8X1 Other specified diseases of right inner ear H83.8X2 Other specified diseases of left inner ear H83.8X3 Other specified diseases of inner ear, bilateral H83.8X9 Other specified diseases of inner ear, unspecified ear H83.9 Unspecified disease of inner ear H83.90 Unspecified disease of inner ear, unspecified ear H83.91 Unspecified disease of right inner ear H83.92 Unspecified disease of left inner ear H83.93 Unspecified disease of inner ear, bilateral Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) 2016 Coding and Billing for Audiology and Speech-Language Pathology 53

59 Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) Other disorders of ear (H90-H94) H90 Conductive and sensorineural hearing loss Excludes1: deaf nonspeaking NEC (H91.3) deafness NOS (H91.9-) hearing loss NOS (H91.9-) noise-induced hearing loss (H83.3-) ototoxic hearing loss (H91.0-) sudden (idiopathic) hearing loss (H91.2-) H90.0 Conductive hearing loss, bilateral H90.1 Conductive hearing loss, unilateral with unrestricted hearing on the contralateral side H90.11 Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.12 Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side H90.2 Conductive hearing loss, unspecified Conductive deafness NOS H90.3 Sensorineural hearing loss, bilateral H90.4 Sensorineural hearing loss, unilateral with unrestricted hearing on the contralateral side H90.41 Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.42 Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side H90.5 Unspecified sensorineural hearing loss Central hearing loss NOS Congenital deafness NOS Neural hearing loss NOS Perceptive hearing loss NOS Sensorineural deafness NOS Sensory hearing loss NOS Excludes1: abnormal auditory perception (H93.2-) psychogenic deafness (F44.6) H90.6 Mixed conductive and sensorineural hearing loss, bilateral H90.7 Mixed conductive and sensorineural hearing loss, unilateral with unrestricted hearing on the contralateral side H90.71 Mixed conductive and sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.72 Mixed conductive and sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side H90.8 Mixed conductive and sensorineural hearing loss, unspecified H91 Other and unspecified hearing loss Excludes1: abnormal auditory perception (H93.2-) hearing loss as classified in H90.- impacted cerumen (H61.2-) noise-induced hearing loss (H83.3-) Coding and Billing for Audiology and Speech-Language Pathology

60 psychogenic deafness (F44.6) transient ischemic deafness (H93.01-) H91.0 Ototoxic hearing loss Code first poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4 or 6) Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5) H91.01 Ototoxic hearing loss, right ear H91.02 Ototoxic hearing loss, left ear H91.03 Ototoxic hearing loss, bilateral H91.09 Ototoxic hearing loss, unspecified ear H91.1 Presbycusis Presbyacusia H91.10 Presbycusis, unspecified ear H91.11 Presbycusis, right ear H91.12 Presbycusis, left ear H91.13 Presbycusis, bilateral H91.2 Sudden idiopathic hearing loss Sudden hearing loss NOS H91.20 Sudden idiopathic hearing loss, unspecified ear H91.21 Sudden idiopathic hearing loss, right ear H91.22 Sudden idiopathic hearing loss, left ear H91.23 Sudden idiopathic hearing loss, bilateral H91.3 Deaf nonspeaking, not elsewhere classified H91.8 Other specified hearing loss H91.8X Other specified hearing loss H91.8X1 Other specified hearing loss, right ear H91.8X2 Other specified hearing loss, left ear H91.8X3 Other specified hearing loss, bilateral H91.8X9 Other specified hearing loss, unspecified ear H91.9 Unspecified hearing loss Deafness NOS High frequency deafness Unspecified hearing loss Low frequency deafness codes: It is recommended H91.90 Unspecified hearing loss, unspecified ear H91.91 Unspecified hearing loss, right ear that audiologists limit the use of these and other unspecified hearing loss codes to cases where the type H91.92 Unspecified hearing loss, left ear of hearing loss has not yet H91.93 Unspecified hearing loss, bilateral H92 Otalgia and effusion of ear been determined, such as in newborn diagnostics. H92.0 Otalgia H92.01 Otalgia, right ear H92.02 Otalgia, left ear H92.03 Otalgia, bilateral H92.09 Otalgia, unspecified ear Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) 2016 Coding and Billing for Audiology and Speech-Language Pathology 55

61 Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) H92.1 Otorrhea Excludes1: leakage of cerebrospinal fluid through ear (G96.0) H92.10 Otorrhea, unspecified ear H92.11 Otorrhea, right ear H92.12 Otorrhea, left ear H92.13 Otorrhea, bilateral H92.2 Otorrhagia Excludes1: traumatic otorrhagia - code to injury H92.20 Otorrhagia, unspecified ear H92.21 Otorrhagia, right ear H92.22 Otorrhagia, left ear H92.23 Otorrhagia, bilateral H93 Other disorders of ear, not elsewhere classified H93.0 Degenerative and vascular disorders of ear Excludes1: presbycusis (H91.1) H93.01 Transient ischemic deafness H Transient ischemic deafness, right ear H Transient ischemic deafness, left ear H Transient ischemic deafness, bilateral H Transient ischemic deafness, unspecified ear H93.09 Unspecified degenerative and vascular disorders of ear H Unspecified degenerative and vascular disorders of right ear H Unspecified degenerative and vascular disorders of left ear H Unspecified degenerative and vascular disorders of ear, bilateral H Unspecified degenerative and vascular disorders of unspecified ear H93.1 Tinnitus H93.11 Tinnitus, right ear H93.12 Tinnitus, left ear H93.13 Tinnitus, bilateral H93.19 Tinnitus, unspecified ear H93.2 Other abnormal auditory perceptions Excludes2: auditory hallucinations (R44.0) H93.21 Auditory recruitment H Auditory recruitment, right ear H Auditory recruitment, left ear H Auditory recruitment, bilateral H Auditory recruitment, unspecified ear H93.22 Diplacusis H Diplacusis, right ear H Diplacusis, left ear Coding and Billing for Audiology and Speech-Language Pathology

62 H Diplacusis, bilateral H Diplacusis, unspecified ear H93.23 Hyperacusis H Hyperacusis, right ear H Hyperacusis, left ear H Hyperacusis, bilateral H Hyperacusis, unspecified ear H93.24 Temporary auditory threshold shift H Temporary auditory threshold shift, right ear H Temporary auditory threshold shift, left ear H Temporary auditory threshold shift, bilateral H Temporary auditory threshold shift, unspecified ear H93.25 Central auditory processing disorder Congenital auditory imperception Word deafness Central auditory processing disorder now has its own code, H Excludes1: mixed receptive-expressive language disorder (F80.2) H93.29 Other abnormal auditory perceptions H Other abnormal auditory perceptions, right ear H Other abnormal auditory perceptions, left ear H Other abnormal auditory perceptions, bilateral H Other abnormal auditory perceptions, unspecified ear H93.3 Disorders of acoustic nerve Disorder of 8th cranial nerve Excludes1: acoustic neuroma (D33.3) syphilitic acoustic neuritis (A52.15) H93.3X Disorders of acoustic nerve H93.3X1 Disorders of right acoustic nerve H93.3X2 Disorders of left acoustic nerve H93.3X3 Disorders of bilateral acoustic nerves H93.3X9 Disorders of unspecified acoustic nerve H93.8 Other specified disorders of ear H93.8X Other specified disorders of ear H93.8X1 Other specified disorders of right ear H93.8X2 Other specified disorders of left ear H93.8X3 Other specified disorders of ear, bilateral H93.8X9 Other specified disorders of ear, unspecified ear H93.9 Unspecified disorder of ear H93.90 Unspecified disorder of ear, unspecified ear H93.91 Unspecified disorder of right ear H93.92 Unspecified disorder of left ear H93.93 Unspecified disorder of ear, bilateral Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) 2016 Coding and Billing for Audiology and Speech-Language Pathology 57

63 Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) H94 Other disorders of ear in diseases classified elsewhere H94.0 Acoustic neuritis in infectious and parasitic diseases classified elsewhere Code first underlying disease, such as: parasitic disease (B65-B89) Excludes1: acoustic neuritis (in): herpes zoster (B02.29) syphilis (A52.15) H94.00 Acoustic neuritis in infectious and parasitic diseases classified elsewhere, unspecified ear H94.01 Acoustic neuritis in infectious and parasitic diseases classified elsewhere, right ear H94.02 Acoustic neuritis in infectious and parasitic diseases classified elsewhere, left ear H94.03 Acoustic neuritis in infectious and parasitic diseases classified elsewhere, bilateral H94.8 Other specified disorders of ear in diseases classified elsewhere Code first underlying disease, such as: congenital syphilis (A50.0) Excludes1: aural myiasis (B87.4) syphilitic labyrinthitis (A52.79) H94.80 Other specified disorders of ear in diseases classified elsewhere, unspecified ear H94.81 Other specified disorders of right ear in diseases classified elsewhere H94.82 Other specified disorders of left ear in diseases classified elsewhere H94.83 Other specified disorders of ear in diseases classified elsewhere, bilateral Intraoperative and postprocedural complications and disorders of ear and mastoid process, not elsewhere classified (H95) H95 Intraoperative and postprocedural complications and disorders of ear and mastoid process, not elsewhere classified H95.0 Recurrent cholesteatoma of postmastoidectomy cavity H95.1 Other disorders of ear and mastoid process following mastoidectomy H95.2 Intraoperative hemorrhage and hematoma of ear and mastoid process complicating a procedure H95.3 Accidental puncture and laceration of ear and mastoid process during a procedure H95.4 Postprocedural hemorrhage and hematoma of ear and mastoid process following a procedure H95.8 Other intraoperative and postprocedural complications and disorders of the ear and mastoid process, not elsewhere classified Ch. 17 Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) Congenital malformations of eye, ear, face and neck (Q10-Q18) Q16 Congenital malformations of ear causing impairment of hearing Excludes1: congenital deafness (H90.-) Q16.0 Congenital absence of (ear) auricle Q16.1 Congenital absence, atresia and stricture of auditory canal (external) Congenital atresia or stricture of osseous meatus Q16.2 Absence of eustachian tube Coding and Billing for Audiology and Speech-Language Pathology

64 Q16.3 Congenital malformation of ear ossicles Congenital fusion of ear ossicles Q16.4 Other congenital malformations of middle ear Congenital malformation of middle ear NOS Q16.5 Congenital malformation of inner ear Congenital anomaly of membranous labyrinth Congenital anomaly of organ of Corti Q16.9 Congenital malformation of ear causing impairment of hearing, unspecified Congenital absence of ear NOS Q17 Other congenital malformations of ear Excludes1: congenital malformations of ear with impairment of hearing (Q16.0-Q16.9) preauricular sinus (Q18.1) Q17.0 Accessory auricle Accessory tragus Polyotia Preauricular appendage or tag Supernumerary ear Supernumerary lobule Q17.1 Macrotia Q17.2 Microtia Q17.3 Other misshapen ear Pointed ear Q17.4 Misplaced ear Low-set ears Excludes1: cervical auricle (Q18.2) Q17.5 Prominent ear Bat ear Q17.8 Other specified congenital malformations of ear Congenital absence of lobe of ear Q17.9 Congenital malformation of ear, unspecified Congenital anomaly of ear NOS Ch. 18 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) Symptoms and signs involving cognition, perception, emotional state and behavior (R40-R46) Excludes1: symptoms and signs constituting part of a pattern of mental disorder (F01-F99) R42 Dizziness and giddiness Light-headedness Vertigo NOS Excludes1: vertiginous syndromes (H81.-) vertigo from infrasound (T75.23) R44 Other symptoms and signs involving general sensations and perceptions Excludes1: alcoholic hallucinations (F1.5) hallucinations in drug psychosis (F11-F19 with.5) Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) 2016 Coding and Billing for Audiology and Speech-Language Pathology 59

65 Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) hallucinations in mood disorders with psychotic symptoms (F30.2, F31.5, F32.3, F33.3) hallucinations in schizophrenia, schizotypal and delusional disorders (F20-F29) Excludes2: disturbances of skin sensation (R20.-) R44.0 Auditory hallucinations Abnormal findings on diagnostic imaging and in function studies, without diagnosis (R90-R94) R94 Abnormal results of function studies R94.0 Abnormal results of function studies of central nervous system R94.01 Abnormal electroencephalogram [EEG] R94.02 Abnormal brain scan R94.09 Abnormal results of other function studies of central nervous system R94.1 Abnormal results of function studies of peripheral nervous system and special senses R94.12 Abnormal results of function studies of ear and other special senses R Abnormal auditory function study R Abnormal vestibular function study R Abnormal results of other function studies of ear and other special senses Ch. 19 Injury, poisoning and certain other consequences of external causes (S00-T88) Note: Use secondary code(s) from Chapter 20, external causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code Use additional code to identify any retained foreign body, if applicable (Z18.-) Excludes1: birth trauma (P10-P15) obstetric trauma (O70-O71) Note: The chapter uses the S-section for coding different types of injuries related to single body regions and the T-section to cover injuries to unspecified body regions as well as poisoning and certain other consequences of external causes. Injuries to the head (S00-S09) Includes: injuries of ear injuries of eye injuries of face [any part] injuries of gum injuries of jaw injuries of oral cavity injuries of palate injuries of periocular area injuries of scalp injuries of temporomandibular joint area injuries of tongue injuries of tooth Excludes2: burns and corrosions (T20-T32) effects of foreign body in ear (T16) effects of foreign body in larynx (T17.3) Coding and Billing for Audiology and Speech-Language Pathology

66 effects of foreign body in mouth NOS (T18.0) effects of foreign body in nose (T17.0-T17.1) effects of foreign body in pharynx (T17.2) effects of foreign body on external eye (T15.-) frostbite (T33-T34) S00 Superficial injury of head Excludes1: diffuse cerebral contusion (S06.2-) focal cerebral contusion (S06.3-) injury of eye and orbit (S05.-) open wound of head (S01.-) The appropriate 7th character is to be added to each code from category S00 A - initial encounter D - subsequent encounter S - sequela S00.4 Superficial injury of ear S00.41 Abrasion of ear S00.43 Contusion of ear Bruise of ear Hematoma of ear S00.44 External constriction of ear S00.45 Superficial foreign body of ear Splinter in the ear S01 Open wound of head Code also any associated: injury of cranial nerve (S04.-) injury of muscle and tendon of head (S09.1-) intracranial injury (S06.-) wound infection Excludes1: open skull fracture (S02.- with 7th character B) Excludes2: injury of eye and orbit (S05.-) traumatic amputation of part of head (S08.-) The appropriate 7th character is to be added to each code from category S01 A - initial encounter D - subsequent encounter S - sequela S01.3 Open wound of ear S08 Avulsion and traumatic amputation of part of head An amputation not identified as partial or complete should be coded to complete The appropriate 7th character is to be added to each code from category S08 A - initial encounter D - subsequent encounter S - sequela Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) 2016 Coding and Billing for Audiology and Speech-Language Pathology 61

67 Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) S08.1 Traumatic amputation of ear S09 Other and unspecified injuries of head The appropriate 7th character is to be added to each code from category S09 A - initial encounter D - subsequent encounter S - sequela S09.2 Traumatic rupture of ear drum Excludes1: traumatic rupture of ear drum due to blast injury (S09.31-) S09.3 Other specified and unspecified injury of middle and inner ear Excludes1: injury to ear NOS (S09.91-) Excludes2: injury to external ear (S00.4-, S01.3-, S08.1-) Injury, poisoning and certain other consequences of external causes (T07-T88) T16 Foreign body in ear The appropriate 7th character is to be added to each code from category T17 A - initial encounter D - subsequent encounter S - sequela T16.1 Foreign body in right ear T16.2 Foreign body in left ear T16.9 Foreign body in ear, unspecified ear Ch. 21 Factors Influencing Health Status and Contact with Health Services (Z00-Z99) Note: Z codes represent reasons for encounters. A corresponding procedure code Z codes were must accompany a Z code if a procedure is performed. Categories Z00-Z99 known as are provided for occasions when circumstances other than a disease, V codes in injury, or external cause classifiable to categories A00-Y89 are recorded as ICD-9-CM diagnoses or problems. This can arise in two main ways: a. When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury. b. When some circumstance or problem is present which influences the person s health status but is not in itself a current illness or injury. Persons encountering health services for examinations (Z00-Z13) Note: Nonspecific abnormal findings disclosed at the time of these examinations are classified to categories R70-R94. Excludes1: examinations related to pregnancy and reproduction (Z30-Z36, Z39.-) Z01 Encounter for other special examination without complaint, suspected or reported diagnosis Includes: routine examination of specific system Note: Codes from category Z01 represent the reason for the encounter. A separate procedure code is required to identify any examinations or procedures performed Excludes1: encounter for examination for administrative purposes (Z02.-) encounter for examination for suspected conditions, proven not to exist (Z03.-) encounter for laboratory and radiologic examinations as a component of general medical examinations (Z00.0-) Coding and Billing for Audiology and Speech-Language Pathology

68 encounter for laboratory, radiologic and imaging examinations for sign(s) and symptom(s) - code to the sign(s) or symptom(s) Excludes2: screening examinations (Z11-Z13) Z01.1 Encounter for examination of ears and hearing Z01.10 Encounter for examination of ears and hearing without abnormal findings Encounter for examination of ears and hearing NOS Z01.11 Encounter for examination of ears and hearing with abnormal findings Z Encounter for hearing examination following failed hearing screening Z Encounter for examination of ears and hearing with other abnormal findings Use additional code to identify abnormal findings Z01.12 Encounter for hearing conservation and treatment Z02 Encounter for administrative examination Z02.7 Encounter for issue of medical certificate Excludes1: encounter for general medical examination (Z00-Z01, Z02.0-Z02.6, Z02.8-Z02.9) Z02.71 Encounter for disability determination Encounter for issue of medical certificate of incapacity Encounter for issue of medical certificate of invalidity Z02.79 Encounter for issue of other medical certificate Z13 Encounter for screening for other diseases and disorders Screening is the testing for disease or disease precursors in asymptomatic individuals so that early detection and treatment can be provided for those who test positive for the disease. Excludes1: encounter for diagnostic examination-code to sign or symptom Z13.4 Encounter for screening for certain developmental disorders in childhood Encounter for screening for developmental handicaps in early childhood Excludes1: routine development testing of infant or child (Z00.1-) Z13.5 Encounter for screening for eye and ear disorders Excludes2: encounter for general hearing examination (Z01.1-) encounter for general vision examination (Z01.0-) Z13.8 Encounter for screening for other specified diseases and disorders Excludes2: screening for malignant neoplasms (Z12.-) Z13.85 Encounter for screening for nervous system disorders Z Encounter for screening for traumatic brain injury Encounters for other specific health care (Z40-Z53) Categories Z40-Z53 are intended for use to indicate a reason for care. They may be used for patients who have already been treated for a disease or injury, but who are receiving aftercare or prophylactic care, care to consolidate the treatment, or to deal with a residual state. Excludes2: follow-up examination for medical surveillance after treatment (Z08-Z09) Z45 Encounter for adjustment and management of implanted device Includes: removal or replacement of implanted device Excludes1: malfunction or other complications of device presence of prosthetic and other devices (Z95-Z97) Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) 2016 Coding and Billing for Audiology and Speech-Language Pathology 63

69 Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) Excludes2: encounter for fitting and adjustment of non-implanted device (Z46.-) Z45.3 Encounter for adjustment and management of implanted devices of the special senses Z45.32 Encounter for adjustment and management of implanted hearing device Excludes1: Encounter for fitting and adjustment of hearing aid (Z46.1) Z Encounter for adjustment and management of bone conduction device Z Encounter for adjustment and management of cochlear device Z Encounter for adjustment and management of other implanted hearing device Z46 Encounter for fitting and adjustment of other devices Includes: removal or replacement of other device Excludes1: malfunction or other complications of device - see Alphabetical Index Excludes2: encounter for fitting and management of implanted devices (Z45.-) issue of repeat prescription only (Z76.0) presence of prosthetic and other devices (Z95-Z97) Z46.1 Encounter for fitting and adjustment of hearing aid Excludes1: encounter for adjustment and management of implanted hearing device (Z45.32-) Z51 Encounter for other aftercare Z51.8 Encounter for other specified aftercare Excludes1: holiday relief care (Z75.5) Z51.89 Encounter for other specified aftercare Persons with potential health hazards related to socioeconomic and psychosocial circumstances (Z55-Z65) Z57 Occupational exposure to risk factors Z57.0 Occupational exposure to noise Persons encountering health services in other circumstances (Z69-Z76) Z73 Problems related to life management difficulty Excludes2: problems related to socioeconomic and psychosocial circumstances (Z55-Z65) Z73.8 Other problems related to life management difficulty Z73.82 Dual sensory impairment Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99) Code also any follow-up examination (Z08-Z09) Z77 Other contact with and (suspected) exposures hazardous to health Z77.1 Contact with and (suspected) exposure to environmental pollution and hazards in the physical environment Z77.12 Contact with and (suspected) exposure to hazards in the physical environment Z Contact with and (suspected) exposure to noise Z81 Family history of mental and behavioral disorders Z82 Family history of certain disabilities and chronic diseases (leading to disablement) Coding and Billing for Audiology and Speech-Language Pathology

70 Z82.2 Family history of deafness and hearing loss Conditions classifiable to H90-H91 Z83 Family history of other specific disorders Excludes2: contact with and (suspected) exposure to communicable disease in the family (Z20.-) Z83.5 Family history of eye and ear disorders Conditions classifiable to H00-H53, H55-H83, H92-H95 Excludes2: family history of blindness and visual loss (Z82.1) family history of deafness and hearing loss (Z82.2) Z83.52 Family history of ear disorders Conditions classifiable to H60-H83, H92-H95 Excludes2: family history of deafness and hearing loss (Z82.2) Z86 Personal history of certain other diseases Code first any follow-up examination after treatment (Z09) Z86.5 Personal history of mental and behavioral disorders Conditions classifiable to F40-F59 Z86.59 Personal history of other mental and behavioral disorders Z87 Personal history of other diseases and conditions Code first any follow-up examination after treatment (Z09) Z87.7 Personal history of (corrected) congenital malformations Conditions classifiable to Q00-Q89 that have been repaired or corrected Z87.72 Personal history of (corrected) congenital malformations of nervous system and sense organs Z Personal history of (corrected) congenital malformations of ear Z87.79 Personal history of other (corrected) congenital malformations Z Personal history of (corrected) congenital malformations of face and neck Z90 Acquired absence of organs, not elsewhere classified Includes: postprocedural or post-traumatic loss of body part NEC Excludes1: congenital absence Z90.0 Acquired absence of part of head and neck Z90.09 Acquired absence of other part of head and neck Acquired absence of nose Excludes2: teeth (K08.1) Z96 Presence of other functional implants Excludes2: complications of internal prosthetic devices, implants and grafts (T82-T85) fitting and adjustment of prosthetic and other devices (Z44-Z46) Z96.2 Presence of otological and audiological implants Z96.20 Presence of otological and audiological implant, unspecified Z96.21 Cochlear implant status Z96.22 Myringotomy tube(s) status Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) 2016 Coding and Billing for Audiology and Speech-Language Pathology 65

71 Chapter 3: ICD-10-CM Diagnostic Codes (Audiology) Z96.29 Presence of other otological and audiological implants Z97 Presence of other devices Presence of bone-conduction hearing device Presence of eustachian tube stent Stapes replacement Excludes1: complications of internal prosthetic devices, implants and grafts (T82-T85) fitting and adjustment of prosthetic and other devices (Z44-Z46) Z97.4 Presence of external hearing-aid Coding and Billing for Audiology and Speech-Language Pathology

72 ICD-10-CM Diagnostic Codes: Speech-Language Pathology ICD-10-CM Tabular List of Diseases and Injuries Related to speech, language, and swallowing disorders Note: This is not a comprehensive list and a number of codes are included for information purposes only. Some categories of codes (e.g., neoplasms) may be more extensive, contain additional instructional notes, and may also require coding to a higher degree of specificity than indicated here. However, in general, speech-language pathology related diagnoses will be listed to their highest level of specificity. For a full list of ICD-10-CM codes, descriptors, and instructions, see the official ICD-10-CM publication at Code typically used by speech-language pathologists Additional digits not listed here Ch. 2 Neoplasms (C00-D49) Malignant neoplasms of lip, oral cavity, and pharynx (C00-C14) C00 Malignant neoplasm of lip C00.0 Malignant neoplasm of external upper lip C00.1 Malignant neoplasm of external lower lip C00.2 Malignant neoplasm of external lip, unspecified C00.3 Malignant neoplasm of upper lip, inner aspect C00.4 Malignant neoplasm of lower lip, inner aspect C00.5 Malignant neoplasm of lip, unspecified, inner aspect C00.6 Malignant neoplasm of commissure of lip, unspecified C00.8 Malignant neoplasm of overlapping sites of lip C00.9 Malignant neoplasm of lip, unspecified C01 Malignant neoplasm of base of tongue C02 Malignant neoplasm of other and unspecified parts of tongue C02.0 Malignant neoplasm of dorsal surface of tongue C02.1 Malignant neoplasm of border of tongue C02.2 Malignant neoplasm of ventral surface of tongue C02.3 Malignant neoplasm of anterior two-thirds of tongue, part unspecified C02.4 Malignant neoplasm of lingual tonsil C02.8 Malignant neoplasm of overlapping sites of tongue C02.9 Malignant neoplasm of tongue, unspecified C03 Malignant neoplasm of gum C04 Malignant neoplasm of floor of mouth C05 Malignant neoplasm of palate C05.0 Malignant neoplasm of hard palate C05.1 Malignant neoplasm of soft palate C05.2 Malignant neoplasm of uvula C06 Malignant neoplasm of other and unspecified parts of mouth C08 Malignant neoplasm of other and unspecified major salivary glands C09 Malignant neoplasm of tonsil Chapter 3: ICD-10-CM Diagnostic Codes (SLP) 2016 Coding and Billing for Audiology and Speech-Language Pathology 67

73 Chapter 3: ICD-10-CM Diagnostic Codes (SLP) C10 Malignant neoplasm of oropharynx C10.1 Malignant neoplasm of anterior surface of epiglottis C10.2 Malignant neoplasm of lateral wall of oropharynx C10.3 Malignant neoplasm of posterior wall of oropharynx C11 Malignant neoplasm of nasopharynx C11.0 Malignant neoplasm of superior wall of nasopharynx C11.1 Malignant neoplasm of posterior wall of nasopharynx C11.2 Malignant neoplasm of lateral wall of nasopharynx C11.3 Malignant neoplasm of anterior wall of nasopharynx C11.8 Malignant neoplasm of overlapping sites of nasopharynx C14 Malignant neoplasm of other and ill-defined sites in the lip, oral cavity and pharynx C14.0 Malignant neoplasm of pharynx, unspecified C15 Malignant neoplasm of esophagus Malignant neoplasms of digestive organs (C15-C26) Malignant neoplasms of respiratory and intrathoracic organs (C30-C39) C30 Malignant neoplasm of nasal cavity and middle ear C32 Malignant neoplasm of larynx C32.0 Malignant neoplasm of glottis C32.1 Malignant neoplasm of supraglottis C32.2 Malignant neoplasm of subglottis C32.3 Malignant neoplasm of laryngeal cartilage C32.8 Malignant neoplasm of overlapping sites of larynx C32.9 Malignant neoplasm of larynx, unspecified C33 Malignant neoplasm of trachea Malignant neoplasms of eye, brain and other parts of central nervous system (C69-C72) C71 Malignant neoplasm of brain In situ neoplasms (D00-D09) D00 Carcinoma in situ of oral cavity, esophagus and stomach D00.07 Carcinoma in situ of tongue D02 Carcinoma in situ of middle ear and respiratory system D02.1 Carcinoma in situ of trachea Benign neoplasms, except benign neuroendocrine tumors (D10-D36) D10 Benign neoplasm of mouth and pharynx D14 Benign neoplasm of middle ear and respiratory system D14.1 Benign neoplasm of larynx D14.2 Benign neoplasm of trachea D33 Benign neoplasm of brain and other parts of central nervous system D38 Neoplasm of uncertain behavior of middle ear and respiratory and intrathoracic organs Coding and Billing for Audiology and Speech-Language Pathology

74 Ch. 5 Mental, behavioral, and neurodevelopmental disorders (F01-F99) Mental disorders due to known physiological conditions (F01-F09) F01 Vascular dementia F01.5 Vascular dementia F01.50 Vascular dementia without behavioral disturbance F01.51 Vascular dementia with behavioral disturbance F02 Dementia in other diseases classified elsewhere Code first the underlying physiological condition, such as: Alzheimer s (G30.-) cerebral lipidosis (E75.4) Creutzfeldt-Jakob disease (A81.0-) dementia with Lewy bodies (G31.83) epilepsy and recurrent seizures (G40.-) frontotemporal dementia (G31.09) hepatolenticular degeneration (E83.0) human immunodeficiency virus [HIV] disease (B20) hypercalcemia (E83.52) hypothyroidism, acquired (E00-E03.-) intoxications (T36-T65) Jakob-Creutzfeldt disease (A81.0-) multiple sclerosis (G35) neurosyphilis (A52.17) niacin deficiency [pellagra] (E52) Parkinson s disease (G20) Pick s disease (G31.01) polyarteritis nodosa (M30.0) systemic lupus erythematosus (M32.-) trypanosomiasis (B56.-, B57.-) vitamin B deficiency (E53.8) F02.8 Dementia in other diseases classified elsewhere F02.80 Dementia in other diseases classified elsewhere, without behavioral disturbance F02.81 Dementia in other diseases classified elsewhere, with behavioral disturbance F03 Unspecified dementia F03.9 Unspecified dementia F03.90 Unspecified dementia without behavioral disturbance Dementia NOS F03.91 Unspecified dementia with behavioral disturbance Unspecified dementia with aggressive behavior Unspecified dementia with combative behavior Unspecified dementia with violent behavior Use additional code, if applicable, to identify wandering in unspecified dementia (Z91.83) Chapter 3: ICD-10-CM Diagnostic Codes (SLP) 2016 Coding and Billing for Audiology and Speech-Language Pathology 69

75 Chapter 3: ICD-10-CM Diagnostic Codes (SLP) Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (F20-F29) F20 Schizophrenia Intellectual Disabilities (F70-F79) Code first any associated physical or developmental disorders Excludes1: borderline intellectual functioning, IQ above 70 to 84 (R41.83) F70 Mild intellectual disabilities IQ level to approximately 70 Mild mental subnormality F71 Moderate intellectual disabilities IQ level to Moderate mental subnormality F72 Severe intellectual disabilities IQ to Severe mental subnormality F73 Profound intellectual disabilities IQ level below Profound mental subnormality F78 Other intellectual disabilities F79 Unspecified intellectual disabilities Mental deficiency NOS Mental subnormality NOS Pervasive and specific developmental disorders (F80-F89) F80 Specific developmental disorders of speech and language F80.0 Phonological disorder Dyslalia Functional speech articulation disorder Lalling Lisping Phonological developmental disorder Speech articulation developmental disorder Excludes1: speech articulation impairment due to aphasia NOS (R47.01) speech articulation impairment due to apraxia (R48.2) Excludes2: speech articulation impairment due to hearing loss (F80.4) speech articulation impairment due to intellectual disabilities (F70-F79) speech articulation impairment with expressive language developmental disorder (F80.1) speech articulation impairment with mixed receptive expressive language developmental disorder (F80.2) F80.1 Expressive language disorder Developmental dysphasia or aphasia, expressive type Excludes1: mixed receptive-expressive language disorder (F80.2) dysphasia and aphasia NOS (R47.-) Coding and Billing for Audiology and Speech-Language Pathology

76 Excludes2: acquired aphasia with epilepsy [Landau-Kleffner] (G40.80-) selective mutism (F94.0) intellectual disabilities (F70-F79) pervasive developmental disorders (F84.-) F80.2 Mixed receptive-expressive language disorder Developmental dysphasia or aphasia, receptive type Developmental Wernicke s aphasia Excludes1: central auditory processing disorder (H93.25) dysphasia or aphasia NOS (R47.-) expressive language disorder (F80.1) expressive type dysphasia or aphasia (F80.1) word deafness (H93.25) Excludes2: acquired aphasia with epilepsy [Landau-Kleffner] (G40.80-) pervasive developmental disorders (F84.-) selective mutism (F94.0) intellectual disabilities (F70-F79) F80.4 Speech and language development delay due to hearing loss Code also type of hearing loss (H90.-, H91.-) F80.8 Other developmental disorders of speech and language F80.81 Childhood onset fluency disorder Cluttering NOS Stuttering NOS Excludes1: adult onset fluency disorder (F98.5) fluency disorder in conditions classified elsewhere (R47.82) fluency disorder (stuttering) following cerebrovascular disease (I69. with final characters-23) F80.89 Other developmental disorders of speech and language F80.9 Developmental disorder of speech and language, unspecified Communication disorder NOS Language disorder NOS F81 Specific developmental disorders of scholastic skills F81.0 Specific reading disorder Backward reading Developmental dyslexia Specific reading retardation Excludes1: alexia NOS (R48.0) dyslexia NOS (R48.0) F81.2 Mathematics disorder Developmental acalculia Developmental arithmetical disorder Developmental Gerstmann s syndrome Excludes1: acalculia NOS (R48.8) Chapter 3: ICD-10-CM Diagnostic Codes (SLP) 2016 Coding and Billing for Audiology and Speech-Language Pathology 71

77 Chapter 3: ICD-10-CM Diagnostic Codes (SLP) Excludes2: arithmetical difficulties associated with a reading disorder (F81.0) arithmetical difficulties associated with a spelling disorder (F81.81) arithmetical difficulties due to inadequate teaching (Z55.8) F81.8 Other developmental disorders of scholastic skills F81.81 Disorder of written expression Specific spelling disorder F81.89 Other developmental disorders of scholastic skills F81.9 Developmental disorder of scholastic skills, unspecified Knowledge acquisition disability NOS Learning disability NOS Learning disorder NOS F82 Specific developmental disorder of motor function Clumsy child syndrome Developmental coordination disorder Developmental dyspraxia Excludes1: abnormalities of gait and mobility (R26.-) lack of coordination (R27.-) Excludes2: lack of coordination secondary to intellectual disabilities (F70-F79) F84 Pervasive developmental disorders Use additional code to identify any associated medical condition and intellectual disabilities. F84.0 Autistic disorder Infantile autism Infantile psychosis Kanner s syndrome Excludes1: Asperger s syndrome (F84.5) F84.2 Rett s syndrome Excludes1: Asperger s syndrome (F84.5) Autistic disorder (F84.0) Other childhood disintegrative disorder (F84.3) F84.3 Other childhood disintegrative disorder Dementia infantilis Disintegrative psychosis Heller s syndrome Symbiotic psychosis Use additional code to identify any associated neurological condition. Excludes1: Asperger s syndrome (F84.5) Autistic disorder (F84.0) Rett s syndrome (F84.2) Coding and Billing for Audiology and Speech-Language Pathology

78 F84.5 Asperger s syndrome Asperger s disorder Autistic psychopathy Schizoid disorder of childhood F84.8 Other pervasive developmental disorders Overactive disorder associated with intellectual disabilities and stereotyped movements F84.9 Pervasive developmental disorder, unspecified Atypical autism F88 Other disorders of psychological development Developmental agnosia F89 Unspecified disorder of psychological development Behavioral and emotional disorders with onset usually occurring in childhood and adolescence (F90-F98) F90 Attention-deficit hyperactivity disorders Includes: attention deficit disorder with hyperactivity attention deficit syndrome with hyperactivity Excludes2: anxiety disorders (F40.-, F41.-) mood [affective] disorders (F30-F39) pervasive developmental disorders (F84.-) schizophrenia (F20.-) F90.0 Attention-deficit hyperactivity disorder, predominantly inattentive type F90.1 Attention-deficit hyperactivity disorder, predominantly hyperactive type F90.2 Attention-deficit hyperactivity disorder, combined type F90.8 Attention-deficit hyperactivity disorder, other type F90.9 Attention-deficit hyperactivity disorder, unspecified type F94 Disorders of social functioning with onset specific to childhood and adolescence F94.0 Selective mutism Elective mutism Excludes2: pervasive developmental disorders (F84.-) schizophrenia (F20.-) specific developmental disorders of speech and language (F80.-) transient mutism as part of separation anxiety in young children (F93.0) F98 Other behavioral and emotional disorders with onset usually occurring in childhood and adolescence F98.5 Adult onset fluency disorder Excludes1: childhood onset fluency disorder (F80.81) dysphasia (R47.02) fluency disorder in conditions classified elsewhere (R47.82) fluency disorder (stuttering) following cerebrovascular disease (I69. with final characters -23) tic disorders (F95.-) Chapter 3: ICD-10-CM Diagnostic Codes (SLP) 2016 Coding and Billing for Audiology and Speech-Language Pathology 73

79 Chapter 3: ICD-10-CM Diagnostic Codes (SLP) Ch. 6 Diseases of the nervous system (G00-G99) Inflammatory diseases of the central nervous system (G00-G09) G00 Bacterial meningitis, not elsewhere classified G00.0 Hemophilus meningitis G00.1 Pneumococcal meningitis G00.2 Streptococcal meningitis Use additional code to further identify organism (B95.0-B95.5) G00.3 Staphylococcal meningitis Use additional code to further identify organism (B95.6-B95.8) G00.8 Other bacterial meningitis G00.9 Bacterial meningitis, unspecified G04 Encephalitis, myelitis and encephalomyelitis Systemic atrophies primarily affecting the central nervous system (G10-G14) G10 Huntington s disease G12 Spinal muscular atrophy and related syndromes G12.2 Motor neuron disease G12.21 Amyotrophic lateral sclerosis Extrapyramidal and movement disorders (G20-G26) G20 Parkinson s disease Hemiparkinsonism Idiopathic parkinsonism or Parkinson s disease Paralysis agitans Parkinsonism or Parkinson s disease NOS Primary parkinsonism or Parkinson s disease Excludes1: dementia with parkinsonism (G31.83) G21 Secondary parkinsonism Excludes1: dementia with parkinsonism (G31.83) Huntington s disease (G10) Shy-Drager syndrome (G90.3) syphilitic parkinsonism (A52.19) G21.0 Malignant neuroleptic syndrome G21.1 Other drug-induced secondary parkinsonism G21.11 Neuroleptic induced parkinsonism Use additional code for adverse effect, if applicable, to identify drug (T43.3X5, T43.4X5, T43.505,T43.595) Excludes1: malignant neuroleptic syndrome (G21.0) G21.19 Other drug induced secondary parkinsonism Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixthcharacter 5) G21.2 Secondary parkinsonism due to other external agents Code first (T51-T65) to identify external agent G21.3 Postencephalitic parkinsonism G21.4 Vascular parkinsonism G21.8 Other secondary parkinsonism G21.9 Secondary parkinsonism, unspecified Coding and Billing for Audiology and Speech-Language Pathology

80 Other degenerative diseases of the nervous system (G30-G32) G30 Alzheimer s disease Includes: Alzheimer s dementia senile and presenile forms Use additional code to identify: delirium, if applicable (F05) dementia with behavioral disturbance (F02.81) dementia without behavioral disturbance (F02.80) Excludes1: senile degeneration of brain NEC (G31.1) senile dementia NOS (F03) senility NOS (R41.81) G30.0 Alzheimer s disease with early onset G30.1 Alzheimer s disease with late onset G30.8 Other Alzheimer s disease G30.9 Alzheimer s disease, unspecified G31 Other degenerative diseases of nervous system, not elsewhere classified Use additional code to identify: dementia with behavioral disturbance (F02.81) dementia without behavioral disturbance (F02.80) Excludes2: Reye s syndrome (G93.7) G31.0 Frontotemporal dementia G31.01 Pick s disease Circumscribed brain atrophy Progressive isolated aphasia G31.09 Other frontotemporal dementia Frontal dementia G31.1 Senile degeneration of brain, not elsewhere classified Excludes1: Alzheimer s disease (G30.-) senility NOS (R41.81) G31.8 Other specified degenerative diseases of nervous system G31.84 Mild cognitive impairment, so stated Excludes1: age related cognitive decline (R41.81) altered mental status (R41.82) cerebral degeneration (G31.9) change in mental status (R41.82) cognitive deficits following (sequelae of) cerebral hemorrhage or infarction (I69.01,I69.11, I69.21, I69.31, I69.81, I69.91) cognitive impairment due to intracranial or head injury (S06.-) dementia (F01.-, F02.-, F03) mild memory disturbance (F06.8) neurologic neglect syndrome (R41.4) personality change, nonpsychotic (F68.8) Chapter 3: ICD-10-CM Diagnostic Codes (SLP) 2016 Coding and Billing for Audiology and Speech-Language Pathology 75

81 Chapter 3: ICD-10-CM Diagnostic Codes (SLP) Demyelinating diseases of the central nervous system (G35-G37) G35 Multiple sclerosis Disseminated multiple sclerosis Generalized multiple sclerosis Multiple sclerosis NOS Multiple sclerosis of brain stem Multiple sclerosis of cord Episodic and paroxysmal disorders (G40-G47) G40 Epilepsy and recurrent seizures G40.8 Other epilepsy and recurrent seizures Epilepsies and epileptic syndromes undetermined as to whether they are focal or generalized Landau-Kleffner syndrome G40.80 Other epilepsy G Other epilepsy, not intractable, with status epilepticus G Other epilepsy, not intractable, without status epilepticus Other epilepsy NOS Other epilepsy without intractability without status epilepticus G Other epilepsy, intractable, with status epilepticus G Other epilepsy, intractable, without status epilepticus G45 Transient cerebral ischemic attacks and related syndromes G46 Vascular syndromes of brain in cerebrovascular diseases Nerve, nerve root and plexus disorders (G50-G59) G51 Facial nerve disorders Includes: disorders of 7th cranial nerve G51.0 Bell s palsy Facial palsy G51.1 Geniculate ganglionitis Excludes1: postherpetic geniculate ganglionitis (B02.21) G51.2 Melkersson s syndrome Melkersson-Rosenthal syndrome G51.3 Clonic hemifacial spasm G51.4 Facial myokymia G51.8 Other disorders of facial nerve G51.9 Disorder of facial nerve, unspecified G71 Primary disorders of muscles Excludes2: arthrogryposis multiplex congenita (Q74.3) metabolic disorders (E70-E88) myositis (M60.-) G71.0 Muscular dystrophy Autosomal recessive, childhood type, muscular dystrophy resembling Duchenne or Becker muscular dystrophy Benign [Becker] muscular dystrophy Coding and Billing for Audiology and Speech-Language Pathology

82 Benign scapuloperoneal muscular dystrophy with early contractures [Emery- Dreifuss] Congenital muscular dystrophy NOS Congenital muscular dystrophy with specific morphological abnormalities of the muscle fiber Distal muscular dystrophy Facioscapulohumeral muscular dystrophy Limb-girdle muscular dystrophy Ocular muscular dystrophy Oculopharyngeal muscular dystrophy Scapuloperoneal muscular dystrophy Severe [Duchenne] muscular dystrophy G71.1 Myotonic disorders G71.11 Myotonic muscular dystrophy Dystrophia myotonica [Steinert] Myotonia atrophica Myotonic muscular dystrophy Dystrophia myotonica [Steinert] Myotonia atrophica G71.12 Myotonia congenital Acetazolamide responsive myotonia congenita Dominant myotonia congenita [Thomsen disease] Myotonia levior Recessive myotonia congenita [Becker disease] G71.13 Myotonic chondrodystrophy Chondrodystrophic myotonia Congenital myotonic chondrodystrophy Schwartz-Jampel disease G71.14 Drug induced myotonia Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixthcharacter 5) G71.19 Other specified myotonic disorders Myotonia fluctuans Myotonia permanens Neuromyotonia [Isaacs] Paramyotonia congenita (of von Eulenburg) Pseudomyotonia Symptomatic myotonia Cerebral palsy and other paralytic syndromes (G80-G83) G80 Cerebral palsy Excludes1: hereditary spastic paraplegia (G11.4) G80.0 Spastic quadriplegic cerebral palsy Congenital spastic paralysis (cerebral) Chapter 3: ICD-10-CM Diagnostic Codes (SLP) 2016 Coding and Billing for Audiology and Speech-Language Pathology 77

83 Chapter 3: ICD-10-CM Diagnostic Codes (SLP) G80.1 Spastic diplegic cerebral palsy Spastic cerebral palsy NOS G80.2 Spastic hemiplegic cerebral palsy G80.3 Athetoid cerebral palsy Double athetosis (syndrome) Dyskinetic cerebral palsy Dystonic cerebral palsy Vogt disease G80.4 Ataxic cerebral palsy G80.8 Other cerebral palsy Mixed cerebral palsy syndromes G80.9 Cerebral palsy, unspecified Cerebral palsy NOS G81 Hemiplegia and hemiparesis Note: This category is to be used only when hemiplegia (complete)(incomplete) is reported without further specification, or is stated to be old or longstanding but of unspecified cause. The category is also for use in multiple coding to identify these types of hemiplegia resulting from any cause. Excludes1: congenital cerebral palsy (G80.-) hemiplegia and hemiparesis due to sequela of cerebrovascular disease (I69.05-, I69.15-, I69.25-, I69.35-, I69.45-, I69.85-, I69.95-) Other disorders of the nervous system (G89-G99) G91 Hydrocephalus G93 Other disorders of brain G96 Other disorders of central nervous system G96.0 Cerebrospinal fluid leak Excludes1: cerebrospinal fluid leak from spinal puncture (G97.0) Ch. 9 Diseases of the circulatory system (I00-I99) Pulmonary heart disease and diseases of pulmonary circulation (I26-I28) Other forms of heart disease (I30-I52) I46 Cardiac arrest Cerebrovascular diseases (I60-I69) The original ICD-9 series for cerebrovascular disease (438) is I63 Cerebral infarction expanded under ICD-10. Check the entire I69 Sequelae of cerebrovascular disease I69.- category before assigning a code. Note: Category I69 is to be used to indicate conditions in I60-I67 as the cause of sequelae. The sequelae include conditions specified as such or as residuals which may occur at any time after the onset of the causal condition. I69.0 Sequelae of nontraumatic subarachnoid hemorrhage I69.00 Unspecified sequelae of nontraumatic subarachnoid hemorrhage I69.01 Cognitive deficits following nontraumatic subarachnoid hemorrhage I69.02 Speech and language deficits following nontraumatic subarachnoid hemorrhage I Aphasia following nontraumatic subarachnoid hemorrhage I Dysphasia following nontraumatic subarachnoid hemorrhage Coding and Billing for Audiology and Speech-Language Pathology

84 I Dysarthria following nontraumatic subarachnoid hemorrhage I Fluency disorder following nontraumatic subarachnoid hemorrhage Stuttering following nontraumatic subarachnoid hemorrhage I Other speech and language deficits following nontraumatic subarachnoid hemorrhage I69.09 Other sequelae of nontraumatic subarachnoid hemorrhage I Apraxia following nontraumatic subarachnoid hemorrhage I Dysphagia following nontraumatic subarachnoid hemorrhage Use additional code to identify the type of dysphagia, if known (R13.1-) I Facial weakness following nontraumatic subarachnoid hemorrhage Facial droop following nontraumatic subarachnoid hemorrhage I Ataxia following nontraumatic subarachnoid hemorrhage I Other sequelae following nontraumatic subarachnoid hemorrhage Alterations of sensation following nontraumatic subarachnoid hemorrhage Disturbance of vision following nontraumatic subarachnoid hemorrhage Use additional code to identify the sequelae I69.1 Sequelae of nontraumatic intracerebral hemorrhage I69.10 Unspecified sequelae of nontraumatic intracerebral hemorrhage I69.11 Cognitive deficits following nontraumatic intracerebral hemorrhage I69.12 Speech and language deficits following nontraumatic intracerebral hemorrhage I Aphasia following nontraumatic intracerebral hemorrhage I Dysphasia following nontraumatic intracerebral hemorrhage I Dysarthria following nontraumatic intracerebral hemorrhage I Fluency disorder following nontraumatic intracerebral hemorrhage Stuttering following nontraumatic subarachnoid hemorrhage I Other speech and language deficits following nontraumatic intracerebral hemorrhage I69.19 Other sequelae of nontraumatic intracerebral hemorrhage I Apraxia following nontraumatic intracerebral hemorrhage I Dysphagia following nontraumatic intracerebral hemorrhage Use additional code to identify the type of dysphagia, if known (R13.1-) Chapter 3: ICD-10-CM Diagnostic Codes (SLP) 2016 Coding and Billing for Audiology and Speech-Language Pathology 79

85 Chapter 3: ICD-10-CM Diagnostic Codes (SLP) I Facial weakness following nontraumatic intracerebral hemorrhage Facial droop following nontraumatic intracerebral hemorrh age I Ataxia following nontraumatic intracerebral hemorrhage I Other sequelae of nontraumatic intracerebral hemorrhage Alteration of sensations following nontraumatic intracerebral hemorrhage Disturbance of vision following nontraumatic intracerebral hemorrhage Use additional code to identify the sequelae I69.2 Sequelae of other nontraumatic intracranial hemorrhage I69.20 Unspecified sequelae of other nontraumatic intracranial hemorrhage I69.21 Cognitive deficits following other nontraumatic intracranial hemorrhage I69.22 Speech and language deficits following other nontraumatic intracranial hemorrhage I Aphasia following other nontraumatic intracranial hemorrhage I Dysphasia following other nontraumatic intracranial hemorrhage I Dysarthria following other nontraumatic intracranial hemorrhage I Fluency disorder following other nontraumatic intracranial hemorrhage Stuttering following nontraumatic subarachnoid hemorrhage I Other speech and language deficits following other nontraumatic intracranialhemorrhage I69.29 Other sequelae of other nontraumatic intracranial hemorrhage I Apraxia following other nontraumatic intracranial hemorrhage I Dysphagia following other nontraumatic intracranial hemorrhage Use additional code to identify the type of dysphagia, if known (R13.1-) I Facial weakness following other nontraumatic intracranial hemorrhage Facial droop following other nontraumatic intracranial hemorrhage I Ataxia following other nontraumatic intracranial hemorrhage I Other sequelae other nontraumatic intracranial hemorrhage Alteration of sensation following other nontraumatic intracranial hemorrhage Disturbance of vision following other nontraumatic intracranial hemorrhage Use additional code to identify the sequelae Coding and Billing for Audiology and Speech-Language Pathology

86 I69.3 Sequelae of cerebral infarction Sequelae of stroke NOS I69.30 Unspecified sequelae of cerebral infarction I69.31 Cognitive deficits following cerebral infarction I69.32 Speech and language deficits following cerebral infarction I Aphasia following cerebral infarction I Dysphasia following cerebral infarction I Dysarthria following cerebral infarction I Fluency disorder following cerebral infarction Stuttering following nontraumatic subarachnoid hemorrhage I Other speech and language deficits following cerebral infarction I69.39 Other sequelae of cerebral infarction I Apraxia following cerebral infarction I Dysphagia following cerebral infarction Use additional code to identify the type of dysphagia, if known (R13.1-) I Facial weakness following cerebral infarction Facial droop following cerebral infarction I Ataxia following cerebral infarction I Other sequelae of cerebral infarction Alteration of sensation following cerebral infarction Disturbance of vision following cerebral infarction Use additional code to identify the sequelae I69.8 Sequelae of other cerebrovascular diseases Excludes1: sequelae of traumatic intracranial injury (S06.-) I69.80 Unspecified sequelae of other cerebrovascular disease I69.81 Cognitive deficits following other cerebrovascular disease I69.82 Speech and language deficits following other cerebrovascular disease I Aphasia following other cerebrovascular disease I Dysphasia following other cerebrovascular disease I Dysarthria following other cerebrovascular disease I Fluency disorder following other cerebrovascular disease Stuttering following nontraumatic subarachnoid hemorrhage I Other speech and language deficits following other cerebrovascular disease I69.89 Other sequelae of other cerebrovascular disease I Apraxia following other cerebrovascular disease I Dysphagia following other cerebrovascular disease Use additional code to identify the type of dysphagia, if known (R13.1-) Chapter 3: ICD-10-CM Diagnostic Codes (SLP) 2016 Coding and Billing for Audiology and Speech-Language Pathology 81

87 Chapter 3: ICD-10-CM Diagnostic Codes (SLP) I Facial weakness following other cerebrovascular disease Facial droop following other cerebrovascular disease I Ataxia following other cerebrovascular disease I Other sequelae of other cerebrovascular disease Alteration of sensation following other cerebrovascular disease Disturbance of vision following other cerebrovascular disease Use additional code to identify the sequelae I69.9 Sequelae of unspecified cerebrovascular diseases Excludes1: sequelae of stroke (I63.3) sequelae of traumatic intracranial injury (S06.-) I69.90 Unspecified sequelae of unspecified cerebrovascular disease I69.91 Cognitive deficits following unspecified cerebrovascular disease I69.92 Speech and language deficits following unspecified cerebrovascular disease I Aphasia following unspecified cerebrovascular disease I Dysphasia following unspecified cerebrovascular disease I Dysarthria following unspecified cerebrovascular disease I Fluency disorder following unspecified cerebrovascular disease Stuttering following nontraumatic subarachnoid hemorrhage I Other speech and language deficits following unspecified cerebrovascular disease I69.99 Other sequelae of unspecified cerebrovascular disease I Apraxia following unspecified cerebrovascular disease I Dysphagia following unspecified cerebrovascular disease Use additional code to identify the type of dysphagia, if known (R13.1-) I Facial weakness following unspecified cerebrovascular disease Facial droop following unspecified cerebrovascular disease I Ataxia following unspecified cerebrovascular disease I Other sequelae following unspecified cerebrovascular disease Alteration in sensation following unspecified cerebrovascular disease Disturbance of vision following unspecified cerebrovascular disease Use additional code to identify the sequelae Coding and Billing for Audiology and Speech-Language Pathology

88 Ch. 10 Diseases of the respiratory system (J00-J99) Acute upper respiratory infections (J00-J06) J02 Acute pharyngitis J03 Acute tonsillitis J04 Acute laryngitis and tracheitis J05 Acute obstructive laryngitis [croup] and epiglottitis Other diseases of upper respiratory tract (J30-J39) J31 Chronic rhinitis, nasopharyngitis and pharyngitis J35 Chronic diseases of tonsils and adenoids Use additional code to identify: exposure to environmental tobacco smoke (Z77.22) exposure to tobacco smoke in the perinatal period (P96.81) history of tobacco use (Z87.891) occupational exposure to environmental tobacco smoke (Z57.31) tobacco dependence (F17.-) tobacco use (Z72.0) J35.1 Hypertrophy of tonsils Enlargement of tonsils Excludes1: hypertrophy of tonsils with tonsillitis (J35.0-) J35.2 Hypertrophy of adenoids Enlargement of adenoids Excludes1: hypertrophy of adenoids with adenoiditis (J35.0-) J35.3 Hypertrophy of tonsils with hypertrophy of adenoids Excludes1: hypertrophy of tonsils and adenoids with tonsillitis and adenoiditis (J35.03) Chapter 3: ICD-10-CM Diagnostic Codes (SLP) J37 Chronic laryngitis and laryngotracheitis J37.0 Chronic laryngitis Catarrhal laryngitis Hypertrophic laryngitis Sicca laryngitis Excludes2: acute laryngitis (J04.0) obstructive (acute) laryngitis (J05.0) J38 Diseases of vocal cords and larynx, not elsewhere classified J38.0 Paralysis of vocal cords and larynx Laryngoplegia Paralysis of glottis J38.00 Paralysis of vocal cords and larynx, unspecified J38.01 Paralysis of vocal cords and larynx, unilateral J38.02 Paralysis of vocal cords and larynx, bilateral J38.1 Polyp of vocal cord and larynx Excludes1: adenomatous polyps (D14.1) 2016 Coding and Billing for Audiology and Speech-Language Pathology 83

89 Chapter 3: ICD-10-CM Diagnostic Codes (SLP) J38.2 Nodules of vocal cords Chorditis (fibrinous)(nodosa)(tuberosa) Singer s nodes Teacher s nodes J38.3 Other diseases of vocal cords Abscess of vocal cords Cellulitis of vocal cords Granuloma of vocal cords Leukokeratosis of vocal cords Leukoplakia of vocal cords J38.4 Edema of larynx Edema (of) glottis Subglottic edema Supraglottic edema Excludes1: acute obstructive laryngitis [croup] (J05.0) J38.5 Laryngeal spasm Laryngismus (stridulus) J38.6 Stenosis of larynx J38.7 Other diseases of larynx Abscess of larynx Cellulitis of larynx Disease of larynx NOS Necrosis of larynx Pachyderma of larynx Perichondritis of larynx Ulcer of larynx edematous laryngitis (J04.0) J39.3 Upper respiratory tract hypersensitivity reaction, site unspecified Excludes1: hypersensitivity reaction of upper respiratory tract, such as: extrinsic allergic alveolitis (J67.9) pneumoconiosis (J60-J67.9) J39.8 Other specified diseases of upper respiratory tract J39.9 Disease of upper respiratory tract, unspecified Lung diseases due to external agents (J60-J70) J69 Pneumonitis due to solids and liquids Excludes1: neonatal aspiration syndromes (P24.-) postprocedural pneumonitis (J95.4) J69.0 Pneumonitis due to inhalation of food and vomit Aspiration pneumonia NOS Aspiration pneumonia (due to) food (regurgitated) Aspiration pneumonia (due to) gastric secretions Aspiration pneumonia (due to) milk J38.5 is an option for paradoxical vocal fold motion disorder. Aspiration pneumonia (due to) vomit Coding and Billing for Audiology and Speech-Language Pathology

90 Code also any associated foreign body in respiratory tract (T17.-) Excludes1: chemical pneumonitis due to anesthesia (J95.4) obstetric aspiration pneumonitis (O74.0) Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified (J95) J95 Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified Excludes2: aspiration pneumonia (J69.-) emphysema (subcutaneous) resulting from a procedure (T81.82) hypostatic pneumonia (J18.2) pulmonary manifestations due to radiation (J70.0- J70.1) J95.0 Tracheostomy complications J95.00 Unspecified tracheostomy complication J95.01 Hemorrhage from tracheostomy stoma J95.02 Infection of tracheostomy stoma Use additional code to identify type of infection, such as: cellulitis of neck (L03.8) sepsis (A40, A41.-) J95.03 Malfunction of tracheostomy stoma Mechanical complication of tracheostomy stoma Obstruction of tracheostomy airway Tracheal stenosis due to tracheostomy J95.04 Tracheo-esophageal fistula following tracheostomy J95.09 Other tracheostomy complication Ch. 11 Diseases of the digestive system (K00-K95) Diseases of oral cavity and salivary glands (K00-K14) K00 Disorders of tooth development and eruption K08 Other disorders of teeth and supporting structures Excludes2: dentofacial anomalies [including malocclusion] (M26.-) disorders of jaw (M27.-) K08.2 Atrophy of edentulous alveolar ridge K13 Other diseases of lip and oral mucosa K13.7 Other and unspecified lesions of oral mucosa K13.70 Unspecified lesions of oral mucosa K13.79 Other lesions of oral mucosa Focal oral mucinosis K14 Diseases of tongue K14.0 Glossitis Abscess of tongue Ulceration (traumatic) of tongue Excludes1: atrophic glossitis (K14.4) K14.4 Atrophy of tongue papillae Atrophic glossitis Chapter 3: ICD-10-CM Diagnostic Codes (SLP) 2016 Coding and Billing for Audiology and Speech-Language Pathology 85

91 Chapter 3: ICD-10-CM Diagnostic Codes (SLP) K14.5 Plicated tongue Fissured tongue Furrowed tongue Scrotal tongue Excludes1: fissured tongue, congenital (Q38.3) K14.8 Other diseases of tongue Atrophy of tongue Crenated tongue Enlargement of tongue Glossocele Glossoptosis Hypertrophy of tongue K21 Gastro-esophageal reflux disease Excludes1: newborn esophageal reflux (P78.83) K21.0 Gastro-esophageal reflux disease with esophagitis Reflux esophagitis K21.9 Gastro-esophageal reflux disease without esophagitis Esophageal reflux NOS Ch. 13 Diseases of the musculoskeletal system and connective tissue (M00-M99) Dentofacial anomalies [including malocclusion] and other disorders of jaw (M26-M27) M26 Dentofacial anomalies [including malocclusion] M26.0 Major anomalies of jaw size Excludes1: acromegaly (E22.0) Robin s syndrome (Q87.0) M26.00 Unspecified anomaly of jaw size M26.01 Maxillary hyperplasia M26.02 Maxillary hypoplasia M26.03 Mandibular hyperplasia M26.04 Mandibular hypoplasia M26.05 Macrogenia M26.06 Microgenia M26.07 Excessive tuberosity of jaw Entire maxillary tuberosity M26.09 Other specified anomalies of jaw size M26.1 Anomalies of jaw-cranial base relationship M26.10 Unspecified anomaly of jaw-cranial base relationship M26.11 Maxillary asymmetry M26.12 Other jaw asymmetry M26.19 Other specified anomalies of jaw-cranial base relationship M26.2 Anomalies of dental arch relationship M26.20 Unspecified anomaly of dental arch relationship M26.21 Malocclusion, Angle s class Coding and Billing for Audiology and Speech-Language Pathology

92 M Malocclusion, Angle s class I Neutro-occlusion M Malocclusion, Angle s class II Disto-occlusion Division I Disto-occlusion Division II M Malocclusion, Angle s class III Mesio-occlusion M Malocclusion, Angle s class, unspecified M26.22 Open occlusal relationship M Open anterior occlusal relationship Anterior openbite M Open posterior occlusal relationship Posterior openbite M26.23 Excessive horizontal overlap Excessive horizontal overjet M26.24 Reverse articulation Crossbite (anterior) (posterior) M26.25 Anomalies of interarch distance M26.29 Other anomalies of dental arch relationship Midline deviation of dental arch Overbite (excessive) deep Overbite (excessive) horizontal Overbite (excessive) vertical Posterior lingual occlusion of mandibular teeth M26.3 Anomalies of tooth position of fully erupted tooth or teeth M26.4 Malocclusion, unspecified M26.5 Dentofacial functional abnormalities Excludes1: bruxism (F45.8) teeth-grinding NOS (F45.8) M26.50 Dentofacial functional abnormalities, unspecified M26.51 Abnormal jaw closure M26.52 Limited mandibular range of motion M26.53 Deviation in opening and closing of the mandible M26.54 Insufficient anterior guidance Insufficient anterior occlusal guidance M26.55 Centric occlusion maximum intercuspation discrepancy Excludes1: centric occlusion NOS (M26.59) M26.56 Non-working side interference Balancing side interference M26.57 Lack of posterior occlusal support Chapter 3: ICD-10-CM Diagnostic Codes (SLP) 2016 Coding and Billing for Audiology and Speech-Language Pathology 87

93 Chapter 3: ICD-10-CM Diagnostic Codes (SLP) M26.59 Other dentofacial functional abnormalities Centric occlusion (of teeth) NOS Malocclusion due to abnormal swallowing Malocclusion due to mouth breathing Malocclusion due to tongue, lip or finger habits M26.6 Temporomandibular joint disorders Excludes2: current temporomandibular joint dislocation (S03.0) current temporomandibular joint sprain (S03.4) M26.60 Temporomandibular joint disorder, unspecified M26.61 Adhesions and ankylosis of temporomandibular joint M26.62 Arthralgia of temporomandibular joint M26.63 Articular disc disorder of temporomandibular joint M26.69 Other specified disorders of temporomandibular joint M26.7 Dental alveolar anomalies M26.70 Unspecified alveolar anomaly M26.71 Alveolar maxillary hyperplasia M26.72 Alveolar mandibular hyperplasia M26.73 Alveolar maxillary hypoplasia M26.74 Alveolar mandibular hypoplasia M26.79 Other specified alveolar anomalies M26.8 Other dentofacial anomalies M26.81 Anterior soft tissue impingement Anterior soft tissue impingement on teeth M26.82 Posterior soft tissue impingement Posterior soft tissue impingement on teeth M26.89 Other dentofacial anomalies M26.9 Dentofacial anomaly, unspecified Ch. 16 Certain conditions originating in the perinatal period (P00-P96) Other disorders originating in the perinatal period (P90-P96) P92 Feeding problems of newborn Excludes1: feeding problems in child over 28 days old (R63.3) P92.1 Regurgitation and rumination of newborn P92.2 Slow feeding of newborn P92.6 Failure to thrive in newborn Excludes1: failure to thrive in child over 28 days old (R62.51) P92.8 Other feeding problems of newborn P92.9 Feeding problem of newborn, unspecified Ch. 17 Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) Congenital malformations of the nervous system (Q00-Q07) Q02 Microcephaly Q03 Congenital hydrocephalus Q04 Other congenital malformations of brain Coding and Billing for Audiology and Speech-Language Pathology

94 Q04.3 Other reduction deformities of brain Absence of part of brain Agenesis of part of brain Agyria Aplasia of part of brain Hydranencephaly Hypoplasia of part of brain Lissencephaly Microgyria Pachygyria Excludes1: congenital malformations of corpus callosum (Q04.0) Q05 Spina bifida Congenital malformations of eye, ear, face and neck (Q10-Q18) Q16 Congenital malformations of ear causing impairment of hearing Excludes1: congenital deafness (H90.-) Q16.0 Congenital absence of (ear) auricle Q16.1 Congenital absence, atresia and stricture of auditory canal (external) Congenital atresia or stricture of osseous meatus Q16.2 Absence of eustachian tube Q16.3 Congenital malformation of ear ossicles Congenital fusion of ear ossicles Q16.4 Other congenital malformations of middle ear Congenital malformation of middle ear NOS Q16.5 Congenital malformation of inner ear Congenital anomaly of membranous labyrinth Congenital anomaly of organ of Corti Q16.9 Congenital malformation of ear causing impairment of hearing, unspecified Congenital absence of ear NOS Q17 Other congenital malformations of ear Excludes1: congenital malformations of ear with impairment of hearing (Q16.0-Q16.9) preauricular sinus (Q18.1) Q17.0 Accessory auricle Accessory tragus Polyotia Preauricular appendage or tag Supernumerary ear Supernumerary lobule Q17.1 Macrotia Q17.2 Microtia Q17.3 Other misshapen ear Pointed ear Chapter 3: ICD-10-CM Diagnostic Codes (SLP) 2016 Coding and Billing for Audiology and Speech-Language Pathology 89

95 Chapter 3: ICD-10-CM Diagnostic Codes (SLP) Q17.4 Misplaced ear Low-set ears Excludes1: cervical auricle (Q18.2) Q17.5 Prominent ear Bat ear Q17.8 Other specified congenital malformations of ear Congenital absence of lobe of ear Q17.9 Congenital malformation of ear, unspecified Congenital anomaly of ear NOS Congenital malformations of the respiratory system (Q30-Q34) Q31 Congenital malformations of larynx Excludes1: congenital laryngeal stridor NOS (P28.89) Q31.0 Web of larynx Glottic web of larynx Subglottic web of larynx Web of larynx NOS Q31.1 Congenital subglottic stenosis Q31.2 Laryngeal hypoplasia Q31.3 Laryngocele Q31.5 Congenital laryngomalacia Q31.8 Other congenital malformations of larynx Absence of larynx Agenesis of larynx Atresia of larynx Congenital cleft thyroid cartilage Congenital fissure of epiglottis Congenital stenosis of larynx NEC Posterior cleft of cricoid cartilage Q31.9 Congenital malformation of larynx, unspecified Cleft lip and cleft palate (Q35-Q37) Use additional code to identify associated malformation of the nose (Q30.2) Excludes1: Robin s syndrome (Q87.0) Q35 Cleft palate Includes: fissure of palate palatoschisis Excludes1: cleft palate with cleft lip (Q37.-) Q35.1 Cleft hard palate Q35.3 Cleft soft palate Q35.5 Cleft hard palate with cleft soft palate Q35.7 Cleft uvula Q35.9 Cleft palate, unspecified Cleft palate NOS Coding and Billing for Audiology and Speech-Language Pathology

96 Q36 Cleft lip Includes: cheiloschisis congenital fissure of lip harelip labium leporinum Excludes1: cleft lip with cleft palate (Q37.-) Q36.0 Cleft lip, bilateral Q36.1 Cleft lip, median Q36.9 Cleft lip, unilateral Cleft lip NOS Q37 Cleft palate with cleft lip Includes: cheilopalatoschisis Q37.0 Cleft hard palate with bilateral cleft lip Q37.1 Cleft hard palate with unilateral cleft lip Cleft hard palate with cleft lip NOS Q37.2 Cleft soft palate with bilateral cleft lip Q37.3 Cleft soft palate with unilateral cleft lip Cleft soft palate with cleft lip NOS Q37.4 Cleft hard and soft palate with bilateral cleft lip Q37.5 Cleft hard and soft palate with unilateral cleft lip Cleft hard and soft palate with cleft lip NOS Q37.8 Unspecified cleft palate with bilateral cleft lip Q37.9 Unspecified cleft palate with unilateral cleft lip Cleft palate with cleft lip NOS Other congenital malformations of the digestive system (Q38-Q45) Q38 Other congenital malformations of tongue, mouth and pharynx Excludes1: dentofacial anomalies (M26.-) macrostomia (Q18.4) microstomia (Q18.5) Q38.0 Congenital malformations of lips, not elsewhere classified Congenital fistula of lip Congenital malformation of lip NOS Van der Woude s syndrome Excludes1: cleft lip (Q36.-) cleft lip with cleft palate (Q37.-) macrocheilia (Q18.6) microcheilia (Q18.7) Q38.1 Ankyloglossia Tongue tie Q38.2 Macroglossia Congenital hypertrophy of tongue Chapter 3: ICD-10-CM Diagnostic Codes (SLP) 2016 Coding and Billing for Audiology and Speech-Language Pathology 91

97 Chapter 3: ICD-10-CM Diagnostic Codes (SLP) Q38.3 Other congenital malformations of tongue Aglossia Bifid tongue Congenital adhesion of tongue Congenital fissure of tongue Congenital malformation of tongue NOS Double tongue Hypoglossia Hypoplasia of tongue Microglossia Q38.4 Congenital malformations of salivary glands and ducts Atresia of salivary glands and ducts Congenital absence of salivary glands and ducts Congenital accessory salivary glands and ducts Congenital fistula of salivary gland Q38.5 Congenital malformations of palate, not elsewhere classified Congenital absence of uvula Congenital malformation of palate NOS Congenital high arched palate Excludes1: cleft palate (Q35.-) cleft palate with cleft lip (Q37.-) Q38.6 Other congenital malformations of mouth Congenital malformation of mouth NOS Q38.7 Congenital pharyngeal pouch Congenital diverticulum of pharynx Excludes1: pharyngeal pouch syndrome (D82.1) Q38.8 Other congenital malformations of pharynx Congenital malformation of pharynx NOS Imperforate pharynx Congenital malformations and deformations of the musculoskeletal system (Q65-Q79) Q67 Congenital musculoskeletal deformities of head, face, spine and chest Q67.0 Congenital facial asymmetry Q67.4 Other congenital deformities of skull, face and jaw Congenital depressions in skull Congenital hemifacial atrophy or hypertrophy Deviation of nasal septum, congenital Squashed or bent nose, congenital Excludes1: dentofacial anomalies [including malocclusion] (M26-) syphilitic saddle nose (A50.5) Chromosomal abnormalities, not elsewhere classified (Q90-Q99) Q90 Down syndrome Use additional code(s) to identify any associated physical conditions and degree of intellectual disabilities (F70-F79) Coding and Billing for Audiology and Speech-Language Pathology

98 Q90.0 Trisomy 21, nonmosaicism (meiotic nondisjunction) Q90.1 Trisomy 21, mosaicism (mitotic nondisjunction) Q90.2 Trisomy 21, translocation Q90.9 Down syndrome, unspecified Trisomy 21 NOS Q91 Trisomy 18 and Trisomy 13 Q91.0 Trisomy 18, nonmosaicism (meiotic nondisjunction) Q91.1 Trisomy 18, mosaicism (mitotic nondisjunction) Q91.2 Trisomy 18, translocation Q91.3 Trisomy 18, unspecified Q91.4 Trisomy 13, nonmosaicism (meiotic nondisjunction) Q91.5 Trisomy 13, mosaicism (mitotic nondisjunction) Q91.6 Trisomy 13, translocation Q91.7 Trisomy 13, unspecified Q93 Monosomies and deletions from the autosomes, not elsewhere classified Q93.3 Deletion of short arm of chromosome 4 Wolff-Hirschorn syndrome Q93.4 Deletion of short arm of chromosome 5 Cri-du-chat syndrome Q93.8 Other deletions from the autosomes Q93.81 Velo-cardio-facial syndrome Deletion 22q11.2 Q98 Other sex chromosome abnormalities, male phenotype, not elsewhere classified Q98.0 Klinefelter syndrome karyotype 47, XXY Q98.1 Klinefelter syndrome, male with more than two X chromosomes Ch. 18 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) Symptoms and signs involving the digestive system and abdomen (R10-R19) R12 Heartburn Excludes1: dyspepsia NOS (R10.13) functional dyspepsia (K30) R13 Aphagia and dysphagia R13.0 Aphagia Inability to swallow Excludes1: psychogenic aphagia (F50.9) R13.1 Dysphagia Code first, if applicable, dysphagia following cerebrovascular disease (I69. with final characters -91) Excludes1: psychogenic dysphagia (F45.8) R13.10 Dysphagia, unspecified Difficulty in swallowing NOS R13.11 Dysphagia, oral phase R13.12 Dysphagia, oropharyngeal phase R13.13 Dysphagia, pharyngeal phase Chapter 3: ICD-10-CM Diagnostic Codes (SLP) 2016 Coding and Billing for Audiology and Speech-Language Pathology 93

99 Chapter 3: ICD-10-CM Diagnostic Codes (SLP) R13.14 Dysphagia, pharyngoesophageal phase R13.19 Other dysphagia Cervical dysphagia Neurogenic dysphagia Symptoms and signs involving the nervous and musculoskeletal systems (R25-R29) R27 Other lack of coordination Excludes1: ataxic gait (R26.0) hereditary ataxia (G11.-) vertigo NOS (R42) R27.0 Ataxia, unspecified Excludes1: ataxia following cerebrovascular disease (I69. with final characters -93) R27.8 Other lack of coordination R27.9 Unspecified lack of coordination R29 Other symptoms and signs involving the nervous and musculoskeletal systems R29.8 Other symptoms and signs involving the nervous and musculoskeletal systems R29.81 Other symptoms and signs involving the nervous system R Facial weakness Facial droop Excludes1: Bell s palsy (G51.0) facial weakness following cerebrovascular disease (I69. with final characters-92) R Other symptoms and signs involving the nervous system Symptoms and signs involving cognition, perception, emotional state and behavior (R40-R46) Excludes1: symptoms and signs constituting part of a pattern of mental disorder (F01-F99) R41 Other symptoms and signs involving cognitive functions and awareness Excludes1: dissociative [conversion] disorders (F44.-) mild cognitive impairment, so stated (G31.84) R41.0 Disorientation, unspecified Confusion NOS Delirium NOS R41.1 Anterograde amnesia R41.2 Retrograde amnesia R41.3 Other amnesia Amnesia NOS Memory loss NOS Excludes1: amnestic disorder due to known physiologic condition (F04) amnestic syndrome due to psychoactive substance use (F10-F19 with 5th character.6) transient global amnesia (G45.4) Coding and Billing for Audiology and Speech-Language Pathology

100 R41.4 Neurologic neglect syndrome Asomatognosia Hemi-akinesia Hemi-inattention Hemispatial neglect Left-sided neglect Sensory neglect Visuospatial neglect Excludes1: visuospatial deficit (R41.842) R41.8 Other symptoms and signs involving cognitive functions and awareness R41.81 Age-related cognitive decline Senility NOS R41.82 Altered mental status, unspecified Change in mental status NOS Excludes1: altered level of consciousness (R40.-) altered mental status due to known condition - code to condition delirium NOS (R41.0) R41.83 Borderline intellectual functioning IQ level 71 to 84 Excludes1: intellectual disabilities (F70-F79) R41.84 Other specified cognitive deficit For more information on R Attention and concentration deficit the use of the other specified cognitive Excludes1: attention-deficit hyperactivity disorders (F90.-) deficit codes, see: bit.ly/1sypx1s R Cognitive communication deficit R Visuospatial deficit R Psychomotor deficit R Frontal lobe and executive function deficit R41.89 Other symptoms and signs involving cognitive functions and awareness Anosognosia R41.9 Unspecified symptoms and signs involving cognitive functions and awareness R44 Other symptoms and signs involving general sensations and perceptions Excludes1: alcoholic hallucinations (F1.5) hallucinations in drug psychosis (F11-F19 with.5) hallucinations in mood disorders with psychotic symptoms (F30.2, F31.5, F32.3, F33.3) hallucinations in schizophrenia, schizotypal and delusional disorders (F20-F29) Excludes2: disturbances of skin sensation (R20.-) R44.0 Auditory hallucinations Chapter 3: ICD-10-CM Diagnostic Codes (SLP) 2016 Coding and Billing for Audiology and Speech-Language Pathology 95

101 Chapter 3: ICD-10-CM Diagnostic Codes (SLP) Symptoms and signs involving speech and voice (R47-R49) R47 Speech disturbances, not elsewhere classified Excludes1: autism (F84.0) cluttering (F80.81) specific developmental disorders of speech and language (F80.-) stuttering (F80.81) R47.0 Dysphasia and aphasia R47.01 Aphasia Excludes1: aphasia following cerebrovascular disease (I69. with final characters -20) progressive isolated aphasia (G31.01) R47.02 Dysphasia Excludes1: dysphasia following cerebrovascular disease (I69. with final characters -21) R47.1 Dysarthria and anarthria Excludes1: dysarthria following cerebrovascular disease (I69. with final characters -22) R47.8 Other speech disturbances Excludes1: dysarthria following cerebrovascular disease (I69. with final characters -28) R47.81 Slurred speech R47.82 Fluency disorder in conditions classified elsewhere Stuttering in conditions classified elsewhere Code first: underlying disease or condition, such as: Parkinson s disease (G20) Excludes1: adult onset fluency disorder (F98.5) childhood onset fluency disorder (F80.81) fluency disorder (stuttering) following cerebrovascular disease (I69. with final characters-23) R47.89 Other speech disturbances R47.9 Unspecified speech disturbances R48 Dyslexia and other symbolic dysfunctions, not elsewhere classified Excludes1: specific developmental disorders of scholastic skills (F81.-) R48.0 Dyslexia and alexia R48.1 Agnosia Astereognosia (astereognosis) Autotopagnosia Excludes1: visual object agnosia H53.16 R48.2 Apraxia Excludes1: apraxia following cerebrovascular disease (I69. with final characters -90) R48.3 Visual agnosia Prosopagnosia Simultanagnosia (asimultagnosia) Coding and Billing for Audiology and Speech-Language Pathology

102 R48.8 Other symbolic dysfunctions R48.8 can be used to capture neurological language impairments when there is documented neurological information to support the diagnosis. Unless caused by stroke (I69.-), cognitive communication problems may also be captured here or with R (see bit.ly/1sypx1s for more on the use of R41.841). Acalculia Agraphia R48.9 Unspecified symbolic dysfunctions R49 Voice and resonance disorders Excludes1: psychogenic voice and resonance disorders (F44.4) R49.0 Dysphonia Hoarseness R49.1 Aphonia Loss of voice R49.2 Hypernasality and hyponasality R49.21 Hypernasality R49.22 Hyponasality R49.8 Other voice and resonance disorders R49.9 Unspecified voice and resonance disorder Change in voice NOS Resonance disorder NOS General symptoms and signs (R50-R69) R62 Lack of expected normal physiological development in childhood and adults Excludes1: delayed puberty (E30.0) gonadal dysgenesis (Q99.1) hypopituitarism (E23.0) R62.0 Delayed milestone in childhood Delayed attainment of expected physiological developmental stage Late talker Late walker R62.5 Other and unspecified lack of expected normal physiological development in childhood Excludes1: HIV disease resulting in failure to thrive (B20) physical retardation due to malnutrition (E45) R62.50 Unspecified lack of expected normal physiological development in childhood Infantilism NOS R62.51 Failure to thrive (child) Failure to gain weight Excludes1: failure to thrive in child under 28 days old (P92.6) R63.3 Feeding difficulties Feeding problem (elderly) (infant) NOS Excludes1: feeding problems of newborn (P92.-) infant feeding disorder of nonorganic origin (F98.2-) R63.4 Abnormal weight loss Abnormal findings on diagnostic imaging and in function studies, without diagnosis (R90-R94) R94 Abnormal results of function studies R94.0 Abnormal results of function studies of central nervous system Chapter 3: ICD-10-CM Diagnostic Codes (SLP) 2016 Coding and Billing for Audiology and Speech-Language Pathology 97

103 Chapter 3: ICD-10-CM Diagnostic Codes (SLP) R94.01 Abnormal electroencephalogram [EEG] R94.02 Abnormal brain scan R94.09 Abnormal results of other function studies of central nervous system R94.1 Abnormal results of function studies of peripheral nervous system and special senses R94.12 Abnormal results of function studies of ear and other special senses R Abnormal auditory function study R Abnormal vestibular function study R Abnormal results of other function studies of ear and other special senses Ch. 19 Injury, poisoning and certain other consequences of external causes (S00-T88) Note: Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T-section that include the external cause do not require an additional external cause code Use additional code to identify any retained foreign body, if applicable (Z18.-) Excludes1: birth trauma (P10-P15) obstetric trauma (O70-O71) Note: The chapter uses the S-section for coding different types of injuries related to single body regions and the T-section to cover injuries to unspecified body regions as well as poisoning and certain other consequences of external causes. Injuries to the head (S00-S09) Includes: injuries of ear injuries of eye injuries of face [any part] injuries of gum injuries of jaw injuries of oral cavity injuries of palate injuries of periocular area injuries of scalp injuries of temporomandibular joint area injuries of tongue injuries of tooth Excludes2: burns and corrosions (T20-T32) effects of foreign body in ear (T16) effects of foreign body in larynx (T17.3) effects of foreign body in mouth NOS (T18.0) effects of foreign body in nose (T17.0-T17.1) effects of foreign body in pharynx (T17.2) effects of foreign body on external eye (T15.-) frostbite (T33-T34) S00 Superficial injury of head Excludes1: diffuse cerebral contusion (S06.2-) Coding and Billing for Audiology and Speech-Language Pathology

104 focal cerebral contusion (S06.3-) injury of eye and orbit (S05.-) open wound of head (S01.-) The appropriate 7th character is to be added to each code from category S00 A - initial encounter D - subsequent encounter S sequela S00.5 Superficial injury of lip and oral cavity S01 Open wound of head Code also any associated: injury of cranial nerve (S04.-) injury of muscle and tendon of head (S09.1-) intracranial injury (S06.-) wound infection Excludes1: open skull fracture (S02.- with 7th character B) Excludes2: injury of eye and orbit (S05.-) traumatic amputation of part of head (S08.-) The appropriate 7th character is to be added to each code from category S01 A - initial encounter D - subsequent encounter S sequela S01.5 Open wound of lip and oral cavity S02 Fracture of skull and facial bones Note: A fracture not indicated as open or closed should be coded to closed Code also any associated intracranial injury (S06.-) The appropriate 7th character is to be added to each code from category S02 A - initial encounter for closed fracture B - initial encounter for open fracture D - subsequent encounter for fracture with routine healing G - subsequent encounter for fracture with delayed healing K - subsequent encounter for fracture with nonunion S - sequela S06 Intracranial injury The appropriate 7th character is to be added to each code from category S06 A - initial encounter D - subsequent encounter S - sequela Includes: traumatic brain injury Excludes1: head injury NOS (S09.90) Chapter 3: ICD-10-CM Diagnostic Codes (SLP) 2016 Coding and Billing for Audiology and Speech-Language Pathology 99

105 Chapter 3: ICD-10-CM Diagnostic Codes (SLP) S06.0 Concussion S06.2 Diffuse traumatic brain injury S06.3 Focal traumatic brain injury S12 Fracture of cervical vertebra and other parts of neck S12.8 Fracture of other parts of neck The appropriate 7th character is to be added to code S12.8 A - initial encounter D - subsequent encounter S - sequela Hyoid bone Larynx Thyroid cartilage Trachea Injury, poisoning and certain other consequences of external causes (T07-T88) T17 Foreign body in respiratory tract The appropriate 7th character is to be added to each code from category T17 A - initial encounter D - subsequent encounter S - sequela T17.2 Foreign body in pharynx Foreign body in nasopharynx Foreign body in throat NOS T17.22 Food in pharynx Bones in pharynx Seeds in pharynx T Food in pharynx causing asphyxiation T17.3 Foreign body in larynx T17.32 Food in larynx Bones in larynx Seeds in larynx T Food in larynx causing asphyxiation T17.4 Foreign body in trachea T17.42 Food in trachea Bones in trachea Seeds in trachea T Food in trachea causing asphyxiation T18 Foreign body in alimentary tract Excludes2: foreign body in pharynx (T17.2-) T18.1 Foreign body in esophagus Coding and Billing for Audiology and Speech-Language Pathology

106 Ch. 21 Factors Influencing Health Status and Contact with Health Services (Z00-Z99) Note: Z codes (formerly V codes in ICD-9-CM) represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure Z codes were is performed. Categories Z00-Z99 are provided for occasions when known as V codes in circumstances other than a disease, injury, or external cause classifiable to ICD-9-CM categories A00-Y89 are recorded as diagnoses or problems. This can arise in two main ways: a. When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury. b. When some circumstance or problem is present which influences the person s health status but is not in itself a current illness or injury. Persons encountering health services for examinations (Z00-Z13) Note: Nonspecific abnormal findings disclosed at the time of these examinations are classified to categories R70-R94. Excludes1: examinations related to pregnancy and reproduction (Z30-Z36, Z39.-) Z01 Encounter for other special examination without complaint, suspected or reported diagnosis Includes: routine examination of specific system Note: Codes from category Z01 represent the reason for the encounter. A separate procedure code is required to identify any examinations or procedures performed Excludes1: encounter for examination for administrative purposes (Z02.-) encounter for examination for suspected conditions, proven not to exist (Z03.-) encounter for laboratory and radiologic examinations as a component of general medical examinations (Z00.0-) encounter for laboratory, radiologic and imaging examinations for sign(s) and symptom(s) - code to the sign(s) or symptom(s) Excludes2: screening examinations (Z11-Z13) Z01.1 Encounter for examination of ears and hearing Z01.10 Encounter for examination of ears and hearing without abnormal findings Encounter for examination of ears and hearing NOS Z01.11 Encounter for examination of ears and hearing with abnormal findings Z Encounter for hearing examination following failed hearing screening Z Encounter for examination of ears and hearing with other abnormal findings Use additional code to identify abnormal findings Z01.12 Encounter for hearing conservation and treatment Z Encounter for other preprocedural examination Note: One Medicare Local Coverage Determination (LCD) guides SLPs to use V72.83 to report pre-laryngectomy examinations. Check with payers regarding appropriate use of this code. Chapter 3: ICD-10-CM Diagnostic Codes (SLP) 2016 Coding and Billing for Audiology and Speech-Language Pathology 101

107 Chapter 3: ICD-10-CM Diagnostic Codes (SLP) Z02 Encounter for administrative examination Z02.7 Encounter for issue of medical certificate Excludes1: encounter for general medical examination (Z00-Z01, Z02.0-Z02.6, Z02.8-Z02.9) Z02.71 Encounter for disability determination Encounter for issue of medical certificate of incapacity Encounter for issue of medical certificate of invalidity Z02.79 Encounter for issue of other medical certificate Z13 Encounter for screening for other diseases and disorders Screening is the testing for disease or disease precursors in asymptomatic individuals so that early detection and treatment can be provided for those who test positive for the disease. Excludes1: encounter for diagnostic examination-code to sign or symptom Z13.4 Encounter for screening for certain developmental disorders in childhood Encounter for screening for developmental handicaps in early childhood Excludes1: routine development testing of infant or child (Z00.1-) Z13.5 Encounter for screening for eye and ear disorders Excludes2: encounter for general hearing examination (Z01.1-) encounter for general vision examination (Z01.0-) Z13.8 Encounter for screening for other specified diseases and disorders Excludes2: screening for malignant neoplasms (Z12.-) Z13.85 Encounter for screening for nervous system disorders Z Encounter for screening for traumatic brain injury Encounters for other specific health care (Z40-Z53) Categories Z40-Z53 are intended for use to indicate a reason for care. They may be used for patients who have already been treated for a disease or injury, but who are receiving aftercare or prophylactic care, or care to consolidate the treatment, or to deal with a residual state Excludes2: follow-up examination for medical surveillance after treatment (Z08-Z09) Z43 Encounter for attention to artificial openings Includes: closure of artificial openings passage of sounds or bougies through artificial openings reforming artificial openings removal of catheter from artificial openings toilet or cleansing of artificial openings Excludes1: artificial opening status only, without need for care (Z93.-) complications of external stoma (J95.0-, K94.-, N99.5-) Excludes2: fitting and adjustment of prosthetic and other devices (Z44-Z46) Z43.0 Encounter for attention to tracheostomy Z44 Encounter for fitting and adjustment of external prosthetic device Includes: removal or replacement of external prosthetic device Excludes1: malfunction or other complications of device - see Alphabetical Index presence of prosthetic device (Z97.-) Z44.8 Encounter for fitting and adjustment of other external prosthetic devices Z44.9 Encounter for fitting and adjustment of unspecified external prosthetic device Coding and Billing for Audiology and Speech-Language Pathology

108 Z45 Encounter for adjustment and management of implanted device Includes: removal or replacement of implanted device Excludes1: malfunction or other complications of device presence of prosthetic and other devices (Z95-Z97) Excludes2: encounter for fitting and adjustment of non-implanted device (Z46.-) Z45.3 Encounter for adjustment and management of implanted devices of the special senses Z45.32 Encounter for adjustment and management of implanted hearing device Excludes1: Encounter for fitting and adjustment of hearing aid (Z46.1) Z Encounter for adjustment and management of bone conduction device Z Encounter for adjustment and management of cochlear device Z Encounter for adjustment and management of other implanted hearing device Z46 Encounter for fitting and adjustment of other devices Includes: removal or replacement of other device Excludes1: malfunction or other complications of device - see Alphabetical Index Excludes2: encounter for fitting and management of implanted devices (Z45.-) issue of repeat prescription only (Z76.0) presence of prosthetic and other devices (Z95-Z97) Z46.1 Encounter for fitting and adjustment of hearing aid Excludes1: encounter for adjustment and management of implanted hearing device (Z45.32-) Z51 Encounter for other aftercare Z51.8 Encounter for other specified aftercare Excludes1: holiday relief care (Z75.5) Z51.89 Encounter for other specified aftercare ICD-9 code V57.3 Speech-language therapy does not have an exact mapping in ICD-10 and is now captured under Z Persons with potential health hazards related to socioeconomic and psychosocial circumstances (Z55-Z65) Z57 Occupational exposure to risk factors Z57.0 Occupational exposure to noise Persons encountering health services in other circumstances (Z69-Z76) Z73 Problems related to life management difficulty Excludes2: problems related to socioeconomic and psychosocial circumstances (Z55-Z65) Z73.8 Other problems related to life management difficulty Z73.82 Dual sensory impairment Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99) Code also any follow-up examination (Z08-Z09) Z77 Other contact with and (suspected) exposures hazardous to health Z77.1 Contact with and (suspected) exposure to environmental pollution and hazards in the physical environment Z77.12 Contact with and (suspected) exposure to hazards in the physical environment Z Contact with and (suspected) exposure to noise Chapter 3: ICD-10-CM Diagnostic Codes (SLP) 2016 Coding and Billing for Audiology and Speech-Language Pathology 103

109 Chapter 3: ICD-10-CM Diagnostic Codes (SLP) Z81 Family history of mental and behavioral disorders Z82 Family history of certain disabilities and chronic diseases (leading to disablement) Z82.2 Family history of deafness and hearing loss Conditions classifiable to H90-H91 Z83 Family history of other specific disorders Excludes2: contact with and (suspected) exposure to communicable disease in the family (Z20.-) Z83.5 Family history of eye and ear disorders Conditions classifiable to H00-H53, H55-H83, H92-H95 Excludes2: family history of blindness and visual loss (Z82.1) family history of deafness and hearing loss (Z82.2) Z83.52 Family history of ear disorders Conditions classifiable to H60-H83, H92-H95 Excludes2: family history of deafness and hearing loss (Z82.2) Z86 Personal history of certain other diseases Code first any follow-up examination after treatment (Z09) Z86.5 Personal history of mental and behavioral disorders Conditions classifiable to F40-F59 Z86.59 Personal history of other mental and behavioral disorders Z87 Personal history of other diseases and conditions Code first any follow-up examination after treatment (Z09) Z87.7 Personal history of (corrected) congenital malformations Conditions classifiable to Q00-Q89 that have been repaired or corrected Z87.72 Personal history of (corrected) congenital malformations of nervous system and sense organs Z Personal history of (corrected) congenital malformations of ear Z87.73 Personal history of (corrected) congenital malformations of digestive system Z Personal history of (corrected) cleft lip and palate Z87.79 Personal history of other (corrected) congenital malformations Z Personal history of (corrected) congenital malformations of face and neck Z87.8 Personal history of other specified conditions Excludes2: personal history of self harm (Z91.5) Z87.82 Personal history of other (healed) physical injury and trauma Conditions classifiable to S00-T88, except traumatic fractures Z Personal history of traumatic brain injury Excludes1: personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits (Z86.73) Z90 Acquired absence of organs, not elsewhere classified Includes: postprocedural or post-traumatic loss of body part NEC Excludes1: congenital absence Z90.0 Acquired absence of part of head and neck Coding and Billing for Audiology and Speech-Language Pathology

110 Z90.02 Acquired absence of larynx Z90.09 Acquired absence of other part of head and neck Acquired absence of nose Excludes2: teeth (K08.1) Z93 Artificial opening status Excludes1: artificial openings requiring attention or management (Z43.-) complications of external stoma (J95.0-, K94.-, N99.5-) Z93.0 Tracheostomy status Z96 Presence of other functional implants Excludes2: complications of internal prosthetic devices, implants and grafts (T82-T85) fitting and adjustment of prosthetic and other devices (Z44-Z46) Z96.2 Presence of otological and audiological implants Z96.20 Presence of otological and audiological implant, unspecified Z96.21 Cochlear implant status Z96.22 Myringotomy tube(s) status Z96.29 Presence of other otological and audiological implants Presence of bone-conduction hearing device Presence of eustachian tube stent Stapes replacement Z96.3 Presence of artificial larynx Z97 Presence of other devices Excludes1: complications of internal prosthetic devices, implants and grafts (T82-T85) fitting and adjustment of prosthetic and other devices (Z44-Z46) Z97.4 Presence of external hearing-aid Chapter 3: ICD-10-CM Diagnostic Codes Coding Normal Results Frequently Asked Questions Many third party payers will not reimburse for audiology or speech-language pathology services when the results of an evaluation are reported simply as within normal limits. These FAQs describe how to use International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes when normal results are found and provides examples for complaints that prompt the referral. The answers are based on general coding principles and best practices, as well as guidance from the Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS). Audiologists and speech-language pathologists are responsible for verifying coding and billing policies with their specific payers. How should an audiologist or speech-language pathologist assign an ICD-10-CM code when an evaluation produces a normal result? The signs and symptoms, chief complaint, or reason(s) for the encounter should be reported as the first-listed diagnosis. The audiologist or speech-language pathologist should also use additional codes that describe any co-existing or chronic conditions. Do not code conditions that were previously treated and no longer exist, although history codes may be used as secondary codes if the historical condition or family history has an impact on current care or influences treatment. Are there official instructions on how to code when the results are normal? The ICD-10-CM Official Guidelines for Coding and Reporting [PDF] ( icd/10cmguidelines_2016_final.pdf) provides a description of how to report an uncertain diagnosis based on setting Coding and Billing for Audiology and Speech-Language Pathology 105

111 Chapter 3: ICD-10-CM Diagnostic Codes For outpatient services, ICD-10-CM guidelines state, Do not code diagnoses documented as probable, suspected, questionable, rule out, or working diagnosis or other similar terms indicating uncertainty. Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit. For inpatient services (including short-term, acute, and long-term care), ICD-10-CM advises If the diagnosis documented at the time of discharge is qualified as probable, suspected, likely, questionable, possible, or still to be ruled out or other similar terms indicating uncertainty, code the condition as if it existed or was established. Can you provide examples of how a speechlanguage pathologist should code signs and symptoms when results are normal? The following chart presents examples of patients who present with specific complaints but are found to be within normal limits after an evaluation is completed. Patient Complaint Hoarse vocal quality Problems with swallowing Unintelligible speech Late talker ICD-10-CM Code R49.0 Dysphonia, hoarseness R13.10 Dysphagia, unspecified F80.0 Phonological disorder, functional speech articulation disorder R62.0 Delayed milestones in childhood Can you provide examples of how an audiologist should code signs and symptoms when results are normal? The following chart presents examples of patients who present with specific complaints but are found to be within normal limits after an evaluation is completed. ICD-10-PCS (Procedure Coding System) for Audiologists and SLPs Beginning October 1, 2015, health care providers will be required to use the new ICD-10 system, which replaces ICD-9. The new ICD-10 will include the ICD-10-CM (clinical modification) and ICD-10-PCS (procedure coding system). The clinical modification was developed by the Centers for Disease Control and Prevention for use in all U.S. health care treatment settings. The procedure coding system (i.e., ICD-9-PCS and ICD-10-PCS) was developed by the Centers for Medicare and Medicaid Services for use in the U.S. for inpatient hospital settings only. ASHA s resources focus mostly on ICD-10-CM. You may want to check with your facility on use of ICD-10- PCS. The ICD-10-PCS is a procedure classification published by the United States for classifying procedures performed in hospital inpatient health care settings only. CMS provides the following link for information about ICD-10-PCS; ICD10/2015-ICD-10-PCS-and-GEMs.html The CMS guidelines for ICD-10-PCS, found in the above link, are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-PCS itself. The instructions and conventions of the classification take precedence over guidelines. The 2015 Code Tables and Index are the actual codes used in ICD-10-PCS. Speech-language pathology and audiology related codes are found in section F - Physical Rehabilitation and Diagnostic Audiology. Patient Complaint Mild hearing loss Dizziness History of noise exposure ICD-10-CM Code H91.90 Unspecified hearing loss, unspecified ear R42 Dizziness and giddiness, light headedness, vertigo NOS H83.3X9 Noise effects on inner ear, unspecified Where can I obtain a list of the ICD-10-CM codes for audiologists and speech-language pathologists? Audiology and speech-language pathology specific ICD- 10-CM lists are available on ASHA s ICD-10 website. For comprehensive speech and hearing related ICD-10 and CPT (Current Procedural Terminology) coding information, we also recommend ASHA s Coding and Billing for Audiology and Speech-Language Pathology, which is updated annually and is available for purchase on ASHA s online store. Questions about coding can be sent to reimbursement@asha.org Coding and Billing for Audiology and Speech-Language Pathology

112 Chapter 4: HCPCS (Healthcare Common Procedure Coding System, Medicare & Medicaid) General The Centers for Medicare & Medicaid Services (CMS) developed a second level of codes, the Healthcare Common Procedure Coding System (HCPCS) or Level II HCPCS National Codes, because the Current Procedural Terminology (CPT) manual does not contain all of the codes needed to report medical services and supplies. Use of Codes HCPCS codes related to audiology and speech-language pathology are included in this book. Audiology Related HCPCS Codes Hearing services fall under some L-codes and V5008-V5336. Please note that Medicare does not cover routine physical checkups for the purposes of prescribing, fitting, or changing hearing aids or examinations for hearing aids. G0402 Initial preventive physical examination, face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment L8629 L8690 L8691 L8692 L8693 L8699 L9900 S0618 V5008 V5010 V5011 V5014 V5020 V5030 Transmitting coil and cable, integrated for use with cochlear implant device, replacement Auditory osseointegrated device, includes all internal and external components Auditory osseointegrated device, external sound processor, replacement Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment (not covered by Medicare) Auditory osseointegrated device abutment, any length, replacement only Prosthetic implant, not otherwise specified Orthotic and prosthetic supply, accessory, and/or service component of another HCPCS L code Audiometry for hearing aid evaluation (Medicare and other federal payers do not recognize S codes; however, these codes may be useful for claims to private payers) Hearing Screening Assessment for hearing aid Fitting/Orientation/Checking of hearing aid Repair/Modification of a hearing aid Conformity evaluation Hearing aid, monaural, body worn, air conduction Chapter 4: HCPCS L8614 Cochlear device, includes all internal and external components V5040 Hearing aid, monaural, body worn, bone conduction L8615 L8616 L8617 Headset/headpiece for use with cochlear implant device, replacement Microphone for use with cochlear implant device, replacement Transmitting coil for use with cochlear implant device, replacement V5050 V5060 V5070 V5080 V5090 Hearing aid, monaural, in the ear Hearing aid, monaural, behind the ear Glasses, air conduction Glasses, bone conduction Dispensing fee, unspecified hearing aid L8618 Transmitter cable for use with cochlear implant device, replacement V5095 Semi-implantable middle ear hearing prosthesis (use for Vibrant Soundbridge) L8619 L8621 L8622 Cochlear implant external speech processor, replacement Zinc air battery for use with cochlear implant device, replacement, each Alkaline battery for use with cochlear implant device, any size, replacement, each V5100 V5110 V5120 V5130 V5140 Hearing aid, bilateral, body worn Dispensing fee, bilateral Binaural, body Binaural, in the ear Binaural, behind the ear L8623 L8624 L8627 L8628 Lithium ion battery for use with cochlear implant device speech processor, worn on the body, other than ear level, replacement, each Lithium ion battery for use with cochlear implant device speech processor, ear level, replacement, each Cochlear implant, external speech processor, component, replacement Cochlear implant, external controller component, replacement V5150 V5160 V5170 V5180 V5190 V5200 V5210 V5220 Binaural, glasses Dispensing fee, binaural Hearing aid, CROS, in the ear Hearing aid, CROS, behind the ear Hearing aid, CROS, glasses Dispensing fee, CROS Hearing aid, BICROS, in the ear Hearing aid, BICROS, behind the ear 2016 Coding and Billing for Audiology and Speech-Language Pathology 107

113 Chapter 4: HCPCS V5230 V5240 V5241 V5242 V5243 V5244 V5245 V5246 V5247 V5248 V5249 V5250 V5251 V5252 Hearing aid, BICROS, glasses Dispensing fee, BICROS Dispensing fee, monaural hearing aid, any type Hearing aid, analog, monaural, CIC (completely in the ear canal) Hearing aid, analog, monaural, ITC (in the canal) Hearing aid, digitally programmable analog, monaural CIC Hearing aid, digitally programmable analog, monaural, ITC Hearing aid, digitally programmable analog, monaural, ITE (in the ear) Hearing aid, digitally programmable analog, monaural, BTE Hearing aid, analog, binaural, CIC Hearing aid, analog, binaural, ITC Hearing aid, digitally programmable analog, binaural, CIC Hearing aid, digitally programmable analog, binaural, ITC Hearing aid, digitally programmable, binaural, ITE V5274 V5275 V5281 V5282 V5283 V5284 V5285 V5286 V5287 V5288 V5289 V5290 V5298 V5299 V5336 Assistive listening device, not otherwise specified Ear impression, each Personal FM/DM system, monaural, (one receiver, transmitter and microphone) Personal FM/DM system, binaural (two receivers, transmitter and microphone) Personal FM/DM neck, loop induction receiver Personal FM/DM, ear level receiver Personal FM/DM, direct audio input receiver Personal blue tooth FM/DM receiver Personal FM/DM receiver, not otherwise specified Personal FM/DM transmitter assistive listening device Personal FM/DM adapter/boot coupling device for receiver, any type Transmitter microphone, any type Hearing aid, not otherwise classified Hearing service, miscellaneous Repair/Modification of augmentative communicative system or device (excl. adaptive hearing aid) V5253 V5254 V5255 Hearing aid, digitally programmable, binaural, BTE Hearing aid, digital, monaural, CIC Hearing aid, digital, monaural, ITC Modifiers GT Via interactive audio and video telecommunication systems V5256 V5257 V5258 V5259 V5260 V5261 V5262 V5263 V5264 V5265 V5266 V5267 V5268 V5269 V5270 V5271 V5272 V5273 Hearing aid, digital, monaural, ITE Hearing aid, digital, monaural, BTE Hearing aid, digital, binaural, CIC Hearing aid, digital, binaural, ITC Hearing aid, digital, binaural, ITE Hearing aid, digital, binaural, BTE Hearing aid, disposable, any type, monaural Hearing aid, disposable, any type, binaural Ear mold/insert, not disposable, any type Ear mold/insert, disposable, any type Battery for use in hearing device Hearing aid or assistive listening device/supplies/ accessories, not otherwise specified Assistive listening device, telephone amplifier, any type Assistive listening device, alerting, any type Assistive listening device, television amplifier, any type Assistive listening device, television caption decoder Assistive listening device, TDD Assistive listening device, for use with cochlear implant LT Left side (used to identify procedures performed on the left side of the body) NU New equipment RA Replacement of a DME, orthotic or prosthetic item RB Replacement of a part of a DME, orthotic or prosthetic item furnished as part of a repair RT Right side (used to identify procedures performed on the right side of the body) SZ Habilitative Services Speech-Language Pathology Related HCPCS Codes HCPCS Level II includes codes for speech generating devices, voice prosthetics, voice amplifiers, and repair of AAC systems or devices. Please note that Medicare claims for E and L codes and V5336 fall under the jurisdiction of the (DME MACs). A7503 Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each A7504 Filter for use in a tracheostoma heat and moisture exchange system, each Coding and Billing for Audiology and Speech-Language Pathology

114 A7505 A7506 A7507 A7508 A7509 E1902 E2500 E2502 E2504 Housing, reusable without adhesive, for use in heat and moisture exchange system and/or with a tracheostoma valve, each Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, and type, each Filter holder and integrated filter without adhesive, for use in a tracheostoma health and moisture exchange system, each Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each Communication board, nonelectronic augmentative or alternative communication device Speech generating device, digitized speech, using prerecorded messages, less than or equal to 8 minutes recording time Speech generating device, digitized speech, using prerecorded messages, greater than 8 minutes but less than or equal to 20 minutes of recording time Speech generating device, digitized speech, using prerecorded messages, greater than 20 minutes but less than or equal to 40 minutes of recording time L8505 L8507 L8509 L8510 L8511 L8512 L8513 L8514 L8515 S9128 S9152 V5336 V5362 V5363 Artificial larynx replacement battery/accessory, any type Tracheo-esophageal voice prosthesis, patient inserted, any type, each Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type Voice amplifier Insert for indwelling tracheoesophageal prosthesis, with our without valve, replacement only, each Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10 Cleaning device used jwith tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each Tracheoesophageal puncture dilator, replacement only, each Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each Speech therapy, in the home, per diem Speech therapy, re-evaluation Repair/modification of augmentative communicative system or device (excludes adaptive hearing aid) Speech screening Language screening Chapter 4: HCPCS E2506 E2508 E2510 Speech generating device, digitized speech, using prerecorded messages, greater than 40 minutes of recording time Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access V5364 Dysphagia screening Modifiers GT Via interactive audio and video telecommunication systems LT Left side (used to identify procedures performed on the left side of the body) NU New equipment RA Replacement of a DME, orthotic or prosthetic item E2511 Speech generating software program, for personal computer or personal digital assistant RB Replacement of a part of a DME, orthotic or prosthetic item furnished as part of a repair E2512 Accessory for speech generating device, mounting system RT Right side (used to identify procedures performed on the right side of the body) E2599 Accessory for speech generating device, not otherwise specified SZ Habilitative Services G0451 Developmental testing with interpretation and report, per standardized instrument L8499 Unlisted procedure for miscellaneous prosthetic services L8500 Artificial larynx, any type L8501 Tracheostomy speaking valve 2016 Coding and Billing for Audiology and Speech-Language Pathology 109

115 Coding and Billing for Audiology and Speech-Language Pathology

116 Chapter 5: G-codes G-codes and Severity Modifiers for Speech- Language Pathology Claims-Based Outcomes Reporting for Medicare Part B Therapy Services Background Speech-language pathologists (SLPs) who treat Medicare Part B beneficiaries must report patient outcomes on claim forms and documenting in the medical record starting January 1, Claims that do not comply with the data reporting requirements are returned unpaid. The outcomes reporting is for data collection. At this time they are not using the data for tracking individual Medicare beneficiaries progress. Anyone providing therapy, including speech-language evaluation and treatment services, for Medicare Part B beneficiaries must report outcomes on the claim form in this mandatory data collection program. This includes Part B services in: hospitals, critical access hospitals, private practices, skilled nursing facilities, home health or rehabilitation agencies, outpatient rehabilitation facilities (ORFs), and comprehensive outpatient rehabilitation facilities (CORFs). Reporting requirements are not mandated for Medicare Part A, Medicare Advantage/HMO plans, Medicaid or private health plans. However, some plans may elect to require them. Chapter 5: G-codes Reporting SLPs are required to report on every Medicare Part B patient they evaluate and treat and can choose from one of seven conditions or one generic measure. Medicare adopted the reportable conditions from ASHA s National Outcomes Measurement System (NOMS) Functional Communication Measures (FCMs) and created HCPCS G-codes to represent current status, projected goal, and discharge status for each condition. Along with the 7-point severity modifier system, the Medicare reporting requirements correspond to the NOMS data collection system, which offers SLPs a reliable tool for documenting outcomes and complying with the Medicare reporting rules. SLPs must report one condition for every Medicare Part B beneficiary at every evaluation, admission, discharge, and every 10th treatment day. With every reporting interval, the SLP will report a status G-code (either current status or discharge status) and projected goal G-code, with the appropriate modifier representing the level of severity for status and projected long-term goal. The alphanumeric codes must be documented in the medical record Coding and Billing for Audiology and Speech-Language Pathology 111

117 Chapter 5: G-codes Speech-Language Pathology Related G-codes G-codes Swallowing Functional Limitation & Status G8996 Swallowing functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals G8997 Swallowing functional limitation, projected goal status, at initial therapy treatment/outset and at discharge from therapy G8998 Swallowing functional limitation, discharge status, at discharge from therapy/end of reporting on limitation Motor Speech (Note: The codes for Motor Speech are not sequentially numbered) G8999 Motor speech functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals G9186 Motor speech functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy G9158 Motor speech functional limitation, discharge status at discharge from therapy/end of reporting on limitation Spoken Language Comprehension G9159 Spoken language comprehension functional limitation, current status at time of initial therapy treatment/ episode outset and reporting intervals G9160 Spoken language comprehension functional limitation, projected goal status at initial therapy treatment/ outset and at discharge from therapy G9161 Spoken language comprehension functional limitation, discharge status at discharge from therapy/end of reporting on limitation Spoken Language Expression G9162 Spoken language expression functional limitation, current status at time of initial therapy treatment/ episode outset and reporting intervals G9163 Spoken language expression functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy G9164 Spoken language expression functional limitation, discharge status at discharge from therapy/end of reporting on limitation Attention G9165 Attention functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals G9166 Attention functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy G9167 Attention functional limitation, discharge status at discharge from therapy/end of reporting on limitation Memory G9168 Memory functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals G9169 Memory functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy G9170 Memory functional limitation, discharge status at discharge from therapy/end of reporting on limitation Voice G9171 Voice functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals G9172 Voice functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy G9173 Voice functional limitation, discharge status at discharge from therapy/end of reporting on limitation Coding and Billing for Audiology and Speech-Language Pathology

118 G-codes Functional Limitation & Status Other SLP Functional Limitation G9174 G9175 G9176 Severity Modifiers Other speech language pathology functional limitation, current status at time of initial therapy treatment/ episode outset and reporting intervals Other speech language pathology functional limitation, projected goal status at initial therapy treatment/ outset and at discharge from therapy Other speech language pathology functional limitation, discharge status at discharge from therapy/end of reporting on limitation Note: Corresponding National Outcomes Measurement System (NOMS) Functional Communication Measures 1 levels are listed here. Use of NOMS can assist with G-code and severity modifier selection, but is not required by CMS. Chapter 5: G-codes Modifier Impairment Limitation Restriction FCM Level CH 0 percent impaired, limited or restricted 7 CI At least 1 percent but less than 20 percent impaired, limited or restricted 6 CJ At least 20 percent but less than 40 percent impaired, limited or restricted 5 CK At least 40 percent but less than 60 percent impaired, limited or restricted 4 CL At least 60 percent but less than 80 percent impaired, limited or restricted 3 CM At least 80 percent but less than 100 percent impaired, limited or restricted 2 CN 100 percent impaired, limited or restricted 1 ASHA Note: GN Modifier Part B services provided under plans of care for speech-language pathology or dysphagia services require a GN modifier as a suffix to the CPT Code. The requirement applies to physician offices as well as facilities and private practices. Occupational therapy and physical therapy modifiers are GO and GP, respectively. 1 See Coding and Billing for Audiology and Speech-Language Pathology 113

119 Chapter 5: G-codes Case Scenarios and Sample Claim Form Entries for Outcomes Reporting for Medicare Part B Therapy Services The American Speech-Language-Hearing Association developed the following scenarios to help speech-language pathologists understand the claims process when reporting outcomes for Medicare Part B therapy services. For more information on claims-based outcomes reporting, go to For questions, contact ASHA s health care economics and advocacy team at reimbursement@asha.org. Scenarios Scenario 1: Patient Seen for One Functional Limitation Scenario 2: Patient Seen for Multiple Functional Limitations Scenario 3: Patient Seen for Evaluation and Treatment Not Recommended Scenario 4: Patient Seen for Evaluation and Referred for Treatment Scenario 5: Patient Seen for Maintenance Therapy Coding and Billing for Audiology and Speech-Language Pathology

120 Scenario 1: Patient Seen for One Functional Limitation Functional limitation: Motor Speech (G-code: G8999), FCM Level 2 (Modifier: CM) Projected Goal: Motor Speech (G-code: G9186), FCM Level 7 (Modifier CH) Reporting on the Initial Claim (Note: The Motor Speech reporting codes are not sequentially numbered) Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92522, Modifier: GN o Line 2: CPT/HCPCS: G8999, Modifier: GN, CM (Current status of motor speech limitation) o Line 3: CPT/HCPCS: G9186, Modifier: GN, CH (Projected goal for motor speech limitation) CMS-1500 Claim Form Example Chapter 5: G-codes Reporting on the Claim for Visits #2-#9 Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92507, Modifier: GN o No additional outcome/goal reporting Reporting on the Claim for Visit #10 (Reporting must occur at least once every 10 treatment days) Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92507, Modifier: GN o Line 2: CPT/HCPCS: G8999, Modifier: GN, CI (Current status of motor speech limitation) o Line 3: CPT/HCPCS: G9186, Modifier: GN, CH (Projected goal for motor speech limitation) CMS-1500 Claim Form Example Scenario continued on next page 2016 Coding and Billing for Audiology and Speech-Language Pathology 115

121 Chapter 5: G-codes Reporting on the Claim for Final Visit (Patient discharged from plan of care) Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: and/or (see note below) o Line 2: CPT/HCPCS: G9158, Modifier: GN, CH (Status of motor speech limitation at discharge) o Line 3: CPT/HCPCS: G9186, Modifier: GN, CH (Status of projected motor speech goal at discharge=goal met) CMS-1500 Claim Form Example ASHA Note: Final visit may include treatment (92507) and/or re-evaluation (92506). The Medicare Benefit Policy Manual ( [PDF]) states that a re-evaluation may be appropriate prior to planned discharge for the purpose of determining whether goals have been met, or for the use of the physician or the treatment setting at which treatment will be continued Coding and Billing for Audiology and Speech-Language Pathology

122 Scenario 2: Patient Seen for Multiple Functional Limitations Functional limitations: Swallowing (G-code: G8996), FCM Level 2 (Modifier: CM) Spoken Language Comprehension (G-code: G9159), FCM Level 2 (Modifier: CM) Spoken Language Expression (G-code: G9162), FCM Level 1 (Modifier: CN) CMS allows the reporting of one functional limitation at a time. For this case, it was determined that Swallowing was the most clinically relevent and would be reported initially. Projected Goal: Swallowing (G-code G8997), FCM Level 6 (Modifier: CI) Reporting on the Claim Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92610, Modifier: GN o Line 2: CPT/HCPCS: G8996, Modifier: GN, CM (Current status of swallowing limitation) o Line 3: CPT/HCPCS: G8997, Modifier: GN, CI (Projected goal for swallowing) o Line 4: CPT/HCPCS: 92523, Modifier: GN o Line 5: CPT/HCPCS: G9159, Modifier: GN, CM (Current status of spoken language comprehension) o Line 6: CPT/HCPCS: G9160, Modifier: GN, CI (Projected goal for spoken language comprehension) o Line 7: CPT/HCPCS: G9161, Modifier: GN, CM (Discharge for spoken language comprehension) Chapter 5: G-codes CMS-1500 Claim Form Example Reporting on the Claim for Visits #2-#9 Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92507, Modifier: GN o Line 2: CPT/HCPCS: 92526, Modifier: GN o No additional outcome/goal reporting Scenario continued on next page 2016 Coding and Billing for Audiology and Speech-Language Pathology 117

123 Chapter 5: G-codes Reporting on the Claim for Visit #10 (Reporting must occur at least once every 10 treatment days) Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92507, Modifier: GN o Line 2: CPT/HCPCS: 92526, Modifier: GN o Line 3: CPT/HCPCX: G8996, Modifier: GN, CK (Current status of swallowing limitation) o Line 4: CPT/HCPCS: G8997, Modifier: GN, CI (Projected goal for swallowing) CMS-1500 Claim Form Example Reporting on the Claim for Visit #18 (Patient discharged from swallowing therapy) Goals were met for swallowing, but spoken language comprehension and expression have not met therapy goals. The claim will indicate a discharge from the plan of care for swallowing, and the following claim will report the secondary condition of spoken language comprehension. Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92507, Modifier: GN o Line 2: CPT/HCPCS: 92526, Modifier: GN o Line 3: CPT/HCPCS: G8998, Modifier: GN, CI (Status of swallowing limitation at discharge) o Line 4: CPT/HCPCS: G8997, Modifier: GN, CI (Status of swallowing projected goal at discharge) CMS-1500 Claim Form Example Scenario continued on next page Coding and Billing for Audiology and Speech-Language Pathology

124 Reporting on the Claim for Visit #19 (Patient continues therapy for spoken language comprehension) Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92507, Modifier: GN o Line 2: CPT/HCPCS: G9159, Modifier: GN, CK (Current status of spoken language comprehension) o Line 3: CPT/HCPCS: G9160, Modifier: GN, CI (Projected goal for spoken language comprehension) CMS-1500 Claim Form Example Chapter 5: G-codes Reporting on the Claim for Visits #20-#27 Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92507, Modifier: GN o No additional outcome/goal reporting Reporting on the Claim for Final Visit (Patient discharged from plan of care) Patient has plateaued in therapy progression at FCM Level 5. The patient is discharged from the plan of care. Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: o Line 2: CPT/HCPCS: G8998, Modifier: GN, CJ (Status of spoken language comprehension at discharge) o Line 3: CPT/HCPCS: G9160, Modifier: GN, CI (Status of spoken language comprehension projected goal at discharge=goal not met)) CMS-1500 Claim Form Example 2016 Coding and Billing for Audiology and Speech-Language Pathology 119

125 Chapter 5: G-codes Scenario 3: Patient Seen for Evaluation and Treatment Not Recommended Functional limitation: Voice (G-code: G9171), FCM Level 5 (Modifier: CJ) Projected Goal: FCM Level 5 (Modifier: CJ) Reporting on the Claim (Required for each time an evaluation procedure is billed) Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92524, Modifier: GN o Line 2: CPT/HCPCS: G9171, Modifier: GN, CJ (Current status of voice limitation) o Line 3: CPT/HCPCS: G9172, Modifier: GN, CJ (Status of projected goal for voice limitation at discharge) o Line 4: CPT/HCPCS: G9173, Modifier: GN, CJ (Status of voice limitation at discharge) CMS-1500 Claim Form Example Coding and Billing for Audiology and Speech-Language Pathology

126 Scenario 4: Patient Seen for Evaluation and Referred for Treatment Functional limitation: Voice (G-code: G9171), FCM Level 3 (Modifier: CL) Projected Goal: FCM Level 7 (Modifier: CH) Reporting on the Initial Claim (Provider #1) Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92524, Modifier: GN o Line 2: CPT/HCPCS: G9171, Modifier: GN, CL (Current status of voice limitation) o Line 3: CPT/HCPCS: G9172, Modifier: GN, CH (Status of projected goal for voice limitation at discharge) o Line 4: CPT/HCPCS: G9173, Modifier: GN, CL (Status of voice limitation at discharge) Chapter 5: G-codes CMS-1500 Claim Form Example Reporting on the Claim for Treatment (Provider #2 Considered first visit) Patient is seen by treating provider, who determines the projected goal should be FCM Level 5 (Modifier: CJ). Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92507, Modifier: GN o Line 2: CPT/HCPCS: G9171, Modifier: GN, CL (Current status of voice limitation) o Line 3: CPT/HCPCS: G9172, Modifier: GN, CJ (Projected goal for voice limitation) CMS-1500 Claim Form Example Scenario continued on next page 2016 Coding and Billing for Audiology and Speech-Language Pathology 121

127 Chapter 5: G-codes Reporting on the Claim for Visits #2-#9 Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92507, Modifier: GN o No additional outcome/goal reporting Reporting on the Claim for Visit #10 (Reporting must occur at least once every 10 treatment days) Patient has completed treatment at treatment visit #10 and is discharged from plan of care. Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92507, Modifier: GN o Line 2: CPT/HCPCS: G9173, Modifier: GN, CJ (Status of voice limitation at discharge) o Line 3: CPT/HCPCS: G9172, Modifier: GN, CJ (Status of projected voice goal at discharge=goal met) CMS-1500 Claim Form Example Coding and Billing for Audiology and Speech-Language Pathology

128 Scenario 5: Patient Seen for Maintenance Therapy Maintenance therapy can be performed by an SLP if skilled services are rendered. CMS requires reporting minimally every 60 days. If the maintenance therapy is so infrequent that the 10 th treatment is not within 60 days, reporting will be required. This patient is seen once every other week, requiring reporting at the 60 day interval. Functional limitation: Motor Speech (G-code: G8999), FCM Level 4 (Modifier: CK) Projected Goal: FCM Level 4 (Modifier: CK) Reporting on the Claim at First Evaluation (Note: Motor speech codes are not in sequential order) Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92507, Modifier: GN o Line 2: CPT/HCPCS: G8999, Modifier: GN, CK (Current status of motor speech limitation) o Line 3: CPT/HCPCS: G9186, Modifier: GN, CK (Projected goal of motor speech limitation) Chapter 5: G-codes CMS-1500 Claim Form Example Reporting on the Claim (60 day interval) Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92507, Modifier: GN o Line 2: CPT/HCPCS: G9158, Modifier: GN, CK (Status of motor speech limitation at discharge) o Line 3: CPT/HCPCS: G9186, Modifier: GN, CK (Status of projected motor speech goal at discharge) CMS-1500 Claim Form Example 2016 Coding and Billing for Audiology and Speech-Language Pathology 123

129 Coding and Billing for Audiology and Speech-Language Pathology

130 Chapter 6: Physician Quality Reporting System (PQRS) for Audiology Background The Physician Quality Reporting System (PQRS) was designed to support improvements in quality of care for Medicare beneficiaries through the tracking of practice patterns. PQRS was initially implemented as a voluntary, incentive-driven program; however, beginning in 2015, it transitioned fully to a penalty for nonparticipation or failure to meet benchmark requirements. PQRS applies to audiologists who bill fee-for-service outpatient Medicare Part B beneficiaries using the CMS-1500 or electronic equivalent in the following clinical settings: Independent private practice Group practices (ENT, group audiology) University clinics (not university medical centers/hospitals) PQRS does not apply to facilities because of the billing form that is used. PQRS participation is measured via the individual s National Provider Identifier (NPI) for audiologists listed on the claim as the provider rendering the billed services to outpatient Medicare Part B beneficiaries Benchmark Requirements CMS captures the data for PQRS from the claim form via nonpayable codes. The codes typically represent one of the following situations: Performance criteria for the measure were met. The patient did not qualify due to acceptable exclusions stated in the measure specifications. Performance criteria for the measure were not met. Only positive performances are calculated for the benchmark requirements. Patients who are excluded from the measure for qualifying reasons are not counted in the total visits, and audiologists are not penalized for those patients. The benchmarks for participation in 2016 are 50% of the qualifying visits. In other words, an audiologist must have performed the measure for a minimum of 50% of either the Medicare patient visits or the number of Medicare patients, depending on the specifications of the codes. The analysis for the payment adjustment is based on participation 2 years prior to the payment adjustment. In other words, 2014 participation determines the application of the % payment adjustment on all procedures billed under the Medicare Physician Fee Schedule (MPFS). For nonparticipation or failure to meet the benchmark requirements in 2016, a 2% penalty will apply to 2018 claims. Chapter 6: PQRS for Audiology 2016 Coding and Billing for Audiology and Speech-Language Pathology 125

131 Chapter 6: PQRS for Audiology 2016 Reporting Requirements In 2016, to avoid the 2018 negative 2% payment adjustment, audiologists need to perform and report the following actions: Measure Action Required Benchmark PQRS Code for Claims Measure #130: Documentation of Current Medications in the Medical Record Measure #134: Screen for Depression and Follow-up Measure #154: Falls: Risk Assessment Audiologists need to make their best efforts to document, update, or review a list of the patient s current medications. This does not involve pharmacological assessment. The medication name, dosage, frequency, and route should be included. A standardized screen for depression must be performed as well as a documented follow-up plan for positive findings. Standardized tests include Depression Scale, Geriatric Depression Scale, or Beck Depression Inventory. The follow-up plan must include referral to another provider or a development of a treatment plan. The audiologist must assess, through balance and counseling, if there is a risk of falling. The assessment MUST include a balance assessment AND one or more of the following screenings: postural blood pressure, vision, home falls hazards, or evidence/documentation of medication effects. Reporting this measure may require multiple codes and modifiers as well as a follow-up with Measure #155. Modifiers indicate that the patient did not qualify or that action was not completed or documented. 50% of all Medicare patient visits for CPT codes 92541, 92542, 92543, 92544, 92545, 92547, 92548, 92557, 92567, 92568, 92570, 92585, 92588, and % of all Medicare patient visits for CPT code (tinnitus evaluation). 50% of all Medicare patients seen in a calendar year for CPT codes 92540, 92541, 92542, and G8427: Provider has documented in the record that he or she has obtained, updated, or reviewed the patient s current medications or that the patient is not taking any medications. G8430: Patient is in an emergency medical situation, and medications were not documented. G8428: There is no documentation of provider obtaining, updating, or reviewing the patient s current medications. G8431: Positive screen for depression with follow-up plan is documented. G8510: Negative screen for depression is documented. G8433: Patient is excluded and not eligible for screen due to severe mental/ physical incapacity or emergency medical situation. G8940: Screen is positive, but patient is not eligible due to severe mental/physical incapacity or emergency medical situation. G8511: Screen for depression is positive, but there is no documentation of a follow-up plan. G8432: There is no documentation of pain assessment. 3288F AND 1100F: Risk assessment for falls was completed. Measure #155 is required (see next measure). 3288F with modifier 1P AND 1100F: Risk assessment was not completed due to medical reasons (patient not ambulatory). Measure #155 is required (see next measure). 1101F: Patient not eligible because there are fewer than two documented falls or no falls without injury. 1101F with modifier 8P: There is no documentation of falls status. 3288F with modifier 8P AND 1100F: Risk assessment is not documented. Measure #155 is required (see next measure) Coding and Billing for Audiology and Speech-Language Pathology

132 Measure Action Required Benchmark PQRS Code for Claims Measure #155: The audiologist must 50% of all Medicare patients 518F: Falls plan of care is documented. Falls: Plan of document a plan of care seen in a calendar year for 0518F with modifier 1P: Falls plan of Care after a positive falls risk CPT codes 92540, 92541, care is not documented for medical assessment. The plan 92542, and reasons (patient is not ambulatory). of care must include a referral to a physician and 0518F with modifier 8P: Falls plan of a recommendation for care is not documented. balance, strength, or gait training. Reporting this measure may require multiple codes and modifiers as well as follow-up with Measure #155. Modifiers indicate that the patient did not qualify or that action was not completed or documented. Measure #226: Tobacco Use: Screening and Cessation Intervention Measure #261: Referral for Acute or Chronic Dizziness The audiologist must ask the patient if he or she smokes. If so, a brief (3-minute or less) consultation on the effects of smoking should be offered. The audiologist must (a) ensure that the patient is under the care of a physician for his or her acute or chronic dizziness or (b) refer the patient to an ENT. Reporting this measure requires the patient to qualify with the diagnosis and the procedure code. 50% of all Medicare patients seen in a calendar year for CPT codes 92540, 92557, and % of all Medicare patients diagnosed with ICD-10-CM codes H81.10, H81.11, H81.12, H81.13, and R42 AND seen in a calendar year for CPT codes 92540, 92541, 92542, 92543, 92545, 92546, 92547,2548, 92550, 92557, 92567, 92568, 92570, and F: Patient was screened for tobacco use and received brief counseling. 1036F: Patient is a tobacco nonuser. 4004F, modifier 1P: For medical reasons, patient was not screened for tobacco use. 4004F, modifier 8P: Neither tobacco screening NOR counseling was documented. G8856: Referral to physician was documented. G8857: Patient is already under the care of a physician for dizziness. G8858: Referral to physician is not documented. Chapter 6: PQRS for Audiology 2016 Coding and Billing for Audiology and Speech-Language Pathology 127

133 Chapter 6: PQRS for Audiology Example A patient is referred from an ENT for a vestibular evaluation (CPT 92540). Before the appointment, the audiologist had requested that the patient bring his list of medications including medication name, dosage, frequency, and route. At the appointment, the audiologist collects and reviews the list of medications and asks the patient if he smokes. The patient indicates yes, and the audiologist educates him briefly. The audiologist also ascertains that the patient has experienced significant falls, with injury, in his home three times during the past year. However, no additional assessment of the environment, home hazards, vision, medication, or blood pressure is noted. The vestibular evaluation indicates mild Benign Paroxysmal Positional Vertigo (BPPV) for the right ear as well as a general sense of dizziness and unbalance, so the audiologist uses ICD-10 codes H81.11 and R42 on the claim form. After the evaluation, the audiologist discusses treatment options for the BPPV and refers the patient back to the ENT with recommendations of treatment for the BPPV and further gait assessment. All of this is documented in the medical record, and the codes are added to the claim form (see figure below). The audiologist receives positive credit for documentation of a follow-up plan for the Falls: Plan of Care (Measure #155). However, because there was no documentation of screenings for postural blood pressure, vision, home falls hazards, or evidence/documentation of medication effects in the falls risk assessment, the audiologist does not receive a performance credit for Falls: Risk Assessment (Measure #154.) The audiologist performed Measure #226 (Tobacco Use: Screening and Cessation Intervention) and Measure #130 (Documentation of Current Medications in the Medical Record) correctly. Because the patient was already under the care of a physician for dizziness (via the referral from the ENT), even though the audiologist referred the patient back to the ENT, it was more appropriate to select exclusion code G8857 for Measure #261 (Referral for Acute or Chronic Dizziness). Measure Applicability Validation (MAV) a process that is not available until the beginning of each calendar year may eliminate some of the requirements for reporting, but it will not increase requirements. For the most current information, additional measure details, flowcharts, and other PQRS reporting rules, see Physician Quality Reporting System for Audiologists at Coding and Billing for Audiology and Speech-Language Pathology

134 Chapter 7: Physician Quality Reporting System (PQRS) for Speech-Language Pathology Background The Physician Quality Reporting System (PQRS) was designed to support improvements in quality of care for Medicare beneficiaries through the tracking of practice patterns. PQRS was initially implemented as a voluntary, incentive-driven program; however, beginning in 2015, it transitioned fully to a penalty for nonparticipation or failure to meet benchmark requirements. PQRS applies to speech-language pathologists (SLPs) who bill fee-for-service outpatient Medicare Part B beneficiaries using the CMS-1500 or electronic equivalent in the following clinical settings: Independent private practice Group practices (ENT, therapy practices) University clinics (not university medical centers/hospitals) PQRS does not apply to facilities because of the billing form that is used. PQRS participation is measured via the individual s National Provider Identifier (NPI) for SLPs on the claim as the provider rendering the billed services to outpatient Medicare Part B beneficiaries Benchmark Requirements CMS captures the PQRS data from the claim form via nonpayable codes. The codes typically represent one of the following situations: Performance criteria for the measure were met. The patient did not qualify due to acceptable exclusions stated in the measure specifications. Performance criteria for the measure were not met. Only positive performances are calculated for the benchmark requirements. Patients who are excluded from the measure for qualifying reasons are not counted in the total visits, and SLPs are not penalized for those patients. The benchmarks for participation in 2016 are 50% of the qualifying visits. In other words, an SLP must have performed the measure for a minimum of 50% of either the Medicare patient visits or the number of Medicare patients, depending on the specifications of the codes. The analysis for the payment adjustment is based on participation 2 years prior to the payment adjustment. In other words, 2014 participation determines the application of the % payment adjustment on all procedures billed under the Medicare Physician Fee Schedule (MPFS). For nonparticipation or failure to meet benchmark requirements in 2016, a 2% penalty will apply to 2018 claims. Chapter 7: PQRS for Speech-Language Pathology 2016 Reporting Requirements In 2016, to avoid the 2018 negative 2% payment adjustment, SLPs need to perform and report the following actions: Measure Action Required Benchmark PQRS Code for Claims Measure #130: Documentation of Current Medications in the Medical Record SLPs need to make their best efforts to document, update, or review a list of the patient s current medications. This does not involve pharmacological assessment. The medication name, dosage, frequency, and route should be included. 50% of all Medicare patient visits for CPT codes 92507, 92508, 92526, 92626, and G8427: Provider has documented in the record that he or she has obtained, updated, or reviewed the patient s current medications or that the patient is not taking any medications. G8430: Patient is in an emergency medical situation, and medications were not documented. G8428: There is no documentation of provider obtaining, updating, or reviewing the patient s current medications Coding and Billing for Audiology and Speech-Language Pathology 129

135 Chapter 7: PQRS for Speech-Language Pathology Measure Action Required Benchmark PQRS Code for Claims Measure #131: Pain Assessment and Follow-Up Measure #226: Tobacco Use: Screening and Cessation Intervention A standardized pain assessment must be performed as well as a documented follow-up plan for positive findings. Standardized tests include Brief Pain Inventory, Faces Pain Scale, Numeric Rating Scale, and McGill Pain Questionnaire. The follow-up plan must include referral to another provider or development of a treatment plan. The SLP must ask the patient if he or she smokes. If so, a brief (3-minute or less) consultation on the effects of smoking should be offered. 50% of all Medicare patient visits for CPT codes 92507, 92508, 92526, and % of all Medicare patients seen in a calendar year for CPT codes 92521, 92522, 92523, and G8730: Positive pain assessment with follow-up plan is documented. G8731: Negative pain assessment is documented. G8442: Patient not eligible due to severe mental/ physical incapacity or emergency medical situation. G8939: Pain assessment is positive, but patient is not eligible for follow-up due to severe mental/ physical incapacity or emergency medical situation. G8732: There is no documentation of pain assessment. G8509: Positive pain assessment is documented, but there is no documentation of a follow-up plan. 4004F: Patient was screened for tobacco use and received brief counseling. 1036F: Patient is a tobacco nonuser. 4004F, modifier 1P: For medical reasons, patient was not screened for tobacco use. 4004F, modifier 8P: Neither tobacco screening NOR counseling was documented. Example A patient is seen on a date of service for a speech-language evaluation (CPT 92523) followed by a treatment session (CPT 92507). Before the appointment, the SLP had requested that the patient bring her list of medications including medication name, dosage, frequency, and route. At the appointment, the SLP collects and reviews the list of medications and administers the Faces Pain Scale, which indicates no pain at this time. The SLP also asks the patient if she smokes. The patient indicates yes, and the SLP educates her briefly. However, the SLP does not document this brief counseling in the medical record. The PQRS codes are added to the claim form (see figure below). The SLP receives positive credit for documentation of the medication (G8427 for Measure #130, Documentation of Current Medications in the Medical Record) and the pain assessment (G8731 for Measure #131, Pain Assessment and Follow-Up). However, because counseling for tobacco use (Measure #226) was not documented in the record, this performance criterion was not met. When performance criterion is not met for Measure #226, reporting on the claim for requires the code (4004F) with the 8P modifier. Therefore, the SLP does not receive a performance credit for Measure #226. For the most current information, additional measure details, flowcharts, and other PQRS reporting rules, see PQRS Measures Available for SLPs to Report on Claims at reimbursement/medicare/pqrs-measures-available-for-slps-to-report-on-claims/ Coding and Billing for Audiology and Speech-Language Pathology

136 Chapter 8: National Correct Coding Initiative (NCCI) Edits The National Correct Coding Initiative (NCCI, or more commonly, CCI) is an automated edit system to control specific Current Procedural Terminology (CPT) code pairs that can be reported on the same day. It was developed by the Centers for Medicare and Medicaid Services (CMS) for use in all Medicare Part B and, more recently, Medicaid claims. The goal of CCI is to eliminate mutually exclusive code pairings and codes considered to be components of more comprehensive services or otherwise inappropriate to be delivered to the same patient on the same day. The CCI is updated quarterly. A subset of the CCI edits is the Outpatient Code Editor (OCE), which applies only to hospital outpatient services. Typically, the OCE edits for audiology are similar to those in the CCI system. The OCE revisions also occur quarterly, but one quarter after the revised CCI edits are implemented. The CCI also includes a set of edits called Medically Unlikely Edits (MUEs), also for Medicare Part B and Medicaid claims. An MUE for a CPT or HCPCS Level II code is the maximum number of times that the code can be reported for the same patient on the same day. Not all codes have an MUE and/or CCI edit. Audiology Procedures The following tables for audiology related CCI and OCE edits are derived from the complete lists of edits published on the Centers for Medicare & Medicaid Services (CMS) CCI website index.html. They apply to both Medicare Part B and Medicaid services. The tables list: Code pairs that cannot be billed together for the same patient on the same date of service Code pairs that can be billed together for the same patient on the same date of service by attaching a -59 modifier to bypass the code edit. The modifier indicates that the two procedures are separate and distinct (must be supported in the medical record) Modifier -59 should be attached to the CPT code listed in Column 2, when applicable Note: Audiology-related code pairs that are not listed here are not subject to CCI restrictions and can be billed on the same day without a modifier. However, audiologists should also be aware of Medically Unlikely Edit (MUE) restrictions Chapter 8: NCCI Edits Table 1: CCI and OCE Edits [1] for Audiology Services Note: CPT 69210, cerumen removal, cannot be paid when billed on the same day as any audiometric or vestibular test. Removal of cerumen is included in the fee for diagnostic tests. See Medicare Coverage Policy on Cerumen Management for additional information Column 1 CPT Procedure (one) Column 2 Paired With (one) Can be performed on same date? Yes/No Office setting Hospital outpatient setting 1 If so, use what modifier? , 92522, 92523, (cerumen removal), N N N/A (CAPD evaluation), (CAPD evaluation add-on) , 92542, 92544, N N N/A , 92544, Y Y , Y Y Y Y , N N N/A or N N N/A N N N/A , 92553, 92555, or N N N/A 2016 Coding and Billing for Audiology and Speech-Language Pathology 131

137 Chapter 8: NCCI Edits Column 1 CPT Procedure (one) Column 2 Paired With (one) Can be performed on same date? Yes/No Office setting Hospital outpatient setting 1 If so, use what modifier? or N N N/A N N N/A , 92567, N N N/A (ABR limited) N N N/A (EOE limited) Y Y , 92572, N N N/A Y Y , 92572, N N N/A Y Y Y Y , 92508, 92550, 92552, 92553, , , , , 92579, , 92596, Y Y -59 Table 2: CCI and OCE Edits [1] for Cochlear Implant Programming Column 1 CPT Procedure (one) Column 2 Paired With (one) , 92508, 92550, 92567, 92568, 92570, 92585, 92586, 92602, , , , , 92603, 92604, , 92508, 92567, 92568, 92585, 92586, , , , 92604, , 92568, 92585, 92586, 92604, , , , 92602, , 92508, 92626, 92567, 92568, 92585, , , , Can be performed on same date? Yes/No Office setting Hospital outpatient setting 1 If so, use what modifier? 2 Y Y -59 N N N/A Y Y -59 N N N/A Y Y -59 N N N/A Y Y -59 N N N/A 1 Hospital outpatient coding edits are determined by the Outpatient Code Editor (OCE) system which usually includes the same therapy edits. New OCE edits are implemented in hospitals one quarter after initiated as CCI edits. 2 The -59 modifier denotes that the procedure is distinct or independent from other services performed on the same day. The modifier is attached to the column 2 CPT code, when applicable Coding and Billing for Audiology and Speech-Language Pathology

138 Speech-Language Pathology Procedures The following tables for speech-language pathology related CCI and OCE edits are derived from the complete lists of edits published on the Centers for Medicare & Medicaid Services (CMS) CCI website They apply to both Medicare Part B and Medicaid services. The tables list: Code pairs that cannot be billed together by one provider for the same patient on the same date of service Code pairs that can be billed together for the same patient on the same date of service by attaching a -59 modifier to bypass the code edit. The modifier indicates that the two procedures are separate and distinct (must be supported in the medical record) Modifier -59 should be attached to the CPT code listed in Column 2, when applicable Note: SLP-related code pairs that are not listed here are not subject to CCI restrictions and can be billed on the same day without a modifier. However, speech-language pathologists should also be aware of Medically Unlikely Edit (MUE) restrictions Chapter 8: NCCI Edits Table 1: CCI Edits and OCE Edits [1] for Speech-Language Pathology Procedures Column 1 CPT Procedure (one) Column 2 Paired With (one) Can be performed on same date? Yes/No Office setting Hospital outpatient setting 1 If so, use what modifier? [3] N N N/A [3] (videostrobe) 70371, Y Y [4] 70731, 74210, N/A N N/A 92507, [5] 97532, N (when both are N (when both are N/A provided by SLP) provided by SLP) (SLP group) Y Y (laryngeal function) (rad. speech eval) Y Y (fluency evaluation) 96105, Y Y , N N N/A (speech sound 96105, Y Y -59 production evaluation) , N N N/A (speech sound 92522, 92620, N N N/A production and language evaluation) , Y Y (qualitative analysis of 96105, Y Y -59 voice and resonance) , N N N/A Y Y (dysphag tx) (laryngeal function), Y Y (dysphag tx) (G0283=97014), N N N/A (SGD eval) 92507, 92508, 92521, 92522, Y Y , 92524, (voice prosth eval), N/A N N/A 2016 Coding and Billing for Audiology and Speech-Language Pathology 133

139 Chapter 8: NCCI Edits Column 1 CPT Procedure (one) Column 2 Paired With (one) Can be performed on same date? Yes/No Office setting Hospital outpatient setting 1 If so, use what modifier? N N N/A , 92508, 92521, Y Y , 92523, N N N/A Y Y (MBS) 92511, Y Y , N N N/A (FEES) 31575, 92511, 92520, N N N/A , Y Y N N N/A 92613, 92615, , Y Y -59 (physician report) (sensory test) 92610, Y Y , 92511, N N N/A , N N N/A (FEESST) 31575, 92511, 92520, N N N/A 92612, , Y Y , 92613, N N N/A (aphasia assessment) (dev screen), Y Y -59 (dev testing), (cognitive testing) (dev screen), (dev testing) (cognitive testing) Y Y Hospital outpatient coding edits are determined by the Outpatient Code Editor (OCE) system which usually includes the same therapy edits as CCI edits. New OCE edits are implemented in hospitals one quarter after initiated as CCI edits. CMS Transmittal 254 ( ) confirms that OCE edits are limited to hospital outpatients. With reference to Transmittal 254, denials should be appealed if based on OCE edits extended to skilled nursing facility, comprehensive outpatient rehabilitation facility, and rehabilitation agency settings. 2 The -59 modifier denotes that the procedure is distinct or independent from other services performed on the same day. The modifier is attached to the column 2 CPT code, when applicable. 3 There is no level of supervision designated in the Medicare Physician Fee Schedule for laryngoscopy (CPT 31575), videostrobscopy (CPT 31579), and nasopharyngoscopy (CPT 92511). However, state and/or Medicare Administrative Contractor (MAC) supervision requirements may supersede Medicare s requirement. Some states have endoscopy laws/regulations specific to speech-language pathologists, including California, New Jersey, Illinois, Michigan, and Tennessee. Other states such as Maryland, New York, and Virginia have policy statements and/or guidance documents. In some cases, the licensure laws and regulations may refer only to fiberoptic endoscopic evaluation of swallowing (FEES) or to all forms of endoscopy. For further information, see; Supervision-Requirements-for-Videostroboscopy-and-Nasopharyngoscopy-Procedures/. 4 The 7000 series are radiology codes. These codes are included here for information purposes and not for billing by speech-language pathologists. 5 A single practitioner, such as an SLP, should not bill CPT codes or on the same date of service as or However, if the two types of services are performed by different types of practitioners on the same date of service (e.g., an SLP bills and a PT bills 97532), then the codes may be billed together using the -59 modifier Coding and Billing for Audiology and Speech-Language Pathology

140 Chapter 9: ASHA Model Superbills ASHA developed superbills for both audiology and speech-language pathology. The superbill is a standard form that health plans use to process claims. For the professional rendering services, it provides a time efficient means to document services, fees, codes, and other information (i.e., certification and licensure) required by insurance companies. The patient uses this form to file for health plan payment. Model Superbill for Audiology The following is a model of a superbill that could be used by an audiology practice when billing private health plans. This sample is not meant to dictate which services should or should not be listed on the bill. Most billable codes are from the American Medical Association (AMA) Current Procedural Terminology (CPT) Prosthetic and durable medical equipment codes, such as hearing aid codes, are published by the Centers for Medicare & Medicaid Services (CMS) as the Healthcare Common Procedure Code System (HCPCS). Note: This is only a model; therefore, some procedures, codes, or other pertinent information may not be included. You can find the copy of the Audiology Superbill at Chapter 9: ASHA Model Superbills 2016 Coding and Billing for Audiology and Speech-Language Pathology 135

141 Chapter 9: ASHA Model Superbills PATIENT: REFERRING PHYSICIAN: FILE: MODEL AUDIOLOGY SUPERBILL INSURED: ADDRESS: INSURANCE PLAN: DATE: INSURANCE PLAN #: DATE INITIAL SYMPTOM: PLACE OF SERVICE: HOME OFFICE OTHER: DIAGNOSIS: PRIMARY (Audiology): SECONDARY (Medical): HEARING AID/EARMOLD DEFECT: SERVICES: PROCEDURE CPT CHARGE Audiological Assessment Procedures Tympanometry and reflex threshold measurements Screening test, pure tone, air only Pure tone audiometry (threshold);air only Pure tone audiometry (threshold); air and bone Speech audiometry threshold Speech audiometry threshold; w/speech recognition Comprehensive audiometry threshold evaluation and speech recognition Audiometric testing of groups Bekesy audiometry; screening Bekesy audiometry; diagnostic Loudness balance test, alternate binaural or monaural Tone decay test Short increment sensitivity index (SISI) Stenger test, pure tone Tympanometry (impedance testing) Acoustic reflex testing, threshold Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing Filtered speech test Staggered spondaic word test Sensorineural acuity level test Synthetic sentence identification test Stenger test, speech Visual reinforcement audiometry (VRA) Conditioning play audiometry Select picture audiometry Electrocochleography DATE FIRST CONSULTATION: ICD-10/9 CODE: ICD-10/9 CODE: Page 1 PROCEDURE CPT CHARGE Auditory evoked potentials, comprehensive Auditory evoked potentials, limited Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report Evaluation of central auditory function, with report; initial 60 minutes each additional 15 minutes Assessment of tinnitus (includes pitch, loudness matching, and masking) Hearing Aid Assessment and Fitting Procedures Hearing aid exam and selection; monaural Hearing aid exam and selection; binaural Hearing aid check; monaural Hearing aid check; binaural Electroacoustic evaluation for hearing aid; monoaural binaural Ear protector attenuation measurements Vestibular and Balance System Assessment Procedures Spontaneous nystagmus, including gaze Positional nystagmus test Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes 4 tests) Optokinetic nystagmus test Coding and Billing for Audiology and Speech-Language Pathology

142 Model Audiology Superbill Page 2 PROCEDURE CPT CHARGE Caloric vestibular test with recording, bilateral; bithermal monothermal Basic vestibular evaluation, incl. spontaneous nystagmus test w/eccentric gaze fixation nystagmus, w/recording, positional nystagmus test, min. of 4 positions, w/recording, optokinetic nystagmus test, bidirectional foveal & peripheral stimulation, w/recording, & oscillating tracking test, w/recording Spontaneous nystagmus test, incl. gaze and fixation nystagmus, with recording Positional nystagmus test, minimum of four positions Optokinetic nystagmus test, bi-directional, foveal or peripheral stimulation, w/ recording Oscillating tracking test, with recording Sinusoidal vertical axis rotational testing Use of vertical electrodes in any or all of the above tests Computerized dynamic posturography Vestibular and Balance Rehabilitation Services Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver) per day Cerumen Management Services Removal of impacted cerumen, one or both ears Auditory Implant Services Cochlear implant follow-up exam <7 years of age Reprogram cochlear implant <7 years of age Cochlear implant follow-up exam >7 years of age Reprogram cochlear implant > 7 years of age Diagnostic analysis with programming of auditory brainstem implant, per hour Habilitative and Rehabilitative Services Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual group, two or more individuals Evaluation of auditory rehabilitation status, 1st hour each additional 15 minutes Auditory rehabilitation; pre-lingual hearing loss Auditory rehabilitation; post-lingual hearing loss Hearing Aids/FM Systems (HCPCS Level II Codes) Assessment for Hearing Aid V5010 Fitting/Orientation/Checking of Hearing Aid V5011 Repair/Modification of a Hearing Aid V5014 Conformity Evaluation V5020 Hearing aid, Monaural, body worn, air conduction V5030 bone conduction V5040 PROCEDURE CPT CHARGE Hearing Aid, Monaural, in the ear (ITE) V5050 Hearing Aid, Monaural, behind the ear (BTE) V5060 Glasses, air conduction V5070 Glasses, bone conduction V5080 Dispensing fee, Unspecified Hearing Aid V5090 Hearing Aid, bilateral, body worn V5100 Dispensing fee, bilateral V5110 Binaural, body V5120 Binaural, ITE V5130 Binaural, BTE V5140 Binaural, glasses V5150 Dispensing fee, binaural V5160 Hearing Aid, CROS, ITE V5170 Hearing Aid, CROS, BTE V5180 Hearing Aid, CROS, glasses V5190 Dispensing fee, CROS V5200 Hearing Aid, BICROS, ITE V5210 Hearing Aid, BICROS, BTE V5220 Hearing Aid, BICROS, glasses V5230 Dispensing Fee, BICROS V5240 Dispensing Fee, Monaural Hearing Aid V5241 Hearing Aid, Analog, monaural, completely in the ear canal (CIC) V5242 Hearing aid, analog, monaural, in the canal (ITC) V5243 Hearing aid, digitally programmable analog, monaural, CIC V5244 Hearing aid, digitally programmable analog, monaural, ITC V5245 Hearing aid, digitally programmable analog, monaural, ITE V5246 Hearing aid, digitally programmable analog, monaural, BTE V5247 Hearing aid, analog, binaural, CIC V5248 Hearing aid, analog, binaural, ITC V5249 Hearing aid, digitally programmable analog, binaural, CIC V5250 Hearing aid, digitally programmable analog, binaural, ITC V5251 Hearing aid, digitally programmable, binaural, ITE V5252 Hearing aid, digitally programmable, binaural, BTE V5253 Hearing aid, digital, monaural, CIC V5254 Hearing aid, digital, monaural, ITC V5255 Hearing aid, digital, monaural, ITE V5256 Hearing aid, digital, monaural, BTE V5257 Hearing aid, digital, binaural, CIC V5258 Hearing aid, digital, binaural, ITC V5259 Hearing aid, digital, binaural, ITE V5260 Hearing aid, digital, binaural, BTE V5261 Hearing aid, disposable, any type, monaural V5262 Hearing aid, disposable, any type, binaural V5263 Chapter 9: ASHA Model Superbills 2016 Coding and Billing for Audiology and Speech-Language Pathology 137

143 Chapter 9: ASHA Model Superbills Model Audiology Superbill Page 3 PROCEDURE CPT CHARGE Earmold/insert, not disposable, any type V5264 Earmold/insert, disposable, any type V5265 Battery for use in hearing device V5266 Hearing aid or assistive listening device/supplies/accessories, not otherwise specified V5267 Assistive listening device, telephone amplifier, any type V5268 Assistive listening device, alerting, any type V5269 Assistive listening device, television amplifier, any type V5270 Assistive listening device, television caption decoder V5271 Assistive listening device, TDD V5272 Assistive listening device, for use with cochlear implant V5273 Assistive learning device not otherwise specified V5274 Ear impression, each V5275 Personal FM/DM system, monaural (one receiver, transmitter and microphone) V5281 Personal FM/DM system, binaural (two receivers, transmitter and microphone) V5282 Personal FM/DM neck, loop induction receiver V5283 Personal FM/DM, ear level receiver V5284 Personal FM/DM, direct audio input receiver V5285 Personal blue tooth FM/DM receiver V5286 Personal FM/DM receiver, not otherwise specified V5287 Personal FM/DM transmitter assistive listening device V5288 Personal FM/DM adapter/boot coupling device for receiver, any type V5289 Transmitter microphone, any type V5290 Hearing Service, Miscellaneous V5299 Electrophysiology Procedures Nerve conduction studies; 1-2 studies studies studies studies studies studies or more studies Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs in lower limbs in upper & lower limbs in the trunk or head PROCEDURE CPT CHARGE Visual evoked potential (VEP) testing central nervous system, checkerboard or flash Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any 1 method Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure) Continuous neurophysiology monitoring, from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (List separately in addition to code for primary procedure) Other Procedures Otorhinolaryngological service or procedure Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure with the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion minutes of medical discussion minutes of medical discussion Online assessment & management service provided by a qualified nonphysician health care professional to an established patient, guardian, or health care provider not originating from a related assessment & management service provided within the previous 7 days, using the Internet or similar electronic communications network Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more; participation by nonphysician qualified health care professional Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by nonphysician qualified health care professional Total Charges: $ Coding and Billing for Audiology and Speech-Language Pathology

144 Model Audiology Superbill Page 4 BILLING INFORMATION PREVIOUS BALANCE: $ TODAY S CHARGES: $ TOTAL DUE: $ PAID TODAY: $ PAID BY: CASH CREDIT VISA MC OTHER BALANCE: $ CHECK AUTHORIZATIONS I hereby authorize direct payment of benefits to Audiology & Hearing Center, Inc. SIGNATURE: DATE: I hereby authorize John Smith, PhD, CCC-A to release any information acquired in the course of treatment. SIGNATURE: DATE: Chapter 9: ASHA Model Superbills John Smith, PhD, CCC-A Audiology & Hearing Center, Inc. 999 Anywhere Street Rockville, MD (999) PHONE (888) FAX NPI # TAX ID # MARYLAND LICENSE # Coding and Billing for Audiology and Speech-Language Pathology 139

145 Chapter 9: ASHA Model Superbills Model Superbill for Speech-Language Pathology The following is a model of a superbill that could be used by a speech-language pathology practice when billing private health plans. This sample is not meant to dictate which services should or should not be listed on the bill. Most billable codes are from the American Medical Association (AMA) Current Procedural Terminology (CPT) Prosthetic and durable medical equipment codes, such as speech-generating device codes, are published by the Centers for Medicare & Medicaid Services (CMS) as the Healthcare Common Procedure Code System (HCPCS). Note: This is only a model; therefore, some procedures, codes, or other pertinent information may not be included. You can find the copy of the Speech-Language Pathology Superbill at Coding and Billing for Audiology and Speech-Language Pathology

146 PATIENT: REFERRING PHYSICIAN: FILE: MODEL SPEECH-LANGUAGE PATHOLOGY SUPERBILL INSURED: ADDRESS: INSURANCE PLAN: DATE: INSURANCE PLAN #: DATE INITIAL SYMPTOM: PLACE OF SERVICE: HOME OFFICE OTHER: DIAGNOSIS: PRIMARY (Speech-Language Pathology): SECONDARY (Medical): SERVICES: PROCEDURE CPT CHARGE Swallowing Function Treatment of swallowing dysfunction and/or oral function for feeding Evaluation of oral & pharyngeal swallowing function Motion fluoroscopic evaluation of swallowing function by cine or video recording Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording interpretation and report only Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording interpretation and report only Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing interpretation and report only Speech and Language Treatment of speech, language, voice, communication, and/or auditory processing disorder, individual group, two or more individuals Development of cognitive skills to improve attention, memory, problem solving, direct one-on-one patient contact by the provider; each 15 minutes Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands; each 15 minutes Nasopharyngoscopy w/ endoscope Laryngeal function studies Evaluation of speech fluency (eg, stuttering, cluttering) Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria) with evaluation of language comprehension and expression (eg, receptive and expressive language) DATE FIRST CONSULTATION: ICD-10/9 CODE: ICD-10/9 CODE: Page 1 PROCEDURE CPT CHARGE Behavioral and qualitative analysis of voice and resonance Evaluation of auditory rehabilitation status, first hour each additional 15 minutes Auditory rehabilitation; pre-lingual hearing loss Auditory rehabilitation; post-lingual hearing loss Assessment of aphasia with interpretation and report, per hour Developmental screening, with interpretation and report, per standardized instrument form Developmental testing, (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments) with interpretation and report Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report Laryngoscopy; flexible fiberoptic; diagnostic Laryngoscopy; flexible or rigid fiberoptic, with stroboscopy Augmentative and Alternative Communication Evaluation for use/fitting of voice prosthetic device to supplement oral speech Evaluation for prescription of non-speech generating augmentative and alternative communication device, face-to-face with the patient; first hour each additional 30 minutes Therapeutic service(s) for the use of nonspeech generating augmentative and alternative communication device, including programming and modification Chapter 9: ASHA Model Superbills 2016 Coding and Billing for Audiology and Speech-Language Pathology 141

147 Chapter 9: ASHA Model Superbills Model Speech-Language Pathology Superbill Page 2 PROCEDURE CPT CHARGE Evaluation for prescription for speechgenerating augmentative and alternative communication device; face-to-face with the patient; first hour each additional 30 minutes Therapeutic services for the use of speechgenerating device, including programming and modification Repair/Modification of AAC device (excluding adaptive hearing aid) V5336 Other Procedures Otorhinolaryngological service or procedure Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure with the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion minutes of medical discussion minutes of medical discussion PROCEDURE CPT CHARGE Online assessment & management service provided by a qualified nonphysician health care professional to an established patient, guardian, or health care provider not originating from a related assessment & management service provided within the previous 7 days, using the Internet or similar electronic communications network Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more; participation by nonphysician qualified health care professional Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by nonphysician qualified health care professional Total Charges: $ BILLING INFORMATION AUTHORIZATIONS PREVIOUS BALANCE: $ TODAY S CHARGES: $ TOTAL DUE: $ I hereby authorize direct payment of benefits to Speech Services, Inc. SIGNATURE: DATE: PAID TODAY: $ PAID BY: CASH CREDIT VISA MC OTHER BALANCE: $ CHECK I hereby authorize Jane Smith, MA, CCC-SLP to release any information acquired in the course of treatment. SIGNATURE: DATE: Jane Smith, MA, CCC-SLP Speech Services, Inc. 999 Anywhere Street Rockville, MD (999) PHONE (888) FAX NPI # TAX ID # MARYLAND LICENSE # Coding and Billing for Audiology and Speech-Language Pathology

148 Chapter 10: 1500 Claim Form The form CMS-1500 is the standard paper claim form used by health care professionals and suppliers to bill Medicare Part A/B and Durable Medical Equipment Medicare Administrative Contractors. To receive reimbursement from Medicare and most state Medicaid agencies, private practitioners must use the CMS-1500 claim form. Many private health plans may also use this claim form. Chapter 10: 1500 Claim Form 2016 Coding and Billing for Audiology and Speech-Language Pathology 143

149 Chapter 10: 1500 Claim Form Coding and Billing for Audiology and Speech-Language Pathology

150 Chapter 11: Fee Data Determining Fees Health care providers have some flexibility when setting private fees. Clinicians should choose a pricing philosophy and gather available charge information in order to establish a rational fee schedule and to negotiate health care contracts. Medicare Fee Schedule You can compare your fees with the current Medicare Fee Schedule: For audiology found at For speech-language pathology found at Additional Medicare Fee Schedule information can be found at Chapter 11: Fee Data Current Milliman Data You can also use fee data (Milliman, 2015) found in this section to determine the average charge per service by CPT code. Use this information to evaluate how your fees compare nationwide. The Milliman data cannot be shared with entities beyond ASHA members and ASHA certified clinicians, but the data can be used as a reference for negotiating rates. Additionally, the Milliman report published here is a condensed version. Not all Exhibit Charts of the full report are included in this publication. Remember, in determining fees for your services avoid any method that can be construed as price fixing, such as discussing fees with other local practices. Setting prices in collusion with colleagues is illegal Coding and Billing for Audiology and Speech-Language Pathology 145

151 Chapter 11: Fee Data November 9, 2015 Commercial Managed Care Contracting Analysis Arthur L. Baldwin III, FSA, MAAA, Principal & Consulting Actuary Milliman has evaluated the cost of services typically provided by Audiologists and Speech-Language Pathologists, as you requested. Our analysis presents the utilization and the cost of services provided to a typical commercially insured population (i.e., employer funded coverage, excluding Medicare, Medicaid, and other payers). It is our understanding that you intend to use this research to provide your members with an estimate of the cost to payers for their services. Milliman prepared this analysis for the internal use of the American Speech-Language Hearing Association (ASHA) and its member organizations. The results may not be distributed beyond these entities without the written permission of Milliman. No benefit is intended for any other party, if such permission is granted. This project was completed under the terms of the Consulting Services Agreement between Milliman and the American Speech-Language-Hearing Association, dated April 11, Nationwide and Regional Results Exhibits A1 thru A4, B1 thru B4, and C1 thru C4 are detailed commercial cost models for services that you identified as being typically provided by Audiologists and/or Speech-Language Pathologists (SLP). The exhibits are separated by geographic region, and each one includes the following information, with regional values listed side-by-side with nationwide values: Procedure Code: CPT Code used to describe the service. Modifier: Any modifier selected for the service. Description: A short description of that particular service. Utilization per 1,000: The annual utilization of the procedure per 1,000 commercial members. Average Allowed Per Service: The average allowed charges for the service provided. Monthly Per Member Claim Cost: The revenue required to provide the services at the level of utilization at the average allowed amount per service. Note that this ignores the impact of deductibles, copays, coinsurance or other cost sharing. Note that each set of Exhibits shows the experience of different sets of codes provided by ASHA for specific Specialties or sets of Specialties. Each exhibit is further reproduced by region, labeled with a lower-case letter (e.g. A1-a displays utilization and allowed costs for the selected audiology code for all specialties at the nationwide level): Exhibits A1-a thru j: Audiology codes for All Specialties Exhibits A2-a thru j: Audiology codes for Audiologists Exhibits A3-a thru j: Audiology codes for SLPs Exhibits A4-a thru j: Audiology codes for All Other Specialties Exhibits B1-a thru j: Hearing codes for All Specialties Exhibits B2-a thru j: Hearing codes for Audiologists Exhibits B3-a thru j: Hearing codes for SLPs Exhibits B4-a thru j: Hearing codes for All Other Specialties Exhibits C1-a thru j: Speech-Language Pathology codes for All Specialties Exhibits C2-a thru j: Speech-Language Pathology codes for Audiologists Exhibits C3-a thru j: Speech-Language Pathology codes for SLPs Exhibits C4-a thru j: Speech-Language Pathology codes for All Other Specialties Coding and Billing for Audiology and Speech-Language Pathology

152 As mentioned above, these exhibits display utilization for different regions. A map of these regions can be found in Appendix 1. Each exhibit is provided a suffix, a thru j, which are defined by the following associations: Exhibits ending with a : Nationwide Exhibits ending with b : East North Central Region (IL, IN, MI, OH, WI) Exhibits ending with c : East South Central Region (AL, KY, MS, TN) Exhibits ending with d : Middle Atlantic Region (DE, NJ, NY, PA) Exhibits ending with e : Mountain Region (AZ, CO, ID, MT, NM, NV, UT, WY) Exhibits ending with f : New England Region (CT, MA, ME, NH, RI, VT) Exhibits ending with g : Pacific Region (AK, CA, HI, OR, WA) Exhibits ending with h : South Atlantic Region (DC, FL, GA, MD, NC, SC, VA, WV) Exhibits ending with i : West North Central Region (IA, KS, MN, MO, ND, NE SD) Exhibits ending with j : West South Central Region (AR, LA, OK, TX) Chapter 11: Fee Data The claim cost assumptions on these exhibits are estimates only and do not include insurer administration, profit margin, or other premium loading. Actual experience will vary from expected claims cost due to variations in population characteristics, structure of the delivery system, provider contracts, regional differences in the charge level for services and the utilization of services, health status of the underlying population, random fluctuations, and numerous other factors. Table 1, below, summarizes the per-member-per-month (PMPM) claim costs from the twelve Nationwide exhibits. Note that some HCPCS appear in more than one Code Type and the sum of all values appearing for the individual Code Types will therefore overstate the total cost for each specialty. The Total (Unique HCPCS) line reflects the total PMPM costs for all unique procedure codes. Table 1 Nationwide Allowed PMPM by Specialty and Code Type Code Type: All Specialties Audiologists Speech Language Pathologist All Other Specialties Audiology $ $ $ $ Hearing $ $ $ $ Speech-Language Pathology $ $ $ $ Total (Unique HCPCS) $ $ $ $ Please note that throughout our analysis, and in Table 1, allowed costs have not been trended. Costs are representative of the first nine months of Methodology, Assumptions and Considerations Our analysis is based on Milliman Health Cost Guidelines (HCGs) research and other sources, including the MarketScan database. The 2014Q3 MarketScan database used as the basis of our analysis is a proprietary database of more than 640 million commercial outpatient claims lines incurred and paid in the period January 1, 2014 thru September 30, 2014 and nearly 42 million member months over the same time period. Milliman 2016 Coding and Billing for Audiology and Speech-Language Pathology 147

153 Chapter 11: Fee Data We limited the scope of our study to only professional services (as classified by the Milliman HCG Grouper) performed for the sets of codes requested by ASHA. Our analysis includes only claims lines where HCPCS codes are associated with a blank modifier, unless otherwise requested by ASHA (e.g. HCPCS modified with SZ). Based on these data considerations, we developed total utilization and allowed dollar amounts from the MarketScan data for all specialties and all regions, including nationwide. The Utilization per 1,000, Average Allowed per Unit and Monthly per Member Allowed values resulting from these totals are included in each table labeled All Specialties (e.g. tables labeled A1, B1, or C1). The data included no professional utilization for some of the codes ASHA requested. We have included them in the relevant tables, but their values are not computed. Rather, the values in the Nationwide Values section of each Exhibit read No Util. These codes are listed in Table 2. Table 2 Codes with No Professional Utilization by Code List Code List HCPCS Modifier Hearing V5070 Hearing V5080 Hearing V5095 Hearing V5150 Hearing V5190 Hearing V5230 SLP SZ SLP E2502 SLP E2504 SLP E2506 SLP E2508 Similarly, codes without utilization in a given region are included in that region s exhibit with the label No Util. We supplemented the All Specialty totals from the MarketScan database with another proprietary database that provided both utilization and allowed dollar allocations by individual provider specialties. We applied these allocations to the composite amounts, in order to estimate utilization and total allowed for Audiologists, Speech Language Pathologists, and All Other specialties. We took this step to adjust for perceived deficiencies in the coding of your specialties in the MarketScan database. For some codes with All Specialty utilization, the proprietary data was insufficient to estimate specialty allocations. Where possible, specialty allocations for these codes were set equal to the nearest equivalent code with utilization and allowed dollar allocations. Table 3 summarizes these codes and to which code their allocations are now equal. Even after the allocation of low-utilization codes described above, there remained some codes for which we were unable to allocate utilization or allowed dollar amounts to individual specialties. We have included these codes, but instead of a computed value, they have the label No Alloc. These codes appear in Table 3 with the label no valid code found. When we update the report for full year data, we can allocate these services, provided you can identify a related CPT for each whose utilization pattern is a reasonable surrogate. Milliman Coding and Billing for Audiology and Speech-Language Pathology

154 Table 3 HCPCS Lack ing Allocation with S ource Allocation HCPCS Re-assigned to HCPCS Range HCPCS V V5298 V5010 E2500-E2510 No valid code found L8509-L8692 No valid code found Chapter 11: Fee Data ASHA also asked that we provide a measure of the variability of the Allowed per Unit by code. Due to the allocation method used, we are unable to calculate the standard deviation of the Allowed per Unit at the Specialty level. However, we were able to calculate the composite standard deviation (i.e., for all specialties combined) at the Regional level. These values are provided by region and code type in Appendix 2. The standard deviation is considered unreliable for regions with low utilization; regions where this is the case have the label Low Cred rather than a computed value. Interpretation of Results Please also consider the following factors when interpreting our results: 1. We recommend that you consider our results shown to be the mean in a distribution of possible results; the utilization for infrequently performed services is likely to be quite volatile. Utilization can be expected to vary from our projections because of many factors, including differences in population health status, delivery system differences, variations in practice patterns by providers, benefit plan variations, and random fluctuations. 2. Our analysis relies in part on the lists of CPT codes provided by ASHA. Any omissions or errors in that list would affect our results. Similarly, we have relied on encounter data for the contributors in both the MarketScan database and our proprietary database. Our results could be affected by their practices, including coding or payment practices. 3. Our utilization allocations are based on research deriving from health claim encounter data. We made no estimates for new CPT codes, if any. To the extent that any new codes refine or replace existing CPT codes, emerging health claim experience will show a shift in the utilization mix away from existing codes and toward the new codes. However, if a new code represents a genuinely new service, utilization for that code will increase the overall utilization level for speech-language and audiology services to the extent that it is performed independently of the services codified in the previous system. 4. Note that the specialty exhibits, if summed, may show lower utilization and PMPM allowed cost than the corresponding total exhibit, for all specialties combined. This anomaly is caused by the credibility issues described above. For example, the total PMPM allowed cost for Hearing codes is $0.468, shown in Exhibit B1-a. The sum of the corresponding PMPM allowed cost for Audiologists ($0.106, from Exhibit B2-a), Speech Language Therapists ($0.002, from Exhibit B3- a), and All Other Specialties ($0.355, found in Exhibit B3-a) is $0.463, roughly 1% lower. Milliman 2016 Coding and Billing for Audiology and Speech-Language Pathology 149

155 Chapter 11: Fee Data Exhibit A1-a American Speech-Language Hearing Association Commercial Cost Model - Professional Services Nationwide Utilization and Allowed Service Levels - Select Audiology Procedures Specialty: All Specialities Data from January, 2014 thru September, 2014 Nationwide Values Average Monthly Per Procedure Utilization Allowed per Member Code Modifier Description Per 1,000 Unit Allowed Cost Removal Impact Cerumen 1/Both Ears $56.74 $ Facial Nerve Function Studies Spontaneous nystagmus, including gaze Positional nystagmus test Caloric vestibular test, each irrigation Optokinetic nystagmus test Basic vestibular evaluation Spontaneous Nystagmus Test W/Record Pstn Nystagms Min 4 Pstn W/Record Caloric Vestibular Test, Each Irrigation Optokinetic Nystagms Bidirec/Foveal Oscillat Tracking Test W/Recording Sinusoidal Verticl Axis Rotatal Tst Use Of Vertical Electrodes Computerized Dynamic Posturography Tympanometry and reflex threshold measurements Screening Test Pure Tone Air Only Pure Tone Audiometry; Air Only Pure Tone Audiometry; Air And Bone Speech Audiometry Threshold; Speech Audiom Threshld; W/Recognitn Comp Audiometry Threshold Eval Audiometric testing of groups Bekesy audiometry; screening Bekesy audiometry; diagnostic Loud Balanc Test Altern Bi/Monaural Tone Decay Test Short Increment Sensitivity Index Stenger Test Pure Tone Tympanometry Acoustic Reflex Testing Acoustic immittance testing Filtered Speech Test Staggered Spondaic Word Test Sensorineural Acuity Level Test Synthetic Sentence Id Test Stenger Test Speech Visual Reinforcement Audiometry Conditioning Play Audiometry Select Picture Audiometry Electrocochleography Milliman Coding and Billing for Audiology and Speech-Language Pathology

156 Exhibit A1-a American Speech-Language Hearing Association Commercial Cost Model - Professional Services Nationwide Utilization and Allowed Service Levels - Select Audiology Procedures Specialty: All Specialities Data from January, 2014 thru September, 2014 Nationwide Values Average Monthly Per Procedure Utilization Allowed per Member Code Modifier Description Per 1,000 Unit Allowed Cost Aud Evokd Potnt &/ Test Cns; Comp Aud Evokd Potent &/ Test Cns; Ltd Evoked otoacoustic emissions, screening Distortion product evoked otoacoustic emissions; limited evaluation Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation Hearing aid exam and selection; monaural Hearing aid examination and selection; binaural Hearing aid check; monaural Hearing aid check; binaural Electroacoustic evaluation for hearing aid; monaural Electroacoustic evaluation for hearing aid; binaural Ear protector attenuation measurements Dx analysis of cochlear implant, patient younger than 7 years of age; with programming subsequent reprogramming Diagnostic analysis of cochlear implant, age 7 years or older; with programming subsequent reprogramming Evaluation of central auditory function, with report; initial 60 minutes each additional 15 minutes Assessment of tinnitus Evaluation of auditory rehabilitation status; first hour each additional 15 minutes Auditory rehabilitation; prelingual hearing loss Auditory rehabilitation; postlingual hearing loss Diagnostic analysis with programming of auditory brainstem implant, per hour Canalith repositioning procedure Nerve conduction studies; 1 2 studies Nerve conduction studies; 3 4 studies Nerve conduction studies; 5 6 studies Nerve conduction studies; 7 8 studies Nerve conduction studies; 9 10 studies Nerve conduction studies; studies Nerve conduction studies; 13 or more studies Short-latency somatosensory evoked potential study, upper limbs Short-latency somatosensory evoked potential study, lower limbs Short-latency somatosensory evoked potential study, upper and lower limbs Short-latency somatosensory evoked potential study, trunk, head Chapter 11: Fee Data Milliman 2016 Coding and Billing for Audiology and Speech-Language Pathology 151

157 Chapter 11: Fee Data Exhibit A1-a American Speech-Language Hearing Association Commercial Cost Model - Professional Services Nationwide Utilization and Allowed Service Levels - Select Audiology Procedures Specialty: All Specialities Data from January, 2014 thru September, 2014 Nationwide Values Average Monthly Per Procedure Utilization Allowed per Member Code Modifier Description Per 1,000 Unit Allowed Cost Central motor evoked potential study, upper limbs lower limbs in upper and lower limbs Visual evoked potential (VEP) testing Neuromuscular junction testing Continuous intraoperative neurophysiology monitoring in the operating room Continuous neurophysiology monitoring, from outside the operating room Total $ "No Util" in a field indicates no utilization was found for the specified region. "No Alloc" in a field indicates insuffieient data exists to calculate a regions utiliation and/or allowed dollar specialty allocation. Milliman Coding and Billing for Audiology and Speech-Language Pathology

158 Exhibit A2-a American Speech-Language Hearing Association Commercial Cost Model - Professional Services Nationwide Utilization and Allowed Service Levels - Select Audiology Procedures Specialty: Audiology Only Data from January, 2014 thru September, 2014 Nationwide Values Average Monthly Per Procedure Utilization Allowed per Member Code Modifier Description Per 1,000 Unit Allowed Cost Removal Impact Cerumen 1/Both Ears $39.11 $ Facial Nerve Function Studies Spontaneous nystagmus, including gaze Positional nystagmus test Caloric vestibular test, each irrigation Optokinetic nystagmus test Basic vestibular evaluation Spontaneous Nystagmus Test W/Record Pstn Nystagms Min 4 Pstn W/Record Caloric Vestibular Test, Each Irrigation Optokinetic Nystagms Bidirec/Foveal Oscillat Tracking Test W/Recording Sinusoidal Verticl Axis Rotatal Tst Use Of Vertical Electrodes Computerized Dynamic Posturography Tympanometry and reflex threshold measurements Screening Test Pure Tone Air Only Pure Tone Audiometry; Air Only Pure Tone Audiometry; Air And Bone Speech Audiometry Threshold; Speech Audiom Threshld; W/Recognitn Comp Audiometry Threshold Eval Audiometric testing of groups Bekesy audiometry; screening Bekesy audiometry; diagnostic Loud Balanc Test Altern Bi/Monaural Tone Decay Test Short Increment Sensitivity Index Stenger Test Pure Tone Tympanometry Acoustic Reflex Testing Acoustic immittance testing Filtered Speech Test Staggered Spondaic Word Test Sensorineural Acuity Level Test Synthetic Sentence Id Test Stenger Test Speech Visual Reinforcement Audiometry Conditioning Play Audiometry Select Picture Audiometry Electrocochleography Chapter 11: Fee Data Milliman 2016 Coding and Billing for Audiology and Speech-Language Pathology 153

159 Chapter 11: Fee Data Exhibit A2-a American Speech-Language Hearing Association Commercial Cost Model - Professional Services Nationwide Utilization and Allowed Service Levels - Select Audiology Procedures Specialty: Audiology Only Data from January, 2014 thru September, 2014 Nationwide Values Average Monthly Per Procedure Utilization Allowed per Member Code Modifier Description Per 1,000 Unit Allowed Cost Aud Evokd Potnt &/ Test Cns; Comp Aud Evokd Potent &/ Test Cns; Ltd Evoked otoacoustic emissions, screening Distortion product evoked otoacoustic emissions; limited evaluation Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation Hearing aid exam and selection; monaural Hearing aid examination and selection; binaural Hearing aid check; monaural Hearing aid check; binaural Electroacoustic evaluation for hearing aid; monaural Electroacoustic evaluation for hearing aid; binaural Ear protector attenuation measurements Dx analysis of cochlear implant, patient younger than 7 years of age; with programming subsequent reprogramming Diagnostic analysis of cochlear implant, age 7 years or older; with programming subsequent reprogramming Evaluation of central auditory function, with report; initial minutes each additional 15 minutes Assessment of tinnitus Evaluation of auditory rehabilitation status; first hour each additional 15 minutes Auditory rehabilitation; prelingual hearing loss Auditory rehabilitation; postlingual hearing loss Diagnostic analysis with programming of auditory brainstem implant, per hour Canalith repositioning procedure Nerve conduction studies; 1 2 studies Nerve conduction studies; 3 4 studies Nerve conduction studies; 5 6 studies - No Util No Util Nerve conduction studies; 7 8 studies - No Util No Util Nerve conduction studies; 9 10 studies - No Util No Util Nerve conduction studies; studies - No Util No Util Nerve conduction studies; 13 or more studies - No Util No Util Short-latency somatosensory evoked potential study, upper Short-latency somatosensory evoked potential study, lower Milliman Coding and Billing for Audiology and Speech-Language Pathology

160 Exhibit A2-a American Speech-Language Hearing Association Commercial Cost Model - Professional Services Nationwide Utilization and Allowed Service Levels - Select Audiology Procedures Specialty: Audiology Only Data from January, 2014 thru September, 2014 Nationwide Values Average Monthly Per Procedure Utilization Allowed per Member Code Modifier Description Per 1,000 Unit Allowed Cost Short-latency somatosensory evoked potential study, upper and lower limbs Short-latency somatosensory evoked potential study, trunk, Central motor evoked potential study, upper limbs lower limbs in upper and lower limbs , Visual evoked potential (VEP) testing Neuromuscular junction testing Continuous intraoperative neurophysiology monitoring in the operating room Continuous neurophysiology monitoring, from outside the operating room Total $ Chapter 11: Fee Data "No Util" in a field indicates no utilization was found for the specified region. "No Alloc" in a field indicates insuffieient data exists to calculate a regions utiliation and/or allowed dollar specialty allocation. Milliman 2016 Coding and Billing for Audiology and Speech-Language Pathology 155

161 Chapter 11: Fee Data Exhibit B1-a American Speech-Language Hearing Association Commercial Cost Model - Professional Services Nationwide Utilization and Allowed Service Levels - Select Hearing Procedures Specialty: All Specialities Data from January, 2014 thru September, 2014 Nationwide Values Average Monthly Per Procedure Utilization Allowed per Member Code Modifier Description Per 1,000 Unit Allowed Cost Removal Impact Cerumen 1/Both Ears $56.74 $ Spontaneous nystagmus, including gaze Positional nystagmus test Caloric vestibular test, each irrigation Optokinetic nystagmus test Basic vestibular evaluation Spontaneous Nystagmus Test W/Record Pstn Nystagms Min 4 Pstn W/Record Caloric Vestibular Test, Each Irrigation Optokinetic Nystagms Bidirec/Foveal Oscillat Tracking Test W/Recording Sinusoidal Verticl Axis Rotatal Tst Use Of Vertical Electrodes Computerized Dynamic Posturography Tympanometry and reflex threshold measurements Screening Test Pure Tone Air Only Pure Tone Audiometry; Air Only Pure Tone Audiometry; Air And Bone Speech Audiometry Threshold; Speech Audiom Threshld; W/Recognitn Comp Audiometry Threshold Eval Audiometric testing of groups Bekesy audiometry; screening Bekesy audiometry; diagnostic Loud Balanc Test Altern Bi/Monaural Tone Decay Test Short Increment Sensitivity Index Stenger Test Pure Tone Tympanometry Acoustic Reflex Testing Acoustic immittance testing Filtered Speech Test Staggered Spondaic Word Test Sensorineural Acuity Level Test Synthetic Sentence Id Test Stenger Test Speech Visual Reinforcement Audiometry Conditioning Play Audiometry Select Picture Audiometry Electrocochleography Aud Evokd Potnt &/ Test Cns; Comp Milliman Coding and Billing for Audiology and Speech-Language Pathology

162 Exhibit B1-a American Speech-Language Hearing Association Commercial Cost Model - Professional Services Nationwide Utilization and Allowed Service Levels - Select Hearing Procedures Specialty: All Specialities Data from January, 2014 thru September, 2014 Nationwide Values Average Monthly Per Procedure Utilization Allowed per Member Code Modifier Description Per 1,000 Unit Allowed Cost Aud Evokd Potent &/ Test Cns; Ltd Evoked otoacoustic emissions, screening Distortion product evoked otoacoustic emissions; limited evaluation Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation Hearing aid exam and selection; monaural Hearing aid examination and selection; binaural Hearing aid check; monaural Hearing aid check; binaural Electroacoustic evaluation for hearing aid; monaural Electroacoustic evaluation for hearing aid; binaural Ear protector attenuation measurements Dx analysis of cochlear implant, patient younger than 7 years of age; with programming subsequent reprogramming Diagnostic analysis of cochlear implant, age 7 years or older; with programming subsequent reprogramming Evaluation of central auditory function, with report; initial each additional 15 minutes Assessment of tinnitus Evaluation of auditory rehabilitation status; first hour each additional 15 minutes Auditory rehabilitation; prelingual hearing loss Auditory rehabilitation; postlingual hearing loss Diagnostic analysis with programming of auditory brainstem implant, per hour L8619 Cochlear implant external speech processor , L8627 Cochlear implant, external speech processor, component, , replacement L8690 Auditory osseointegrated device, includes all internal and external , components L8691 Auditory osseointegrated device, external sound processor, , replacement L8692 Non-osseointegrated snd proc , V5010 Assessment for hearing aid V5011 Fitting/Orientation/Checking of hearing aid V5014 Repair/Modification of a hearing aid V5020 Conformity evaluation V5030 Hearing aid, monaural, body worn, air conduction , V5040 Hearing aid, monaural, body worn, bone conduction Chapter 11: Fee Data Milliman 2016 Coding and Billing for Audiology and Speech-Language Pathology 157

163 Chapter 11: Fee Data Exhibit B1-a American Speech-Language Hearing Association Commercial Cost Model - Professional Services Nationwide Utilization and Allowed Service Levels - Select Hearing Procedures Specialty: All Specialities Data from January, 2014 thru September, 2014 Nationwide Values Average Monthly Per Procedure Utilization Allowed per Member Code Modifier Description Per 1,000 Unit Allowed Cost V5050 Hearing aid, monaural, in the ear , V5060 Hearing aid, monaural, behind the ear , V5070 Glasses, air conduction No Util No Util No Util V5080 Glasses, bone conduction No Util No Util No Util V5090 Dispensing fee, unspecified hearing aid V5095 Semi-implantable middle ear hearing prosthesis (use for Vibrant No Util No Util No Util Soundbridge) V5100 Hearing aid, bilateral, body worn , V5110 Dispensing fee, bilateral V5120 Binaural, body , V5130 Binaural, in the ear V5140 Binaural, behind the ear $ V5150 Binaural, glasses No Util No Util No Util V5160 Dispensing fee, binaural $ V5170 Hearing aid, CROS, in the ear $ V5180 Hearing aid, CROS, behind the ear $ V5190 Hearing aid, CROS, glasses No Util No Util No Util V5200 Dispensing fee, CROS $ V5210 Hearing aid, BICROS, in the ear $ V5220 Hearing aid, BICROS, behind the ear $ V5230 Hearing aid, BICROS, glasses No Util No Util No Util V5240 Dispensing fee, BICROS $ V5241 Dispensing fee, monaural hearing aid, any type $ V5242 Hearing aid, analog, monaural, CIC (completely in the ear canal) $ V5243 Hearing aid, analog, monaural, ITC (in the canal) $ V5244 Hearing aid, digitally programmable analog, monaural CIC $ V5245 Hearing aid, digitally programmable analog, monaural, ITC $ V5246 Hearing aid, digitally programmable analog, monaural, ITE (in the $ ear) V5247 Hearing aid, digitally programmable analog, monaural, BTE $ V5248 Hearing aid, analog, binaural, CIC $ V5249 Hearing aid, analog, binaural, ITC $ V5250 Hearing aid, digitally programmable analog, binaural, CIC $ V5251 Hearing aid, digitally programmable analog, binaural, ITC $ V5252 Hearing aid, digitally programmable, binaural, ITE $ V5253 Hearing aid, digitally programmable, binaural, BTE $ V5254 Hearing aid, digital, monaural, CIC $ V5255 Hearing aid, digital, monaural, ITC $ V5256 Hearing aid, digital, monaural, ITE $ V5257 Hearing aid, digital, monaural, BTE $ V5258 Hearing aid, digital, binaural, CIC $ Milliman Coding and Billing for Audiology and Speech-Language Pathology

164 Exhibit B1-a American Speech-Language Hearing Association Commercial Cost Model - Professional Services Nationwide Utilization and Allowed Service Levels - Select Hearing Procedures Specialty: All Specialities Data from January, 2014 thru September, 2014 Nationwide Values Average Monthly Per Procedure Utilization Allowed per Member Code Modifier Description Per 1,000 Unit Allowed Cost V5259 Hearing aid, digital, binaural, ITC $ V5260 Hearing aid, digital, binaural, ITE $ V5261 Hearing aid, digital, binaural, BTE $ V5262 Hearing aid, disposable, any type, monaural $ V5263 Hearing aid, disposable, any type, binaural $ V5298 Hearing aid, not otherwise classified $ V5264 Ear mold/insert, not disposable, any type $ V5265 Ear mold/insert, disposable, any type $ V5268 Assistive listening device, telephone amplifier, any type $ Total $ "No Util" in a field indicates no utilization was found for the specified region. "No Alloc" in a field indicates insuffieient data exists to calculate a regions utiliation and/or allowed dollar specialty allocation. Chapter 11: Fee Data Milliman 2016 Coding and Billing for Audiology and Speech-Language Pathology 159

165 Chapter 11: Fee Data Exhibit B2-a American Speech-Language Hearing Association Commercial Cost Model - Professional Services Nationwide Utilization and Allowed Service Levels - Select Hearing Procedures Specialty: Audiology Only Data from January, 2014 thru September, 2014 Nationwide Values Average Monthly Per Procedure Utilization Allowed per Member Code Modifier Description Per 1,000 Unit Allowed Cost Removal Impact Cerumen 1/Both Ears $39.11 $ Spontaneous nystagmus, including gaze Positional nystagmus test Caloric vestibular test, each irrigation Optokinetic nystagmus test Basic vestibular evaluation Spontaneous Nystagmus Test W/Record Pstn Nystagms Min 4 Pstn W/Record Caloric Vestibular Test, Each Irrigation Optokinetic Nystagms Bidirec/Foveal Oscillat Tracking Test W/Recording Sinusoidal Verticl Axis Rotatal Tst Use Of Vertical Electrodes Computerized Dynamic Posturography Tympanometry and reflex threshold measurements Screening Test Pure Tone Air Only Pure Tone Audiometry; Air Only Pure Tone Audiometry; Air And Bone Speech Audiometry Threshold; Speech Audiom Threshld; W/Recognitn Comp Audiometry Threshold Eval Audiometric testing of groups Bekesy audiometry; screening Bekesy audiometry; diagnostic Loud Balanc Test Altern Bi/Monaural Tone Decay Test Short Increment Sensitivity Index Stenger Test Pure Tone Tympanometry Acoustic Reflex Testing Acoustic immittance testing Filtered Speech Test Staggered Spondaic Word Test Sensorineural Acuity Level Test Synthetic Sentence Id Test Stenger Test Speech Visual Reinforcement Audiometry Conditioning Play Audiometry Select Picture Audiometry Electrocochleography Aud Evokd Potnt &/ Test Cns; Comp Milliman Coding and Billing for Audiology and Speech-Language Pathology

166 Exhibit B2-a American Speech-Language Hearing Association Commercial Cost Model - Professional Services Nationwide Utilization and Allowed Service Levels - Select Hearing Procedures Specialty: Audiology Only Data from January, 2014 thru September, 2014 Nationwide Values Average Monthly Per Procedure Utilization Allowed per Member Code Modifier Description Per 1,000 Unit Allowed Cost Aud Evokd Potent &/ Test Cns; Ltd Evoked otoacoustic emissions, screening Distortion product evoked otoacoustic emissions; limited evaluation Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation Hearing aid exam and selection; monaural Hearing aid examination and selection; binaural Hearing aid check; monaural Hearing aid check; binaural Electroacoustic evaluation for hearing aid; monaural Electroacoustic evaluation for hearing aid; binaural Ear protector attenuation measurements Dx analysis of cochlear implant, patient younger than 7 years of age; with programming subsequent reprogramming Diagnostic analysis of cochlear implant, age 7 years or older; with programming subsequent reprogramming minutes each additional 15 minutes Assessment of tinnitus Evaluation of auditory rehabilitation status; first hour each additional 15 minutes Auditory rehabilitation; prelingual hearing loss Auditory rehabilitation; postlingual hearing loss Diagnostic analysis with programming of auditory brainstem implant, per hour L8619 Cochlear implant external speech processor No Alloc No Alloc No Alloc L8627 replacement No Alloc No Alloc No Alloc L8690 Auditory osseointegrated device, includes all internal and external components No Alloc No Alloc No Alloc L8691 Auditory osseointegrated device, external sound processor, replacement No Alloc No Alloc No Alloc L8692 Non-osseointegrated snd proc No Alloc No Alloc No Alloc V5010 Assessment for hearing aid V5011 Fitting/Orientation/Checking of hearing aid V5014 Repair/Modification of a hearing aid V5020 Conformity evaluation V5030 Hearing aid, monaural, body worn, air conduction , V5040 Hearing aid, monaural, body worn, bone conduction V5050 Hearing aid, monaural, in the ear , Chapter 11: Fee Data Milliman 2016 Coding and Billing for Audiology and Speech-Language Pathology 161

167 Chapter 11: Fee Data Exhibit B2-a American Speech-Language Hearing Association Commercial Cost Model - Professional Services Nationwide Utilization and Allowed Service Levels - Select Hearing Procedures Specialty: Audiology Only Data from January, 2014 thru September, 2014 Nationwide Values Average Monthly Per Procedure Utilization Allowed per Member Code Modifier Description Per 1,000 Unit Allowed Cost V5060 Hearing aid, monaural, behind the ear , V5070 Glasses, air conduction No Util No Util No Util V5080 Glasses, bone conduction No Util No Util No Util V5090 Dispensing fee, unspecified hearing aid V5095 Semi-implantable middle ear hearing prosthesis (use for Vibrant Soundbridge) No Util No Util No Util V5100 Hearing aid, bilateral, body worn , V5110 Dispensing fee, bilateral V5120 Binaural, body , V5130 Binaural, in the ear V5140 Binaural, behind the ear $ V5150 Binaural, glasses No Util No Util No Util V5160 Dispensing fee, binaural $ V5170 Hearing aid, CROS, in the ear $ V5180 Hearing aid, CROS, behind the ear $ V5190 Hearing aid, CROS, glasses No Util No Util No Util V5200 Dispensing fee, CROS $ V5210 Hearing aid, BICROS, in the ear $ V5220 Hearing aid, BICROS, behind the ear $ V5230 Hearing aid, BICROS, glasses No Util No Util No Util V5240 Dispensing fee, BICROS $ V5241 Dispensing fee, monaural hearing aid, any type $ V5242 Hearing aid, analog, monaural, CIC (completely in the ear canal) $ V5243 Hearing aid, analog, monaural, ITC (in the canal) $ V5244 Hearing aid, digitally programmable analog, monaural CIC $ V5245 Hearing aid, digitally programmable analog, monaural, ITC $ V5246 ear) $ V5247 Hearing aid, digitally programmable analog, monaural, BTE $ V5248 Hearing aid, analog, binaural, CIC $ V5249 Hearing aid, analog, binaural, ITC $ V5250 Hearing aid, digitally programmable analog, binaural, CIC $ V5251 Hearing aid, digitally programmable analog, binaural, ITC $ V5252 Hearing aid, digitally programmable, binaural, ITE $ V5253 Hearing aid, digitally programmable, binaural, BTE $ V5254 Hearing aid, digital, monaural, CIC $ V5255 Hearing aid, digital, monaural, ITC $ V5256 Hearing aid, digital, monaural, ITE $ V5257 Hearing aid, digital, monaural, BTE $ V5258 Hearing aid, digital, binaural, CIC $ V5259 Hearing aid, digital, binaural, ITC $ V5260 Hearing aid, digital, binaural, ITE $ Milliman Coding and Billing for Audiology and Speech-Language Pathology

168 Exhibit B2-a American Speech-Language Hearing Association Commercial Cost Model - Professional Services Nationwide Utilization and Allowed Service Levels - Select Hearing Procedures Specialty: Audiology Only Data from January, 2014 thru September, 2014 Nationwide Values Average Monthly Per Procedure Utilization Allowed per Member Code Modifier Description Per 1,000 Unit Allowed Cost V5261 Hearing aid, digital, binaural, BTE $ V5262 Hearing aid, disposable, any type, monaural $ V5263 Hearing aid, disposable, any type, binaural $ V5298 Hearing aid, not otherwise classified $ V5264 Ear mold/insert, not disposable, any type $ V5265 Ear mold/insert, disposable, any type $ V5268 Assistive listening device, telephone amplifier, any type $ Total $ "No Util" in a field indicates no utilization was found for the specified region. Chapter 11: Fee Data "No Alloc" in a field indicates insuffieient data exists to calculate a regions utiliation and/or allowed dollar specialty allocation. Milliman 2016 Coding and Billing for Audiology and Speech-Language Pathology 163

169 Chapter 11: Fee Data Exhibit C1-a American Speech-Language Hearing Association Commercial Cost Model - Professional Services Nationwide Utilization and Allowed Service Levels - Select Speech Language Pathology Procedures Specialty: All Specialities Data from January, 2014 thru September, 2014 Nationwide Values Average Monthly Per Procedure Utilization Allowed per Member Code Modifier Description Per 1,000 Unit Allowed Cost Laryngscpy Flexible Fiberoptic; Dx $ $ Laryngscpy Flex/Rigid W/Stroboscpy Cmplx Dynamic Pharyngeal & Speech Swllow Funct W/Cinerad/Videoradgrph Us Soft Tiss Head&Nck B-Scan W/Imag Speech/hearing therapy SZ Speech-language treatment; habilitation No Util No Util No Util Tx Speech Lang Voice&/Aud D/O;2/Mor Nasopharyngoscopy With Endoscope Nasal function studies Facial Nerve Function Studies Laryngeal Function Studies Evaluation of speech fluency Evaluation of speech sound production Evaluation of speech sound production with evaluation of language comprehension/exp Behavioral and qualitative analysis of voice and resonance Tx Swallow Dysfunct&/Oral Funct Fd Screening Test Pure Tone Air Only Eval&/Fit Voice Pros Supl Orl Spch Dx Analy Ci Pt Und 7 Yr Age; W/Prog Dx Analy Ci Pt <7 Yr; Subsqt Reprog Dx Analy Coch Impl 7 Yr/>; W/Prog Eval Rx Spch-Gen Devc F/F Pt; 1 Hr Eval Rx Spch-Gen Devc F/F Pt;30 Min Tx Srvc Use Spch-Gen Devc Prog&Mod Eval Orl&Pharyngeal Swallwing Funct Mot Fluoro Eval Swallw Cine/Video Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording interpretation and report only Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video interpretation and report only Flexible fiberoptic endoscopic evaluation of swallow, laryngeal sensory testing by cine v interpretation and report only Evaluation of auditory rehabilitation status; first hour each additional 15 minutes Auditory rehabilitation; prelingual hearing loss Auditory rehabilitation; postlingual hearing loss Milliman Coding and Billing for Audiology and Speech-Language Pathology

170 Exhibit C1-a American Speech-Language Hearing Association Commercial Cost Model - Professional Services Nationwide Utilization and Allowed Service Levels - Select Speech Language Pathology Procedures Specialty: All Specialities Data from January, 2014 thru September, 2014 Nationwide Values Average Monthly Per Procedure Utilization Allowed per Member Code Modifier Description Per 1,000 Unit Allowed Cost Assessment Aphasia W/I&R Per Hour Dvlpmentl Testing; Limited W/I&R Dvlpmentl Tst; Ext W/I&R Per Hour Cognitive testing Tx Actv Dir Pt Cntc Prov Ea 15 Min Dev Congnitive Skill-1:1-Ea 15 Min Self-care/home management training Medical team conference; direct care, non-physician Medical team conference; without direct care; non-physician L8509 Tracheo-esophageal voice prosthesis, inserted by a lic. health care provider, any type L8510 Voice amplifier E2500 Speech generating device, digitized speech E2502 Speech generating device No Util No Util No Util E2504 Speech generating device No Util No Util No Util E2506 Speech generating device No Util No Util No Util E2508 Speech generating device No Util No Util No Util E2510 Speech generating device , Total $ "No Util" in a field indicates no utilization was found for the specified region. "No Alloc" in a field indicates insuffieient data exists to calculate a regions utiliation and/or allowed dollar specialty allocation. Chapter 11: Fee Data Milliman 2016 Coding and Billing for Audiology and Speech-Language Pathology 165

171 Chapter 11: Fee Data Exhibit C3-a American Speech-Language Hearing Association Commercial Cost Model - Professional Services Nationwide Utilization and Allowed Service Levels - Select Speech Language Pathology Procedures Specialty: Speech Language Therapy Only Data from January, 2014 thru September, 2014 Nationwide Values Average Monthly Per Procedure Utilization Allowed per Member Code Modifier Description Per 1,000 Unit Allowed Cost Laryngscpy Flexible Fiberoptic; Dx $ $ Laryngscpy Flex/Rigid W/Stroboscpy Cmplx Dynamic Pharyngeal & Speech Swllow Funct W/Cinerad/Videoradgrph Us Soft Tiss Head&Nck B-Scan W/Imag Speech/hearing therapy SZ Speech-language treatment; habilitation No Util No Util No Util Tx Speech Lang Voice&/Aud D/O;2/Mor Nasopharyngoscopy With Endoscope Nasal function studies Facial Nerve Function Studies Laryngeal Function Studies Evaluation of speech fluency Evaluation of speech sound production Evaluation of speech sound production with evaluation of language comprehension/exp Behavioral and qualitative analysis of voice and resonance Tx Swallow Dysfunct&/Oral Funct Fd Screening Test Pure Tone Air Only Eval&/Fit Voice Pros Supl Orl Spch Dx Analy Ci Pt Und 7 Yr Age; W/Prog - No Util No Util Dx Analy Ci Pt <7 Yr; Subsqt Reprog Dx Analy Coch Impl 7 Yr/>; W/Prog Eval Rx Spch-Gen Devc F/F Pt; 1 Hr Eval Rx Spch-Gen Devc F/F Pt;30 Min Tx Srvc Use Spch-Gen Devc Prog&Mod Eval Orl&Pharyngeal Swallwing Funct Mot Fluoro Eval Swallw Cine/Video Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording interpretation and report only Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video interpretation and report only Flexible fiberoptic endoscopic evaluation of swallow, laryngeal sensory testing by cine v interpretation and report only Evaluation of auditory rehabilitation status; first hour each additional 15 minutes Auditory rehabilitation; prelingual hearing loss Auditory rehabilitation; postlingual hearing loss Milliman Coding and Billing for Audiology and Speech-Language Pathology

172 Exhibit C3-a American Speech-Language Hearing Association Commercial Cost Model - Professional Services Nationwide Utilization and Allowed Service Levels - Select Speech Language Pathology Procedures Specialty: Speech Language Therapy Only Data from January, 2014 thru September, 2014 Nationwide Values Average Monthly Per Procedure Utilization Allowed per Member Code Modifier Description Per 1,000 Unit Allowed Cost Assessment Aphasia W/I&R Per Hour Dvlpmentl Testing; Limited W/I&R Dvlpmentl Tst; Ext W/I&R Per Hour Cognitive testing Tx Actv Dir Pt Cntc Prov Ea 15 Min Dev Congnitive Skill-1:1-Ea 15 Min Self-care/home management training Medical team conference; direct care, non-physician Medical team conference; without direct care; non-physician L8509 Tracheo-esophageal voice prosthesis, inserted by a lic. health care No Alloc No Alloc No Alloc provider, any type L8510 Voice amplifier No Alloc No Alloc No Alloc E2500 Speech generating device, digitized speech No Alloc No Alloc No Alloc E2502 Speech generating device No Util No Util No Util E2504 Speech generating device No Util No Util No Util E2506 Speech generating device No Util No Util No Util E2508 Speech generating device No Util No Util No Util E2510 Speech generating device No Alloc No Alloc No Alloc Total $ Chapter 11: Fee Data "No Util" in a field indicates no utilization was found for the specified region. "No Alloc" in a field indicates insuffieient data exists to calculate a regions utiliation and/or allowed dollar specialty allocation. Milliman 2016 Coding and Billing for Audiology and Speech-Language Pathology 167

173 Coding and Billing for Audiology and Speech-Language Pathology

174 Chapter 12: Documentation Guidance Documentation Tips No universal template or documentation style exists - specific documentation requirements or formats may vary by institution or payer. Remember: If you didn t document it, it didn t happen. Clinical documentation is one of a clinician s most important tasks. The clinical record is an overall indicator of clinical and service quality and serves as a basis for planning care and for service continuity. Medicare and Medicaid have specific guidelines on documentation, and commercial payers may have certain rules as well. Remember that documentation is often reviewed by nurses, rather than speech-language pathologists (SLPs) or audiologists, and an SLP or audiologist should not assume that the reviewer will understand why the service requires the skill of an SLP or all aspects of hearing assessment. This manual covers Medicare documentation requirements and outlines very specific rules. Documentation for Audiology, Based on Medicare Requirements Documentation justifies why the patient was seen, what was done, what was found, and what was recommended. Together, these components of documentation support the respective selections for procedure and diagnosis codes. In general, documentation should include, in addition to the signature and service date: History. The history section of a report includes the patient s chief complaints, signs, and symptoms; pertinent medical, social, and family history; and the referral source. History should be sufficient to justify the medical necessity of the patient s visit and the procedures that were performed. Procedures performed. This portion of the report documents the procedures executed and the diagnostic test results for each procedure. Clinical assessment. This section is an interpretation of the findings. Sufficient detail and discussion should be included so that the unfamiliar reader may understand not only what was found, but also why the findings affect the overall well-being of the patient. Recommendations. This section should be a logical conclusion to the flow of information from the previous three sections; recommendations should be specific and cover follow-up, referral, discharge, and/ or plan of care, as appropriate. For Medicare documentation, audiologists should write clear and comprehensive information in each patient s records detailing the physician/npp referral or order, the services and procedures performed, and the follow-up provided to the referring physician. Specific Medicare instructions for audiology documentation follow: Documenting Audiological Tests The reason for performing the test should be included on the order, and/or the audiological evaluation report, and/ or the patient s medical record. Examples of appropriate reasons include but are not limited to: Evaluation of suspected change in hearing, tinnitus, or balance; Evaluation of the cause of disorders of hearing, tinnitus, or balance; Determination of the effect of medication, surgery, or other treatment. Reevaluation is appropriate to follow-up changes in hearing, tinnitus, or balance that may be caused by, but not limited to, such conditions as otosclerosis, atelectatic tympanic membrane, tymposclerosis, cholesteatoma, resolving middle ear infection, Ménière s disease, sudden idiopathic sensorineural hearing loss, autoimmune inner ear disease, acoustic neuroma, demyelinating diseases, ototoxicity secondary to medications, genetic, or vascular or viral conditions. Screening tests are not payable, but failure of a screening test may be an appropriate reason to conduct diagnostic audiological tests. The medical record should identify the name and professional identity of the person who ordered the evaluation and the person who actually performed the service. When the medical record is subject to medical review, it is necessary that the contractor determine that the service qualifies as an audiological diagnostic test that requires the skills of an audiologist. Services by audiologists must be documented and billed by the audiologist. For Medicare, audiologists cannot supervise technicians that must be done by physicians. Documentation should also include a section describing the procedures that were completed and their outcomes; a section on clinical assessment of the findings; recommendations; signature; and date of service. The Medicare other diagnostic tests benefit requires an order from a physician, or, where allowed by state and local law, by a non-physician practitioner. The reason for the test should be documented either on the order, on the audiological evaluation report, or in the patient s medical record. Examples of appropriate reasons include but are not limited to: Evaluation of suspected change in hearing, tinnitus, or balance. Evaluation of the cause of disorders of hearing, tinnitus, or balance. Determination of the effect of medication, surgery or other treatment. Chapter 12: Documentation Guidance 2016 Coding and Billing for Audiology and Speech-Language Pathology 169

175 Chapter 12: Documentation Guidance Medicare Documentation for Speech-Language Pathology The documentation required by the Centers for Medicare & Medicaid Services (CMS) for Medicare payment is summarized below: Summary Evaluation Plan of Care/Certification of the Plan of Care Progress reports Treatment encounter notes Discharge note Summary In general, Medicare requires that therapy services are of appropriate type, frequency, intensity, and duration for the individual needs of the patient. Documentation should: Establish the variables that influence the patient s condition, especially those factors that influence the clinician s decision to provide more services than are typical for the individual s condition. Establish through objective measurements that the patient is making progress toward goals. CMS realizes that regression and plateaus can happen during treatment. CMS recommends that the reasons for lack of progress be noted and the justification for continued treatment be documented, if treatment continues after regression or plateaus. Evaluation The initial evaluation, or the plan of care including an evaluation, should document the necessity for a course of therapy through objective findings. Documentation of the evaluation should list the conditions and complexities and describe the impact of the conditions and complexities on the prognosis and/or the plan for treatment so that it is clear to a reviewer that the services planned are appropriate for the individual. Evaluation shall include the following: A diagnosis and description of the specific problem(s) to be evaluated and/or treated. The diagnosis should be specific and as relevant as possible to the problem to be treated. The treatment diagnosis may or may not be identified by the therapist, depending on his or her scope of practice. Where a diagnosis is not allowed, CMS advises the use of a condition description similar to the appropriate ICD-9 code. Results of ASHA s National Outcomes Measurement System (NOMS), is optional. Additional information can be found on the NOMS section of the ASHA website. If NOMS is not used, the record shall contain documentation indicating objective, measurable beneficiary physical function, including, for example, (a) functional assessment individual item and summary scores (and comparisons to prior assessment scores) from commercially available therapy outcomes instruments other than those listed above, or (b) functional assessment scores (and comparisons to prior assessment scores) from tests and measurements validated in the professional literature that are appropriate for the condition/ function being measured, or (c) other measurable progress towards identified goals for functioning in the home environment at the conclusion of this therapy episode of care. When an evaluation is the only service provided in an episode of treatment, the evaluation serves as the plan of care provided that it contains (a) a diagnosis or states where a therapist may not diagnose, and (b) a description of the condition from which a diagnosis may be determined by the referring physician/non-physician practitioner (NPP). The goal, frequency, intensity, and duration of treatment are implied in the diagnosis and one-time service. The referral/order of a physician/npp is the certification that the evaluation is needed and that the patient is under the care of a physician. Plan of Care/Certification of the Plan of Care The plan of care shall be consistent with the related evaluation. The evaluation and plan may be reported in two separate documents or a single combined document. The certified plan of care ensures that the patient is under the care of a physician or NPP. Long-term treatment goals should be developed for the entire episode of care. The plan of care should contain the following information: Diagnoses Long-term treatment goals Type, amount, duration, and frequency of therapy services The amount of treatment refers to the number of times in a day the type of treatment will be provided. The frequency refers to the number of times in a week the type of treatment will be provided. The duration is the number of weeks or the number of treatment sessions. Progress Reports The progress report provides justification for the medical necessity of treatment. A clinician must complete a progress report at least once every 10 treatment days or at least once during each certification interval, whichever is appropriate. The beginning of the first reporting period is the first day of the episode of treatment, regardless of whether the service provided on that day is an evaluation, re-evaluation, or treatment. Progress notes should contain: An assessment of improvement - extent of progress (or lack thereof) toward each goal; Coding and Billing for Audiology and Speech-Language Pathology

176 Plans for continuing treatment, reference to additional evaluation results, and/or treatment plan revisions documented in the clinician s progress report; Changes to long or short-term goals, discharge, or an updated plan of care that is sent to the physician/ NPP for certification of the next interval of treatment; The alphanumeric G-codes and severity modifiers, along with the tool or method used to determine the patient severity in the clinical assessment. Documentation should justify the necessity of the services provided during the reporting period and include, for example, objective evidence or a clinically supportable statement of expectation that the patient s condition has the potential to improve or is improving in response to therapy; maximum improvement is yet to be attained; and there is an expectation that the anticipated improvement is attainable in a reasonable and generally predictable period of time. Additionally, Medicare must cover services that prevent deterioration and maintain functional levels not just those that result in functional progress according to the recent settlement of Jimmo v. Sebelius (January 2013), which requires CMS to revise its policy manuals by January 2014 to reflect the elimination of the Medicare Improvement Standard that requires patients show functional progress in order to continue to receive rehabilitation services. Objective evidence consists of standardized patient assessment instruments, outcomes measurement tools, or measurable assessments of functional outcomes (e.g., per NOMS). Use of objective measures at the beginning, during, and/or after treatment is recommended to quantify progress and support justifications for continued treatment. Such tools are not required, but their use will enhance the justification for needed therapy. CMS Example of a SLP Progress Note The Plan states diagnosis is Dysphagia secondary to other late effects of CVA. Patient is on a restricted diet and wants to drink thick liquids. Therapy is planned 3X week, 45 minute sessions for 6 weeks. Long-term goal is to consume a mechanical soft diet with thin liquids without complications, such as aspiration pneumonia. Short-Term Goals: Goal 1: Patient will improve rate of laryngeal elevation/ timing of closure by using the super-supraglottic swallow on saliva swallows without cues on 90% of trials. Goal 2: Patient will compensate for reduced laryngeal elevation by controlling bolus size to a ½ teaspoon without cues on 100% of trials. The Progress Report for 1/3/06 to 1/29/06 states: 1. Improved to 80% of trials; 2. Achieved. Comments: Highly motivated; spouse assists with practicing, patient compliant with current restrictions. New Goal: Patient will implement above strategies to swallow a sip of water without coughing for 5 consecutive trials. Mary Johns, CCC-SLP, 1/29/06 Note the provider is billing three times a week, consistent with the plan; progress is documented; skilled treatment is documented. Treatment Notes The purpose of the treatment note is to create a record of all encounters and skilled intervention. Documentation is required for every treatment day and every therapy service and must include: the encounter note must record the name of the treatment, intervention of activity provided; total treatment time; and signature of the professional furnishing the services. If a treatment is added or changed between the progress note intervals, the change must be recorded and justified in the medical record. Frequent professional judgments resulting in upgrades to the patient s activity show skilled treatment. Objective measurement showing patient improvement is also helpful. If there is no improvement, the clinician should provide information to explain the setbacks, illness, new condition, and/or social circumstances that are impeding progress and why he/she believes that progress is still attainable. Discharge Note The discharge note is required and is a progress report written by a clinician that should cover the reporting period from the last progress report to the date of discharge. The discharge note should include all treatment provided since the last progress report and indicate that the therapist reviewed the notes and agrees to the discharge. There is an important distinction between progress notes and treatment encounter notes, which document every treatment day and every treatment service. The purpose of the encounter note is to create a record of all encounters and skilled interventions by qualified professionals to justify the use of the billing codes on the claim (patient bill to Medicare). The progress note documents medical necessity or appropriateness of ongoing services. Chapter 12: Documentation Guidance 2016 Coding and Billing for Audiology and Speech-Language Pathology 171

177 Chapter 12: Documentation Guidance The following elements must be included when documenting each treatment encounter: Date of treatment Treatment minutes and total treatment time for timed codes. (The amount of time for each specific intervention provided to the patient is not required because it is indicated in the billing of the codes.) However, billing and total timed code treatment minutes must be consistent. Identification of each specific intervention/type of treatment provided and billed for both timed and untimed codes. Electronic Health Records The advent of electronic health records (EHR) has both streamlined and complicated clinical documentation. Electronic records can use free text, structured text ( macros or boilerplate ) and interactive text that includes clinical decision-support functions. Electronic records may be supplemented by bar coding (for tracking supplies used, medications administered, etc.) and identity recognition programs that authenticate users. There has been a federal push towards electronic medical records (EMRs) for a number of years. While incentives for EMR adoption are aimed primarily at physicians and health care facilities at this time, other health care providers, such as audiologists and SLPs, may also be encouraged and incentivized to use EMRs in the future. There are commercial practice management software programs available that address everything from billing to documentation and scheduling. Providers may also set-up their own programs or develop their own electronic templates. Consideration must be given to the Health Insurance Portability and Accountability Act (HIPAA) for privacy and security as well as other applicable state and federal laws Coding and Billing for Audiology and Speech-Language Pathology

178 Appendix & Resources ICD-9-CM Conversion to ICD-10-CM Audiology Disclaimer: This product is NOT comprehensive and consists only of codes commonly related to audiology services. Mappings are only to ICD-10-CM codes, not ICD-10-PCS. Every effort was made to accurately map codes using detailed analysis. Keep in mind, however, that while many codes in ICD-9-CM map directly to codes in ICD-10-CM, in some cases, additional clinical analysis may be required to determine which code or codes should be selected for your situation. Always review mapping results before applying them. ICD-9-CM ICD-9-CM Description Code Perichondritis of pinna, unspecified ICD-10-CM ICD-10-CM Description Code H Unspecified perichondritis of right external ear H Unspecified perichondritis of left external ear H Unspecified perichondritis of external ear, bilateral H Unspecified perichondritis of external ear, unspecified ear Acute perichondritis of pinna H Acute perichondritis of right external ear H Acute perichondritis of left external ear H Acute perichondritis of external ear, bilateral H Acute perichondritis of external ear, unspecified ear Chronic perichondritis of pinna H Chronic perichondritis of right external ear H Chronic perichondritis of left external ear H Chronic perichondritis of external ear, bilateral H Chronic perichondritis of external ear, unspecified ear Chondritis of pinna H Chondritis of right external ear H Chondritis of left external ear H Chondritis of external ear, bilateral H Chondritis of external ear, unspecified ear Infective otitis externa, unspecified H60.00 Abscess of external ear, unspecified ear H60.01 Abscess of right external ear H60.02 Abscess of left external ear H60.03 Abscess of external ear, bilateral H60.10 Cellulitis of external ear, unspecified ear H60.11 Cellulitis of right external ear H60.12 Cellulitis of left external ear H60.13 Cellulitis of external ear, bilateral H Diffuse otitis externa, right ear H Diffuse otitis externa, left ear H Diffuse otitis externa, bilateral H Diffuse otitis externa, unspecified ear H Hemorrhagic otitis externa, right ear H Hemorrhagic otitis externa, left ear H Hemorrhagic otitis externa, bilateral H Hemorrhagic otitis externa, unspecified ear H Other infective otitis externa, right ear H Other infective otitis externa, left ear H Other infective otitis externa, bilateral H Other infective otitis externa, unspecified ear Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 173

179 Appendix & Resources ICD-9-CM Code ICD-9-CM Description ICD-10-CM Code ICD-10-CM Description Acute infection of pinna H61.90 Disorder of external ear, unspecified, unspecified ear H61.91 Disorder of right external ear, unspecified H61.92 Disorder of left external ear, unspecified H61.93 Disorder of external ear, unspecified, bilateral Acute swimmers ear H Swimmer s ear, right ear Beach ear H Swimmer s ear, left ear Tank ear H Swimmer s ear, bilateral H Swimmer s ear, unspecified ear Other acute infections of external ear H62.40 Otitis externa in other diseases classified elsewhere, unspecified ear H62.41 Otitis externa in other diseases classified elsewhere, right ear H62.42 Otitis externa in other diseases classified elsewhere, left ear H62.43 Otitis externa in other diseases classified elsewhere, bilateral H62.8X1 Other disorders of right external ear in diseases classified elsewhere H62.8X2 Other disorders of left external ear in diseases classified elsewhere H62.8X3 Other disorders of external ear in diseases classified elsewhere, bilateral H62.8X9 Other disorders of external ear in diseases classified elsewhere, unspecified ear Malignant otitis externa H60.20 Malignant otitis externa, unspecified ear H60.21 Malignant otitis externa, right ear H60.22 Malignant otitis externa, left ear H60.23 Malignant otitis externa, bilateral Chronic myotic otitis externa H62.8X1 Other disorders of right external ear in diseases classified elsewhere H62.8X2 Other disorders of left external ear in diseases classified elsewhere H62.8X3 Other disorders of external ear in diseases classified elsewhere, bilateral H62.8X9 Other disorders of external ear in diseases classified elsewhere, unspecified ear Other chronic infective otitis H Other infective otitis externa, unspecified ear externa Disorder of pinna, unspecified H Unspecified noninfective disorders of pinna, right ear H Unspecified noninfective disorders of pinna, left ear H Unspecified noninfective disorders of pinna, bilateral H Unspecified noninfective disorders of pinna, unspecified ear Hematoma of auricle or pinna H Hematoma of pinna, right ear H Hematoma of pinna, left ear H Hematoma of pinna, bilateral H Hematoma of pinna, unspecified ear Coding and Billing for Audiology and Speech-Language Pathology

180 ICD-9-CM ICD-9-CM Description Code Acquired deformities of auricle or pinna Other noninfectious disorders of pinna Impacted cerumen Wax in ear Acquired stenosis of external ear canal secondary to trauma ICD-10-CM ICD-10-CM Description Code H Acquired deformity of pinna, right ear H Acquired deformity of pinna, left ear H Acquired deformity of pinna, bilateral H Acquired deformity of pinna, unspecified ear H Noninfective disorders of pinna, right ear H Noninfective disorders of pinna, left ear H Noninfective disorders of pinna, bilateral H Noninfective disorders of pinna, unspecified ear H61.20 Impacted cerumen, unspecified ear H61.21 Impacted cerumen, right ear H61.22 Impacted cerumen, left ear H61.23 Impacted cerumen, bilateral H Acquired stenosis of right external ear canal secondary to trauma H Acquired stenosis of left external ear canal secondary to trauma H Acquired stenosis of external ear canal secondary to trauma, bilateral H Acquired stenosis of external ear canal secondary to trauma, unspecified ear Exostosis of external ear canal H Exostosis of right external canal H Exostosis of left external canal H Exostosis of external canal, bilateral H Exostosis of external canal, unspecified ear Other disorders of external ear H Other specified disorders of right external ear H Other specified disorders of left external ear H Other specified disorders of external ear, bilateral H Other specified disorders of external ear, unspecified ear Unspecified disorder of H61.90 Disorder of external ear, unspecified, unspecified ear external ear H61.91 Disorder of right external ear, unspecified H61.92 Disorder of left external ear, unspecified H61.93 Disorder of external ear, unspecified, bilateral Acute nonsuppurative otitis media, H Other acute nonsuppurative otitis media, right ear unspecified H Other acute nonsuppurative otitis media, left ear H Other acute nonsuppurative otitis media, bilateral H Other acute nonsuppurative otitis media, recurrent, right ear H Other acute nonsuppurative otitis media, recurrent, left ear H Other acute nonsuppurative otitis media, recurrent, bilateral H Other acute nonsuppurative otitis media recurrent, unspecified ear H Other acute nonsuppurative otitis media, unspecified ear Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 175

181 Appendix & Resources ICD-9-CM ICD-9-CM Description Code Acute serous otitis media Acute or subacute secretory otitis media Acute mucoid otitis media Acute or subacute seromucinous otitis media Blue drum syndrome ICD-10-CM ICD-10-CM Description Code H65.00 Acute serous otitis media, unspecified ear H65.01 Acute serous otitis media, right ear H65.02 Acute serous otitis media, left ear H65.03 Acute serous otitis media, bilateral H65.04 Acute serous otitis media, recurrent, right ear H65.05 Acute serous otitis media, recurrent, left ear H65.06 Acute serous otitis media, recurrent, bilateral H65.07 Acute serous otitis media, recurrent, unspecified ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), left ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), bilateral H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, right ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, left ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, bilateral H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, unspecified ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), unspecified ear Acute sanguinous otitis media H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), left ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), bilateral H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, right ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, left ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, bilateral H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, unspecified ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), unspecified ear Coding and Billing for Audiology and Speech-Language Pathology

182 ICD-9-CM Code ICD-9-CM Description ICD-10-CM Code ICD-10-CM Description Acute allergic serous otitis media H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), left ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), bilateral H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, right ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, left ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, bilateral H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, unspecified ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous),unspecified ear Acute allergic mucoid otitis media H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), left ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), bilateral H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, right ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, left ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, bilateral H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, unspecified ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous),unspecified ear Acute allergic sanguinous otitis media H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), left ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), bilateral H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, right ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, left ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, bilateral H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, unspecified ear H Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous),unspecified ear Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 177

183 Appendix & Resources ICD-9-CM ICD-9-CM Description Code Chronic serous otitis media, simple or unspecified Other chronic otitis media Serosanguinous chronic otitis media Chronic mucoid otitis media, simple or unspecified Other (Chronic mucoid otitis media) Mucosanguinous chronic otitis media Other and unspecified chronic nonsuppurative otitis media Nonsuppurative otitis media, not specified as acute or chronic Acute suppurative otitis media without spontaneous rupture of ear drum ICD-10-CM ICD-10-CM Description Code H65.20 Chronic serous otitis media, unspecified ear H65.21 Chronic serous otitis media, right ear H65.22 Chronic serous otitis media, left ear H65.23 Chronic serous otitis media, bilateral H65.20 Chronic serous otitis media, unspecified ear H65.21 Chronic serous otitis media, right ear H65.22 Chronic serous otitis media, left ear H65.23 Chronic serous otitis media, bilateral H65.30 Chronic mucoid otitis media, unspecified ear H65.31 Chronic mucoid otitis media, right ear H65.32 Chronic mucoid otitis media, left ear H65.33 Chronic mucoid otitis media, bilateral H65.30 Chronic mucoid otitis media, unspecified ear H65.31 Chronic mucoid otitis media, right ear H65.32 Chronic mucoid otitis media, left ear H65.33 Chronic mucoid otitis media, bilateral H Chronic allergic otitis media, right ear H Chronic allergic otitis media, left ear H Chronic allergic otitis media, bilateral H Chronic allergic otitis media, unspecified ear H Other chronic nonsuppurative otitis media, right ear H Other chronic nonsuppurative otitis media, left ear H Other chronic nonsuppurative otitis media, bilateral H Other chronic nonsuppurative otitis media, unspecified ear H65.90 Unspecified nonsuppurative otitis media, unspecified ear H65.91 Unspecified nonsuppurative otitis media, right ear H65.92 Unspecified nonsuppurative otitis media, left ear H65.93 Unspecified nonsuppurative otitis media, bilateral H Acute suppurative otitis media without spontaneous rupture of ear drum, right ear H Acute suppurative otitis media without spontaneous rupture of ear drum, left ear H Acute suppurative otitis media without spontaneous rupture of ear drum, bilateral H Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear H Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left ear H Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, bilateral H Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, unspecified ear H Acute suppurative otitis media without spontaneous rupture of ear drum, unspecified ear Coding and Billing for Audiology and Speech-Language Pathology

184 ICD-9-CM ICD-9-CM Description Code Acute suppurative otitis media with spontaneous rupture of ear drum Acute suppurative otitis media in diseases classified elsewhere Chronic tubotympanic supprative otitis media Benign chronic suppurative otitis media (with anterior perforation of ear drum) Chronic tubotympanic disease (with anterior perforation of ear drum) Chronic atticoantral suppurative otitis media Chronic atticoantral disease (with posterior or superior marginal perforation of ear drum) Persistent mucosal disease (with posterior or superior marginal perforation of ear drum) Unspecified chronic suppurative otitis media Chronic purulent otitis media Unspecified suppurative otitis media Purulent otitis media NOS ICD-10-CM ICD-10-CM Description Code H Acute suppurative otitis media with spontaneous rupture of ear drum, right ear H Acute suppurative otitis media with spontaneous rupture of ear drum, left ear H Acute suppurative otitis media with spontaneous rupture of ear drum, bilateral H Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, right ear H Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, left ear H Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, bilateral H Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, unspecified ear H Acute suppurative otitis media with spontaneous rupture of ear drum, unspecified ear H67.1 Otitis media in diseases classified elsewhere, right ear H67.2 Otitis media in diseases classified elsewhere, left ear H67.3 Otitis media in diseases classified elsewhere, bilateral H67.9 Otitis media in diseases classified elsewhere, unspecified ear H66.10 Chronic tubotympanic suppurative otitis media, unspecified H66.11 Chronic tubotympanic suppurative otitis media, right ear H66.12 Chronic tubotympanic suppurative otitis media, left ear H66.13 Chronic tubotympanic suppurative otitis media, bilateral H66.20 Chronic atticoantral suppurative otitis media, unspecified ear H66.21 Chronic atticoantral suppurative otitis media, right ear H66.22 Chronic atticoantral suppurative otitis media, left ear H66.23 Chronic atticoantral suppurative otitis media, bilateral H66.3X1 Other chronic suppurative otitis media, right ear H66.3X2 Other chronic suppurative otitis media, left ear H66.3X3 Other chronic suppurative otitis media, bilateral H66.3X9 Other chronic suppurative otitis media, unspecified ear H66.40 Suppurative otitis media, unspecified, unspecified ear H66.41 Suppurative otitis media, unspecified, right ear H66.42 Suppurative otitis media, unspecified, left ear H66.43 Suppurative otitis media, unspecified, bilateral Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 179

185 Appendix & Resources ICD-9-CM Code ICD-9-CM Description ICD-10-CM Code ICD-10-CM Description Unspecified otitis media H66.90 Otitis media, unspecified, unspecified ear H66.91 Otitis media, unspecified, right ear H66.92 Otitis media, unspecified, left ear H66.93 Otitis media, unspecified, bilateral Acute myringitis, unspecified H Acute myringitis, right ear H Acute myringitis, left ear H Acute myringitis, bilateral H Acute myringitis, unspecified ear Bullous myringitis H Bullous myringitis, right ear H Bullous myringitis, left ear H Bullous myringitis, bilateral H Bullous myringitis, unspecified ear Chronic myringitis without mention H Other acute myringitis, right ear of otitis media H Other acute myringitis, left ear Chronic tympanitis H Other acute myringitis, bilateral H Other acute myringitis, unspecified ear Perforation of tympanic membrane, unspecified Central perforation of tympanic membrane Attic perforation of tympanic membrane Pars flaccida Other marginal perforation of tympanic membrane Multiple perforations of tympanic membrane H72.90 Unspecified perforation of tympanic membrane, unspecified ear H72.91 Unspecified perforation of tympanic membrane, right ear H72.92 Unspecified perforation of tympanic membrane, left ear H72.93 Unspecified perforation of tympanic membrane, bilateral H72.00 Central perforation of tympanic membrane, unspecified ear H72.01 Central perforation of tympanic membrane, right ear H72.02 Central perforation of tympanic membrane, left ear H72.03 Central perforation of tympanic membrane, bilateral H72.10 Attic perforation of tympanic membrane, unspecified ear H72.11 Attic perforation of tympanic membrane, right ear H72.12 Attic perforation of tympanic membrane, left ear H72.13 Attic perforation of tympanic membrane, bilateral H72.2X1 Other marginal perforations of tympanic membrane, right ear H72.2X2 Other marginal perforations of tympanic membrane, left ear H72.2X3 Other marginal perforations of tympanic membrane, bilateral H72.2X9 Other marginal perforations of tympanic membrane, unspecified ear H Multiple perforations of tympanic membrane, right ear H Multiple perforations of tympanic membrane, left ear H Multiple perforations of tympanic membrane, bilateral H Multiple perforations of tympanic membrane, unspecified ear Coding and Billing for Audiology and Speech-Language Pathology

186 ICD-9-CM ICD-9-CM Description Code Total perforation of tympanic membrane Atrophic flaccid tympanic membrane Healed perforation of ear drum Atrophic nonflaccid tympanic membrane Unspecified disorder of tympanic membrane Tympanosclerosis, unspecified as to involvement Tympanosclerosis involving tympanic membrane only Tympanosclerosis involving tympanic membrane and ear ossicles Tympanosclerosis involving tympanic membrane, ear ossicles, and middle ear Tympanosclerosis involving other combination of structures Adhesive middle ear disease, unspecified as to involvement ICD-10-CM ICD-10-CM Description Code H Total perforations of tympanic membrane, right ear H Total perforations of tympanic membrane, left ear H Total perforations of tympanic membrane, bilateral H Total perforations of tympanic membrane, unspecified ear H Atrophic flaccid tympanic membrane, right ear H Atrophic flaccid tympanic membrane, left ear H Atrophic flaccid tympanic membrane, bilateral H Atrophic flaccid tympanic membrane, unspecified ear H Atrophic nonflaccid tympanic membrane, right ear H Atrophic nonflaccid tympanic membrane, left ear H Atrophic nonflaccid tympanic membrane, bilateral H Atrophic nonflaccid tympanic membrane, unspecified ear H73.90 Unspecified disorder of tympanic membrane, unspecified ear H73.91 Unspecified disorder of tympanic membrane, right ear H73.92 Unspecified disorder of tympanic membrane, left ear H73.93 Unspecified disorder of tympanic membrane, bilateral H74.01 Tympanosclerosis, right ear H74.02 Tympanosclerosis, left ear H74.03 Tympanosclerosis, bilateral H74.09 Tympanosclerosis, unspecified ear H74.01 Tympanosclerosis, right ear H74.02 Tympanosclerosis, left ear H74.03 Tympanosclerosis, bilateral H74.09 Tympanosclerosis, unspecified ear H74.01 Tympanosclerosis, right ear H74.02 Tympanosclerosis, left ear H74.03 Tympanosclerosis, bilateral H74.09 Tympanosclerosis, unspecified ear H74.01 Tympanosclerosis, right ear H74.02 Tympanosclerosis, left ear H74.03 Tympanosclerosis, bilateral H74.09 Tympanosclerosis, unspecified ear H74.01 Tympanosclerosis, right ear H74.02 Tympanosclerosis, left ear H74.03 Tympanosclerosis, bilateral H74.09 Tympanosclerosis, unspecified ear H74.11 Adhesive right middle ear disease H74.12 Adhesive left middle ear disease H74.13 Adhesive middle ear disease, bilateral H74.19 Adhesive middle ear disease, unspecified ear Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 181

187 Appendix & Resources ICD-9-CM Code ICD-9-CM Description ICD-10-CM Code ICD-10-CM Description Adhesions of drum head to incus H74.11 Adhesive right middle ear disease H74.12 Adhesive left middle ear disease H74.13 Adhesive middle ear disease, bilateral H74.19 Adhesive middle ear disease, unspecified ear Adhesions of drum head to stapes H74.11 Adhesive right middle ear disease H74.12 Adhesive left middle ear disease H74.13 Adhesive middle ear disease, bilateral H74.19 Adhesive middle ear disease, unspecified ear Adhesions of drum head to H74.11 Adhesive right middle ear disease promontorium H74.12 Adhesive left middle ear disease H74.13 Adhesive middle ear disease, bilateral H74.19 Adhesive middle ear disease, unspecified ear Other adhesions and H74.11 Adhesive right middle ear disease combinations H74.12 Adhesive left middle ear disease H74.13 Adhesive middle ear disease, bilateral H74.19 Adhesive middle ear disease, unspecified ear Impaired mobility of malleus H Ankylosis of ear ossicles, right ear Ankylosis of malleus H Ankylosis of ear ossicles, left ear H Ankylosis of ear ossicles, bilateral H Ankylosis of ear ossicles, unspecified ear Impaired mobility of other ear H Ankylosis of ear ossicles, right ear ossicles H Ankylosis of ear ossicles, left ear Ankylosis of ear ossicles, except malleus H Ankylosis of ear ossicles, bilateral H Ankylosis of ear ossicles, unspecified ear Discontinuity or dislocation of ear ossicles Partial loss or necrosis of ear ossicles H74.20 Discontinuity and dislocation of ear ossicles, unspecified ear H74.21 Discontinuity and dislocation of right ear ossicles H74.22 Discontinuity and dislocation of left ear ossicles H74.23 Discontinuity and dislocation of ear ossicles, bilateral H Partial loss of ear ossicles, right ear H Partial loss of ear ossicles, left ear H Partial loss of ear ossicles, bilateral H Partial loss of ear ossicles, unspecified ear Cholesteatoma, unspecified H71.90 Unspecified cholesteatoma, unspecified ear H71.91 Unspecified cholesteatoma, right ear H71.92 Unspecified cholesteatoma, left ear H71.93 Unspecified cholesteatoma, bilateral Cholesteatoma of attic H71.00 Cholesteatoma of attic, unspecified ear H71.01 Cholesteatoma of attic, right ear H71.02 Cholesteatoma of attic, left ear H71.03 Cholesteatoma of attic, bilateral Cholesteatoma of middle ear H71.10 Cholesteatoma of tympanum, unspecified ear H71.11 Cholesteatoma of tympanum, right ear H71.12 Cholesteatoma of tympanum, left ear H71.13 Cholesteatoma of tympanum, bilateral Coding and Billing for Audiology and Speech-Language Pathology

188 ICD-9-CM ICD-9-CM Description Code Cholesteatoma of middle ear and mastoid ICD-10-CM ICD-10-CM Description Code H71.20 Cholesteatoma of mastoid, unspecified ear H71.21 Cholesteatoma of mastoid, right ear H71.22 Cholesteatoma of mastoid, left ear H71.23 Cholesteatoma of mastoid, bilateral Diffuse cholesteatosis H71.30 Diffuse cholesteatosis, unspecified ear H71.31 Diffuse cholesteatosis, right ear H71.32 Diffuse cholesteatosis, left ear H71.33 Diffuse cholesteatosis, bilateral Cholesterin granuloma H74.8X1 Other specified disorders of right middle ear and mastoid H74.8X2 Other specified disorders of left middle ear and mastoid H74.8X3 Other specified disorders of middle ear and mastoid, bilateral H74.8X9 Other specified disorders of middle ear and mastoid, unspecified ear Retained foreign body of H74.8X1 Other specified disorders of right middle ear and mastoid middle ear H74.8X2 Other specified disorders of left middle ear and mastoid H74.8X3 Other specified disorders of middle ear and mastoid, bilateral H74.8X9 Other specified disorders of middle ear and mastoid, unspecified ear Other (Other disorders of middle H74.8X1 Other specified disorders of right middle ear and mastoid ear and mastoid) H74.8X2 Other specified disorders of left middle ear and mastoid H74.8X3 Other specified disorders of middle ear and mastoid, bilateral H74.8X9 Other specified disorders of middle ear and mastoid, unspecified ear Unspecified disorder of middle ear and mastoid Ménière s disease, unspecified Ménière s disease (active) Active Ménière s disease, cochleovestibular H74.90 Unspecified disorder of middle ear and mastoid, unspecified ear H74.91 Unspecified disorder of right middle ear and mastoid H74.92 Unspecified disorder of left middle ear and mastoid H74.93 Unspecified disorder of middle ear and mastoid, bilateral H81.01 Ménière s disease, right ear H81.02 Ménière s disease, left ear H81.03 Ménière s disease, bilateral H81.09 Ménière s disease, unspecified ear H81.01 Ménière s disease, right ear H81.02 Ménière s disease, left ear H81.03 Ménière s disease, bilateral H81.09 Ménière s disease, unspecified ear Active Ménière s disease, cochlear H81.01 Ménière s disease, right ear H81.02 Ménière s disease, left ear H81.03 Ménière s disease, bilateral H81.09 Ménière s disease, unspecified ear Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 183

189 Appendix & Resources ICD-9-CM ICD-9-CM Description Code Active Ménière s disease, vestibular Inactive Ménière s disease Ménière s disease in remission ICD-10-CM ICD-10-CM Description Code H81.01 Ménière s disease, right ear H81.02 Ménière s disease, left ear H81.03 Ménière s disease, bilateral H81.09 Ménière s disease, unspecified ear H81.01 Ménière s disease, right ear H81.02 Ménière s disease, left ear H81.03 Ménière s disease, bilateral H81.09 Ménière s disease, unspecified ear Peripheral vertigo, unspecified H Other peripheral vertigo, right ear H Other peripheral vertigo, left ear H Other peripheral vertigo, bilateral H Other peripheral vertigo, unspecified ear Benign paroxysmal positional H81.10 Benign paroxysmal vertigo, unspecified ear vertigo H81.11 Benign paroxysmal vertigo, right ear Benign paroxysmal positional nystagmus H81.12 Benign paroxysmal vertigo, left ear H81.13 Benign paroxysmal vertigo, bilateral Vestibular neuronitis H81.20 Vestibular neuronitis, unspecified ear Acute (and recurrent) peripheral H81.21 Vestibular neuronitis, right ear vestibulopathy H81.22 Vestibular neuronitis, left ear H81.23 Vestibular neuronitis, bilateral Other (Other and unspecified H Aural vertigo, right ear vertigo) H Aural vertigo, left ear Aural vertigo Otogenic vertigo H Aural vertigo, bilateral H Aural vertigo, unspecified ear Vertigo of central origin H81.41 Vertigo of central origin, right ear Central positional nystagmus H81.42 Vertigo of central origin, left ear Malignant positional vertigo H81.43 Vertigo of central origin, bilateral H81.49 Vertigo of central origin, unspecified ear Serous labyrinthitis H83.01 Labyrinthitis, right ear Diffuse labyrinthitis H83.02 Labyrinthitis, left ear H83.03 Labyrinthitis, bilateral H83.09 Labyrinthitis, unspecified ear Labyrinthitis, unspecified H83.01 Labyrinthitis, right ear H83.02 Labyrinthitis, left ear H83.03 Labyrinthitis, bilateral H83.09 Labyrinthitis, unspecified ear Circumscribed labyrinthitis H83.01 Labyrinthitis, right ear Focal labyrinthitis H83.02 Labyrinthitis, left ear H83.03 Labyrinthitis, bilateral H83.09 Labyrinthitis, unspecified ear Suppurative labyrinthitis H83.01 Labyrinthitis, right ear H83.02 Labyrinthitis, left ear H83.03 Labyrinthitis, bilateral H83.09 Labyrinthitis, unspecified ear Coding and Billing for Audiology and Speech-Language Pathology

190 ICD-9-CM Code ICD-9-CM Description ICD-10-CM Code ICD-10-CM Description Toxic labyrinthitis H83.01 Labyrinthitis, right ear H83.02 Labyrinthitis, left ear H83.03 Labyrinthitis, bilateral H83.09 Labyrinthitis, unspecified ear Viral labyrinthitis H83.01 Labyrinthitis, right ear H83.02 Labyrinthitis, left ear H83.03 Labyrinthitis, bilateral H83.09 Labyrinthitis, unspecified ear Labyrinthine fistula, unspecified H83.11 Labyrinthine fistula, right ear H83.12 Labyrinthine fistula, left ear H83.13 Labyrinthine fistula, bilateral H83.19 Labyrinthine fistula, unspecified ear Round window fistula H83.11 Labyrinthine fistula, right ear H83.12 Labyrinthine fistula, left ear H83.13 Labyrinthine fistula, bilateral H83.19 Labyrinthine fistula, unspecified ear Oval window fistula H83.11 Labyrinthine fistula, right ear H83.12 Labyrinthine fistula, left ear H83.13 Labyrinthine fistula, bilateral H83.19 Labyrinthine fistula, unspecified ear Semicircular canal fistula H83.11 Labyrinthine fistula, right ear H83.12 Labyrinthine fistula, left ear H83.13 Labyrinthine fistula, bilateral H83.19 Labyrinthine fistula, unspecified ear Labyrinthine fistula of combined H83.11 Labyrinthine fistula, right ear sites H83.12 Labyrinthine fistula, left ear H83.13 Labyrinthine fistula, bilateral H83.19 Labyrinthine fistula, unspecified ear Labyrinthine dysfunction, H83.2X1 Labyrinthine dysfunction, right ear unspecified H83.2X2 Labyrinthine dysfunction, left ear H83.2X3 Labyrinthine dysfunction, bilateral H83.2X9 Labyrinthine dysfunction, unspecified ear Hyperactive labyrinth, unilateral H83.2X1 Labyrinthine dysfunction, right ear H83.2X2 Labyrinthine dysfunction, left ear H83.2X9 Labyrinthine dysfunction, unspecified ear Hyperactive labyrinth, bilateral H83.2X3 Labyrinthine dysfunction, bilateral H83.2X9 Labyrinthine dysfunction, unspecified ear Hypoactive labyrinth, unilateral H83.2X1 Labyrinthine dysfunction, right ear H83.2X2 Labyrinthine dysfunction, left ear H83.2X9 Labyrinthine dysfunction, unspecified ear Hypoactive labyrinth, bilateral H83.2X3 Labyrinthine dysfunction, bilateral H83.2X9 Labyrinthine dysfunction, unspecified ear Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 185

191 Appendix & Resources ICD-9-CM ICD-9-CM Description ICD-10-CM ICD-10-CM Description Code Code Loss of labyrinthine reactivity, H83.2X1 Labyrinthine dysfunction, right ear unilateral H83.2X2 Labyrinthine dysfunction, left ear H83.2X9 Labyrinthine dysfunction, unspecified ear Loss of labyrinthine reactivity, H83.2X3 Labyrinthine dysfunction, bilateral bilateral H83.2X9 Labyrinthine dysfunction, unspecified ear Other forms and combinations H83.2X1 Labyrinthine dysfunction, right ear (Labyrinthine dysfunction) H83.2X2 Labyrinthine dysfunction, left ear H83.2X3 Labyrinthine dysfunction, bilateral H83.2X9 Labyrinthine dysfunction, unspecified ear Other disorders of labyrinth H81.8X1 Other disorders of vestibular function, right ear H81.8X2 Other disorders of vestibular function, left ear H81.8X3 Other disorders of vestibular function, bilateral H81.8X9 Other disorders of vestibular function, unspecified ear H82.1 Vertiginous syndromes in diseases classified elsewhere, right ear H82.2 Vertiginous syndromes in diseases classified elsewhere, left ear H82.3 Vertiginous syndromes in diseases classified elsewhere, bilateral H82.9 Vertiginous syndromes in diseases classified elsewhere, unspecified ear H83.8X1 Other specified diseases of right inner ear H83.8X2 Other specified diseases of left inner ear H83.8X3 Other specified diseases of inner ear, bilateral H83.8X9 Other specified diseases of inner ear, unspecified ear Unspecified vertiginous syndromes and labyrinthine disorders Otosclerosis involving oval window, nonobliterative H81.90 Unspecified disorder of vestibular function, unspecified ear H81.91 Unspecified disorder of vestibular function, right ear H81.92 Unspecified disorder of vestibular function, left ear H81.93 Unspecified disorder of vestibular function, bilateral H83.90 Unspecified disease of inner ear, unspecified ear H83.91 Unspecified disease of right inner ear H83.92 Unspecified disease of left inner ear H83.93 Unspecified disease of inner ear, bilateral H80.00 Otosclerosis involving oval window, nonobliterative, unspecified ear H80.01 Otosclerosis involving oval window, nonobliterative, right ear H80.02 Otosclerosis involving oval window, nonobliterative, left ear H80.03 Otosclerosis involving oval window, nonobliterative, bilateral Coding and Billing for Audiology and Speech-Language Pathology

192 ICD-9-CM ICD-9-CM Description Code Otosclerosis involving oval window, obliterative ICD-10-CM ICD-10-CM Description Code H80.10 Otosclerosis involving oval window, obliterative, unspecified ear H80.11 Otosclerosis involving oval window, obliterative, right ear H80.12 Otosclerosis involving oval window, obliterative, left ear H80.13 Otosclerosis involving oval window, obliterative, bilateral Cochlear otosclerosis H80.20 Cochlear otosclerosis, unspecified ear H80.21 Cochlear otosclerosis, right ear H80.22 Cochlear otosclerosis, left ear H80.23 Cochlear otosclerosis, bilateral Other otosclerosis H80.80 Other otosclerosis, unspecified ear H80.81 Other otosclerosis, right ear H80.82 Other otosclerosis, left ear H80.83 Other otosclerosis, bilateral Otosclerosis, unspecified H80.90 Unspecified otosclerosis, unspecified ear H80.91 Unspecified otosclerosis, right ear H80.92 Unspecified otosclerosis, left ear H80.93 Unspecified otosclerosis, bilateral Degenerative and vascular disorders, unspecified H Unspecified degenerative and vascular disorders of right ear H Unspecified degenerative and vascular disorders of left ear H Unspecified degenerative and vascular disorders of ear, bilateral H Unspecified degenerative and vascular disorders of unspecified ear Presbyacusis H91.10 Presbycusis, unspecified ear H91.11 Presbycusis, right ear H91.12 Presbycusis, left ear H91.13 Presbycusis, bilateral Transient ischemic deafness H Transient ischemic deafness, right ear H Transient ischemic deafness, left ear H Transient ischemic deafness, bilateral H Transient ischemic deafness, unspecified ear Noise effects on inner ear, H83.3X1 Noise effects on right inner ear unspecified H83.3X2 Noise effects on left inner ear H83.3X3 Noise effects on inner ear, bilateral H83.3X9 Noise effects on inner ear, unspecified ear Acoustic trauma (explosive) to ear H91.8X1 Other specified hearing loss, right ear Otitic blast injury H91.8X2 Other specified hearing loss, left ear H91.8X3 Other specified hearing loss, bilateral H91.8X9 Other specified hearing loss, unspecified ear Noise-induced hearing loss H83.3X1 Noise effects on right inner ear H83.3X2 Noise effects on left inner ear H83.3X3 Noise effects on inner ear, bilateral H83.3X9 Noise effects on inner ear, unspecified ear Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 187

193 Appendix & Resources ICD-9-CM Code ICD-9-CM Description ICD-10-CM Code ICD-10-CM Description Sudden hearing loss, unspecified H91.20 Sudden idiopathic hearing loss, unspecified ear H91.21 Sudden idiopathic hearing loss, right ear H91.22 Sudden idiopathic hearing loss, left ear H91.23 Sudden idiopathic hearing loss, bilateral Tinnitus, unspecified H93.11 Tinnitus, right ear H93.12 Tinnitus, left ear H93.13 Tinnitus, bilateral H93.19 Tinnitus, unspecified ear Subjective tinnitus H93.11 Tinnitus, right ear H93.12 Tinnitus, left ear H93.13 Tinnitus, bilateral H93.19 Tinnitus, unspecified ear Objective tinnitus H93.11 Tinnitus, right ear H93.12 Tinnitus, left ear H93.13 Tinnitus, bilateral H93.19 Tinnitus, unspecified ear Abnormal auditory perception, H Other abnormal auditory perceptions, right ear unspecified H Other abnormal auditory perceptions, left ear H Other abnormal auditory perceptions, bilateral H Other abnormal auditory perceptions, unspecified ear Diplacusis H Diplacusis, right ear H Diplacusis, left ear H Diplacusis, bilateral H Diplacusis, unspecified ear Hyperacusis H Hyperacusis, right ear H Hyperacusis, left ear H Hyperacusis, bilateral H Hyperacusis, unspecified ear Impairment of auditory H Other abnormal auditory perceptions, unspecified ear discrimination Recruitment H Auditory recruitment, right ear H Auditory recruitment, left ear H Auditory recruitment, bilateral H Auditory recruitment, unspecified ear Acquired auditory processing H Other abnormal auditory perceptions, unspecified ear disorder Disorders of acoustic nerve H93.3X1 Disorders of right acoustic nerve H93.3X2 Disorders of left acoustic nerve H93.3X3 Disorders of bilateral acoustic nerves H93.3X9 Disorders of unspecified acoustic nerve Unspecified otorrhea H92.10 Otorrhea, unspecified ear H92.11 Otorrhea, right ear H92.12 Otorrhea, left ear H92.13 Otorrhea, bilateral Cerebrospinal fluid otorrhea G96.0 Cerebrospinal fluid leak Coding and Billing for Audiology and Speech-Language Pathology

194 ICD-9-CM Code ICD-9-CM Description ICD-10-CM Code ICD-10-CM Description Other otorrhea H92.20 Otorrhagia, unspecified ear H92.21 Otorrhagia, right ear H92.22 Otorrhagia, left ear H92.23 Otorrhagia, bilateral Unspecified otalgia H92.01 Otalgia, right ear H92.02 Otalgia, left ear H92.03 Otalgia, bilateral H92.09 Otalgia unspecified ear Otogenic pain H92.09 Otalgia, unspecified ear Conductive hearing loss, H90.2 Conductive hearing loss, unspecified unspecified Conductive hearing loss, H90.0 Conductive hearing loss, bilateral external ear H90.11 Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.12 Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side H90.2 Conductive hearing loss, unspecified Conductive hearing loss, tympanic H90.0 Conductive hearing loss, bilateral membrane H90.11 Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.12 Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side H90.2 Conductive hearing loss, unspecified Conductive hearing loss, H90.0 Conductive hearing loss, bilateral middle ear H90.11 Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.12 Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side H90.2 Conductive hearing loss, unspecified Conductive hearing loss, inner ear H90.0 Conductive hearing loss, bilateral H90.11 Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.12 Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side H90.2 Conductive hearing loss, unspecified Conductive hearing loss, unilateral H90.11 Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.12 Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side Conductive hearing loss, bilateral H90.0 Conductive hearing loss, bilateral Conductive hearing loss of H90.0 Conductive hearing loss, bilateral combined types H90.11 Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.12 Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side H90.2 Conductive hearing loss, unspecified Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 189

195 Appendix & Resources ICD-9-CM ICD-9-CM Description Code Sensorineural hearing loss, unspecified ICD-10-CM ICD-10-CM Description Code H90.5 Unspecified sensorineural hearing loss Sensory hearing loss, bilateral H90.3 Sensorineural hearing loss, bilateral Neural hearing loss, bilateral H90.3 Sensorineural hearing loss, bilateral Neural hearing loss, unilateral H90.41 Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.42 Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side Central hearing loss H90.3 Sensorineural hearing loss, bilateral H90.41 Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.42 Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side H90.5 Unspecified sensorineural hearing loss Sensorineural hearing loss, unilateral Sensorineural hearing loss, asymmetrical H90.41 Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.42 Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side H90.5 Unspecified sensorineural hearing loss Sensory hearing loss, unilateral H90.41 Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.42 Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side Sensorineural hearing loss, H90.3 Sensorineural hearing loss, bilateral bilateral Mixed hearing loss, unspecified H90.8 Mixed conductive and sensorineural hearing loss, unspecified Mixed hearing loss, unilateral H90.71 Mixed conductive and sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.72 Mixed conductive and sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side Mixed hearing loss, bilateral H90.6 Mixed conductive and sensorineural hearing loss, bilateral Deaf nonspeaking, not elsewhere H91.3 Deaf nonspeaking, not elsewhere classified classifiable Other specified forms of hearing H91.01 Ototoxic hearing loss, right ear loss H91.02 Ototoxic hearing loss, left ear H91.03 Ototoxic hearing loss, bilateral H91.09 Ototoxic hearing loss, unspecified ear H91.8X1 Other specified hearing loss, right ear H91.8X2 Other specified hearing loss, left ear H91.8X3 Other specified hearing loss, bilateral H91.8X9 Other specified hearing loss, unspecified ear Coding and Billing for Audiology and Speech-Language Pathology

196 ICD-9-CM ICD-9-CM Description Code Unspecified hearing loss Deafness NOS Unspecified anomaly of ear with impairment of hearing Absence of external ear (Anomalies of ear causing impairment of hearing) Other anomalies of external ear with impairment of hearing Anomalies of middle ear, except ossicles (Anomalies of ear causing impairment of hearing) Anomalies of ear ossicles (Anomalies of ear causing impairment of hearing) Anomalies of inner ear (Anomalies of ear causing impairment of hearing) Other (Anomalies of ear causing impairment of hearing) Absence of ear, congenital ICD-10-CM ICD-10-CM Description Code H91.90 Unspecified hearing loss, unspecified ear H91.91 Unspecified hearing loss, right ear H91.92 Unspecified hearing loss, left ear H91.93 Unspecified hearing loss, bilateral Q16.9 Congenital malformation of ear causing impairment of hearing, unspecified Congenital absence of ear NOS Q16.0 Congenital absence of (ear) auricle (Congenital malformations of ear causing impairment of hearing) Q16.1 Congenital absence, atresia and stricture of auditory canal (external) Congenital atresia or stricture of osseous meatus Q16.4 Other congenital malformations of middle ear (Congenital malformations of ear causing impairment of hearing) Q16.3 Congenital malformation of ear ossicles (Congenital malformations of ear causing impairment of hearing) Congenital fusion of ear ossicles Q16.5 Congenital malformation of inner ear (Congenital malformations of ear causing impairment of hearing) Congenital anomaly of membranous labyrinth Congenital anomaly of organ of Corti Q16.9 Congenital malformation of ear causing impairment of hearing, unspecified Congenital absence of ear NOS Accessory auricle Q17.0 Accessory auricle Absence of ear lobe, congenital Q17.8 Other specified congenital malformations of ear Congenital absence of lobe of ear Macrotia Q17.1 Macrotia Microtia Q17.2 Microtia Specified anomalies of Eustachian tube Absence of Eustachian tube Q16.2 Absence of eustachian tube Other (Other specified anomalies of ear) Bat ear Darwin s tubercle Pointed ear Prominence of auricle Q17.3 Other misshapen ear Pointed ear Q17.4 Misplaced ear Low-set ears Excludes1: cervical auricle (Q18.2) Q17.5 Prominent ear Bat ear Q17.8 Other specified congenital malformations of ear Congenital absence of lobe of ear Unspecified anomaly of ear Q17.9 Congenital malformation of ear, unspecified Congenital anomaly of ear NOS Dizziness and giddiness R42 Dizziness and giddiness Light-headedness Vertigo NOS Excludes1: vertiginous syndromes (H81.-), vertigo from infrasound (T75.23) Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 191

197 Appendix & Resources ICD-9-CM ICD-9-CM Description Code Abnormal function study, unspecified (Brain and central nervous system) Other (Brain and central nervous system) Abnormal brain scan Abnormal visually evoked potential (Peripheral nervous system and special senses) Abnormal auditory function studies (Peripheral nervous system and special senses) Abnormal vestibular function studies (Peripheral nervous system and special senses) V13.64 Personal history of (corrected) congenital malformation of eye, ear, face and neck Corrected cleft lip and palate ICD-10-CM ICD-10-CM Description Code R94.09 Abnormal results of other function studies of central nervous system (Abnormal results of function studies of central nervous system) R94.02 Abnormal brain scan (Abnormal results of function studies of central nervous system) R94.09 Abnormal results of other function studies of central nervous system (Abnormal results of function studies of central nervous system) R Abnormal visually evoked potential [VEP] (Abnormal results of function studies of peripheral nervous system and special senses) R Abnormal auditory function study (Abnormal results of function studies of peripheral nervous system and special senses) R Abnormal vestibular function study (Abnormal results of function studies of peripheral nervous system and special senses) Z Personal history of (corrected) congenital malformations of ear Z Personal history of (corrected) cleft lip and palate Z Personal history of (corrected) congenital malformations of face and neck V15.52 History of traumatic brain injury Z Personal history of traumatic brain injury V40.1 Problems with communication Z86.59 Personal history of other mental and behavioral disorders (including speech) V44.0 Tracheostomy Z93.0 Tracheostomy status V49.85 Dual-sensory impairment Z73.82 Dual sensory impairment V52.8 Fitting and adjustment of prosthetic device and implant, Other specified prosthetic device Z44.8 Encounter for fitting and adjustment of other external prosthetic devices V52.9 Unspecified prosthetic device Z44.9 Encounter for fitting and adjustment of unspecified external prosthetic device V53.2 Fitting and adjustment of other Z46.1 Encounter for fitting and adjustment of hearing aid device, hearing aid V57.3 Speech-language therapy Z51.89 Encounter for other specified aftercare V72.11 Encounter for hearing exam following failed hearing screening V72.12 Encounter for hearing conservation and treatment V80.01 Special screening for neurological, eye, and ear diseases, traumatic brain injury Z Encounter for hearing examination following failed hearing screening Z01.12 Encounter for hearing conservation and treatment Z Encounter for screening for traumatic brain injury Coding and Billing for Audiology and Speech-Language Pathology

198 Speech-Language Pathology Disclaimer: This product is NOT comprehensive and consists only of codes commonly related to speech-language pathology services. Mappings are only to ICD-10-CM codes, not ICD-10-PCS. Every effort was made to accurately map codes using detailed analysis. Keep in mind, however, that while many codes in ICD-9-CM map directly to codes in ICD-10-CM, in some cases, additional clinical analysis may be required to determine which code or codes should be selected for your situation. Always review mapping results before applying them. ICD-9-CM ICD-9-CM Description Code Presenile dementia, uncomplicated ICD-10-CM ICD-10-CM Description Code F03.90 Unspecified dementia without behavioral disturbance Vascular dementia, uncomplicated F01.50 Vascular dementia without behavioral disturbance Vascular dementia with delirium F01.51 Vascular dementia with behavioral disturbance Dementia in conditions classified elsewhere without behavioral disturbance Dementia in conditions classified elsewhere Autistic disorder (current or active state) Other specified pervasive developmental disorders (current or active state) Aspergers s disorder Unspecified pervasive developmental disorder (current or active state) F02.80 Dementia in other diseases classified elsewhere without behavioral disturbance F02.81 Dementia in other diseases classified elsewhere with behavioral disturbance F84.0 Autistic disorder Excludes1: Asperger s syndrome (F84.5) F84.5 Asperger s syndrome F84.8 Other pervasive developmental disorders F84.9 Pervasive developmental disorder, unspecified Adult onset fluency disorder F98.5 Adult onset fluency disorder Excludes1: childhood onset fluency disorder (F80.81), dysphasia (R47.02), fluency disorder in conditions classified elsewhere (R47.82), fluency disorder (stuttering) following cerebrovascular disease (I69. with final characters -23), tic disorders (F95.-) Pseudobulbar affect Involuntary emotional expression disorder Other specified nonpsychotic mental disorders following organic brain damage Mild memory disturbance Other focal (partial) organic psychosyndromes Postencephalitic syndrome Excludes: memory loss of unknown cause (780.93) F48.2 Pseudobulbar affect Involuntary emotional expression disorder Code first underlying cause, if known, such as: amyotrophic lateral sclerosis (G12.21), multiple sclerosis (G35), sequelae of cerebrovascular disease (I69.-), sequelae of traumatic intracranial injury (S06.-) F07.89 Other personality and behavioral disorders due to known physiological condition Postencephalitic syndrome Right hemispheric organic affective disorder Selective mutism F94.0 Selective mutism Elective mutism Excludes2: pervasive developmental disorders (F84.-), schizophrenia (F20.-), specific developmental disorders of speech and language (F80.-), transient mutism as part of separation anxiety in young children (F93.0) Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 193

199 Appendix & Resources ICD-9-CM ICD-9-CM Description Code Without mention of hyperactivity (Attention deficit disorder) With hyperactivity (Attention deficit disorder) ICD-10-CM ICD-10-CM Description Code F90.9 Attention-deficit hyperactivity disorder, unspecified type F90.0 Attention-deficit hyperactivity disorder, predominantly inattentive type F90.1 Attention-deficit hyperactivity disorder, predominantly hyperactive type F90.2 Attention-deficit hyperactivity disorder, combined type F90.8 Attention-deficit hyperactivity disorder, other type F90.9 Attention-deficit hyperactivity disorder, unspecified type Reading disorder, unspecified F81.0 Specific reading disorder Backward reading Developmental dyslexia Specific reading retardation Excludes1: alexia NOS (R48.0), dyslexia NOS (R48.0) Alexia R48.0 Dyslexia and alexia Developmental dyslexia F81.0 Specific reading disorder Backward reading Developmental dyslexia Specific reading retardation Excludes1: alexia NOS (R48.0), dyslexia NOS (R48.0) Other (specific reading disorder) Specific spelling difficulty Mathematics disorder Dyscalculia Other specific delays in development Disorder of written expression F81.81 Disorder of written expression Specific spelling disorder F81.2 Mathematics disorder Developmental acalculia Developmental arithmetical disorder Developmental Gerstmann s syndrome Excludes1: acalculia NOS (R48.8) Excludes2: arithmetical difficulties associated with a reading disorder (F81.0), arithmetical difficulties associated with a spelling disorder (F81.81), arithmetical difficulties due to inadequate teaching (Z55.8) F81.81 Disorder of written expression Specific spelling disorder F81.89 Other developmental disorders of scholastic skills Expressive language disorder (Developmental speech or language disorder) F80.1 Expressive language disorder Developmental dysphasia or aphasia, expressive type Excludes1: mixed receptive-expressive language disorder (F80.2), dysphasia and aphasia NOS (R47.-) Excludes2: acquired aphasia with epilepsy [Landau- Kleffner] (G40.80-), selective mutism (F94.0), intellectual disabilities (F70-F79), pervasive developmental disorders (F84.-) Coding and Billing for Audiology and Speech-Language Pathology

200 ICD-9-CM ICD-9-CM Description Code Mixed receptive-expressive language disorder Central auditory processing disorder Speech and language developmental delay due to hearing loss Childhood onset fluency disorder Cluttering NOS Stuttering NOS Other (developmental speech or language disorder) Developmental articulation disorder Dyslalia Phonological disorder Developmental coordination disorder Clumsiness syndrome Dyspraxia syndrome Specific motor development disorder ICD-10-CM ICD-10-CM Description Code F80.2 Mixed receptive-expressive language disorder Developmental dysphasia or aphasia, receptive type Developmental Wernicke s aphasia Excludes1: central auditory processing disorder (H93.25), dysphasia or aphasia NOS (R47.-), expressive language disorder (F80.1), expressive type dysphasia or aphasia (F80.1), word deafness (H93.25) Excludes2: acquired aphasia with epilepsy [Landau- Kleffner] (G40.80-), pervasive developmental disorders (F84.-), selective mutism (F94.0), intellectual disabilities (F70-F79) H93.25 Central auditory processing disorder Congenital auditory imperception Word deafness Excludes1: mixed receptive-expressive language disorder (F80.2) F80.4 Speech and language developmental delay due to hearing loss Code also: type of hearing loss (H90.-, H91.-) F80.81 Childhood onset fluency disorder Excludes1: adult onset fluency disorder (F98.5), fluency disorder in conditions classified elsewhere (R47.82), fluency disorder (stuttering) following cerebrovascular disease (I69. with final characters-23) F80.0 Phonological disorder Dyslalia Functional speech articulation disorder Lalling Lisping Phonological developmental disorder Speech articulation developmental disorder Excludes1: speech articulation impairment due to aphasia NOS (R47.01), speech articulation impairment due to apraxia (R48.2) Excludes2: speech articulation impairment due to hearing loss (F80.4), speech articulation impairment due to intellectual disabilities (F70-F79), speech articulation impairment with expressive language developmental disorder (F80.1), speech articulation impairment with mixed receptive expressive language developmental disorder (F80.2) F80.89 Other developmental disorders of speech and language F80.9 Developmental disorder of speech and language, unspecified Communication disorder NOS Language disorder NOS F82 Specific developmental disorder of motor function Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 195

201 Appendix & Resources ICD-9-CM Code ICD-9-CM Description ICD-10-CM Code ICD-10-CM Description Mixed developmental disorder F82 Specific developmental disorder of motor function Clumsy child syndrome Developmental coordination disorder Developmental dyspraxia Excludes1: abnormalities of gait and mobility (R26.-) lack of coordination (R27.-) Excludes2: lack of coordination secondary to intellectual disabilities (F70-F79) Other specific delays in development Unspecified delay in development Developmental disorder NOS Learning disorder NOS F88 Other disorders of psychological development Developmental agnosia F81.9 Developmental disorder of scholastic skills, unspecified Knowledge acquisition disability NOS Learning disability NOS Learning disorder NOS F89 Unspecified disorder of psychological development Developmental disorder NOS 317 Mild intellectual disabilities F70 Mild intellectual disabilities IQ level to approximately 70 Mild mental subnormality Moderate intellectual disabilities F71 Moderate intellectual disabilities IQ level to Moderate mental subnormality Severe intellectual disabilities F72 Severe intellectual disabilities IQ to Severe mental subnormality Profound intellectual disabilities F73 Profound intellectual disabilities IQ level below Profound mental subnormality 319 Unspecified intellectual disabilities F78 Other intellectual disabilities F79 Unspecified intellectual disabilities Other specified cerebral degenerations in childhood (Rett s syndrome) F84.2 Rett s syndrome Excludes1: Asperger s syndrome (F84.5) Autistic disorder (F84.0) Other childhood disintegrative disorder (F84.3) Alzheimer s disease G30.0 Alzheimer s disease with early onset G30.1 Alzheimer s disease with late onset G30.8 Other Alzheimer s disease G30.9 Alzheimer s disease, unspecified Mild cognitive impairment, so G31.84 Mild cognitive impairment, so stated stated Paralysis agitans parkinsonism or Parkinson s disease G20 Parkinson s disease Hemiparkinsonism Idiopathic parkinsonism or Parkinson s disease Paralysis agitans Parkinsonism or Parkinson s disease NOS Primary Parkinsonism or Parkinson s disease Excludes1: dementia with parkinsonism (G31.83) G21.4 Vascular parkinsonism Coding and Billing for Audiology and Speech-Language Pathology

202 ICD-9-CM Code ICD-9-CM Description ICD-10-CM Code ICD-10-CM Description Secondary parkinsonism G21.11 Neuroleptic induced parkinsonism Use additional code for adverse effect, if applicable, to identify drug (T43.3X5, T43.4X5, T43.505,T43.595) Excludes1: malignant neuroleptic syndrome (G21.0) G21.19 Other drug induced secondary parkinsonism Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5) G21.2 Secondary parkinsonism due to other external agents Code first: (T51-T65) to identify external agent G21.3 Postencephalitic parkinsonism G21.8 Other secondary parkinsonism G21.9 Secondary parkinsonism, unspecified Amyotrophic lateral sclerosis (Lou Gehrig s disease) Motor neuron disease (bulbar) (mixed type) G12.21 Amyotrophic lateral sclerosis Progressive spinal muscle atrophy 340 Multiple sclerosis G35 Multiple sclerosis Disseminated multiple sclerosis Generalized multiple sclerosis Multiple sclerosis NOS Multiple sclerosis of brain stem Multiple sclerosis of cord Diplegic (Infantile cerebral palsy) G80.1 Spastic diplegic cerebral palsy Spastic cerebral palsy NOS Hemiplegic (Infantile cerebral palsy) G80.2 Spastic hemiplegic cerebral palsy Quadriplegic (Infantile cerebral palsy) Monoplegic (Infantile cerebral palsy) Infantile hemiplegia (Infantile cerebral palsy) Other specified infantile cerebral palsy Infantile cerebral palsy, unspecified Generalized nonconvulsive epilepsy (without mention of intractable epilepsy) Other forms of epilepsy and recurrent seizures G80.0 Spastic quadriplegic cerebral palsy Congenital spastic paralysis (cerebral) G80.8 Other cerebral palsy Mixed cerebral palsy syndromes G80.2 Spastic hemiplegic cerebral palsy G80.4 Ataxic cerebral palsy G80.8 Other cerebral palsy Mixed cerebral palsy syndromes G80.9 Cerebral palsy, unspecified Bell s palsy G51.0 Bell s palsy G Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus Generalized idiopathic epilepsy and epileptic syndromes NOS G Other epilepsy, not intractable, with status epilepticus G Other epilepsy, not intractable, without status epilepticus Other epilepsy NOS Other epilepsy without intractability without status epilepticus G Other epilepsy, intractable, with status epilepticus G Other epilepsy, intractable, without status epilepticus Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 197

203 Appendix & Resources ICD-9-CM ICD-9-CM Description Code Cognitive deficits (Late effects of cerebrovascular disease) Speech and language deficits, unspecified (Late effects of cerebrovascular disease) Aphasia (Late effects of cerebrovascular disease) Dysphasia (Late effects of cerebrovascular disease) Dysarthria (Late effects of cerebrovascular disease) ICD-10-CM ICD-10-CM Description Code I69.01 Cognitive deficits following nontraumatic subarachnoid hemorrhage I69.11 Cognitive deficits following nontraumatic intracerebral hemorrhage I69.21 Cognitive deficits following other nontraumatic intracranial hemorrhage I69.31 Cognitive deficits following cerebral infarction I69.81 Cognitive deficits following other cerebrovascular disease I69.91 Cognitive deficits following unspecified cerebrovascular disease I Other speech and language deficits following unspecified cerebrovascular disease I Aphasia following nontraumatic subarachnoid hemorrhage I Aphasia following nontraumatic intracerebral hemorrhage I Aphasia following other nontraumatic intracranial hemorrhage I Aphasia following cerebral infarction I Aphasia following other cerebrovascular disease I Aphasia following unspecified cerebrovascular disease I Dysphasia following nontraumatic subarachnoid hemorrhage I Dysphasia following nontraumatic intracerebral hemorrhage I Dysphasia following other nontraumatic intracranial hemorrhage I Dysphasia following cerebral infarction I Dysphasia following other cerebrovascular disease I Dysphasia following unspecified cerebrovascular disease I Dysarthria following nontraumatic subarachnoid hemorrhage I Dysarthria following nontraumatic intracerebral hemorrhage I Dysarthria following other nontraumatic intracranial hemorrhage I Dysarthria following cerebral infarction I Dysarthria following other cerebrovascular disease I Dysarthria following unspecified cerebrovascular disease Coding and Billing for Audiology and Speech-Language Pathology

204 ICD-9-CM ICD-9-CM Description Code Fluency disorder (Late effects of cerebrovascular disease) Stuttering due to late effect of CVA Other speech and language deficits (Late effects of cerebrovascular disease) Apraxia (Other late effects of cerebrovascular disease) ICD-10-CM ICD-10-CM Description Code I Fluency disorder following nontraumatic subarachnoid hemorrhage Stuttering following nontraumatic subarachnoid hemorrhage I Fluency disorder following nontraumatic intracerebral hemorrhage Stuttering following nontraumatic subarachnoid hemorrhage I Fluency disorder following other nontraumatic intracranial hemorrhage Stuttering following nontraumatic subarachnoid hemorrhage I Fluency disorder following cerebral infarction Stuttering following nontraumatic subarachnoid hemorrhage I Fluency disorder following other cerebrovascular disease Stuttering following nontraumatic subarachnoid hemorrhage I Fluency disorder following unspecified cerebrovascular disease Stuttering following nontraumatic subarachnoid hemorrhage I Other speech and language deficits following nontraumatic subarachnoid hemorrhage I Other speech and language deficits following nontraumatic intracerebral hemorrhage I Other speech and language deficits following other nontraumatic intracranial hemorrhage I Other speech and language deficits following cerebral infarction I Other speech and language deficits following other cerebrovascular disease I Other speech and language deficits following unspecified cerebrovascular disease I Apraxia following nontraumatic subarachnoid hemorrhage I Apraxia following nontraumatic intracerebral hemorrhage I Apraxia following other nontraumatic intracranial hemorrhage I Apraxia following cerebral infarction I Apraxia following other cerebrovascular disease I Apraxia following unspecified cerebrovascular disease Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 199

205 Appendix & Resources ICD-9-CM ICD-9-CM Description Code Dysphagia (Other late effects of cerebrovascular disease) Facial weakness (Other late effects of cerebrovascular disease) Facial droop Ataxia (Other late effects of cerebrovascular disease) Vertigo (Other late effects of cerebrovascular disease) ICD-10-CM ICD-10-CM Description Code I Dysphagia following nontraumatic subarachnoid hemorrhage I Dysphagia following nontraumatic intracerebral hemorrhage I Dysphagia following other nontraumatic intracranial hemorrhage I Dysphagia following cerebral infarction I Dysphagia following other cerebrovascular disease I Dysphagia following unspecified cerebrovascular disease I Facial weakness following nontraumatic subarachnoid hemorrhage Facial droop following nontraumatic subarachnoid hemorrhage I Facial weakness following nontraumatic intracerebral hemorrhage Facial droop following nontraumatic intracerebral hemorrhage I Facial weakness following other nontraumatic intracranial hemorrhage Facial droop following other nontraumatic intracranial hemorrhage I Facial weakness following cerebral infarction Facial droop following cerebral infarction I Facial weakness following other cerebrovascular disease Facial droop following other cerebrovascular disease I Facial weakness following unspecified cerebrovascular disease Facial droop following unspecified cerebrovascular disease I Ataxia following nontraumatic subarachnoid hemorrhage I Ataxia following nontraumatic intracerebral hemorrhage I Ataxia following other nontraumatic intracranial hemorrhage I Ataxia following cerebral infarction I Ataxia following other cerebrovascular disease I Ataxia following unspecified cerebrovascular disease I Other sequelae following unspecified cerebrovascular disease Alteration in sensation following unspecified cerebrovascular disease Disturbance of vision following unspecified cerebrovascular disease Use additional code to identify the sequelae Coding and Billing for Audiology and Speech-Language Pathology

206 ICD-9-CM ICD-9-CM Description Code Other late effects of cerebrovascular disease Unspecified late effects of cerebrovascular disease Paralysis, unspecified (Paralysis of vocal cords or larynx) Unilateral, partial (Paralysis of vocal cords or larynx) Unilateral, complete (Paralysis of vocal cords or larynx) Bilateral, partial (Paralysis of vocal cords or larynx) Bilateral, complete (Paralysis of vocal cords or larynx) ICD-10-CM ICD-10-CM Description Code I Other sequelae following nontraumatic subarachnoid hemorrhage Alterations of sensation following nontraumatic subarachnoid hemorrhage Disturbance of vision following nontraumatic subarachnoid hemorrhage I Other sequelae of nontraumatic intracerebral hemorrhage Alteration of sensations following nontraumatic intracerebral hemorrhage Disturbance of vision following nontraumatic intracerebral hemorrhage I Other sequelae of other nontraumatic intracranial hemorrhage Alteration of sensation following other nontraumatic intracranial hemorrhage Disturbance of vision following other nontraumatic intracranial hemorrhage I Other sequelae of cerebral infarction Alteration of sensation following cerebral infarction Disturbance of vision following cerebral infarction I Other sequelae of other cerebrovascular disease Alteration of sensation following other cerebrovascular disease Disturbance of vision following other cerebrovascular disease I Other sequelae following unspecified cerebrovascular disease Alteration in sensation following unspecified cerebrovascular disease Disturbance of vision following unspecified cerebrovascular disease I69.00 Unspecified sequelae of nontraumatic subarachnoid hemorrhage I69.10 Unspecified sequelae of nontraumatic intracerebral hemorrhage I69.20 Unspecified sequelae of other nontraumatic intracranial hemorrhage I69.30 Unspecified sequelae of cerebral infarction I69.80 Unspecified sequelae of other cerebrovascular disease I69.90 Unspecified sequelae of unspecified cerebrovascular disease J38.00 Paralysis of vocal cords and larynx, unspecified J38.01 Paralysis of vocal cords and larynx, unilateral J38.01 Paralysis of vocal cords and larynx, unilateral J38.02 Paralysis of vocal cords and larynx, bilateral J38.02 Paralysis of vocal cords and larynx, bilateral Polyp of vocal cord or larynx J38.1 Polyp of vocal cord and larynx Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 201

207 Appendix & Resources ICD-9-CM Code ICD-9-CM Description ICD-10-CM Code ICD-10-CM Description Other diseases of vocal cords J38.2 Nodules of vocal cords Chorditis (fibrinous)(nodosa)(tuberosa) Singer s nodes J38.3 Other diseases of vocal cords Abscess of vocal cords Cellulitis of vocal cords Granuloma of vocal cords Leukokeratosis of vocal cords Leukoplakia of vocal cords Edema of larynx J38.4 Edema of larynx Edema (of) glottis Subglottic edema Supraglottic edema Unspecified disease of larynx J38.7 Other diseases of larynx Abscess of larynx Cellulitis of larynx Disease of larynx NOS Necrosis of larynx Pachyderma of larynx Perichondritis of larynx Ulcer of larynx Cellulitis and perichondritis of larynx J38.7 Other diseases of larynx Abscess of larynx Cellulitis of larynx Disease of larynx NOS Necrosis of larynx Pachyderma of larynx Perichondritis of larynx Ulcer of larynx Stenosis of larynx J38.6 Stenosis of larynx Laryngeal spasm J38.5 Laryngeal spasm Other diseases of the larynx J38.7 Other diseases of larynx Abscess of larynx Cellulitis of larynx Disease of larynx NOS Necrosis of larynx Pachyderma of larynx Perichondritis of larynx Ulcer of larynx Upper respiratory tract hypersensitivity reaction, site unspecified Due to inhalation of food or vomitus (Pneumonitis due to solids and liquids) Unspecified anomaly (Major anomalies of jaw size) J39.3 Upper respiratory tract hypersensitivity reaction, site unspecified J69.0 Pneumonitis due to inhalation of food and vomit Aspiration pneumonia NOS Aspiration pneumonia (due to) food (regurgitated) Aspiration pneumonia (due to) gastric secretions Aspiration pneumonia (due to) milk Aspiration pneumonia (due to) vomit M26.00 Unspecified anomaly of jaw size Maxillary hyperplasia M26.01 Maxillary hyperplasia Mandibular hyperplasia M26.03 Mandibular hyperplasia Maxillary hypoplasia M26.02 Maxillary hypoplasia Coding and Billing for Audiology and Speech-Language Pathology

208 ICD-9-CM Code ICD-9-CM Description ICD-10-CM Code ICD-10-CM Description Mandibular hypoplasia M26.04 Mandibular hypoplasia Macrogenia M26.05 Macrogenia Microgenia M26.06 Microgenia Excessive tuberosity of jaw M26.07 Excessive tuberosity of jaw Other specified anomaly (Major M26.09 Other specified anomalies of jaw size anomalies of jaw size) Unspecified anomaly (Anomalies M26.10 Unspecified anomaly of jaw-cranial base relationship of relationship of jaw to cranial base) Prognathism Retrognathism Maxillary asymmetry M26.11 Maxillary asymmetry Other jaw asymmetry M26.12 Other jaw asymmetry Other specified anomaly M26.19 Other specified anomalies of jaw-cranial base relationship (Anomalies of relationship of jaw to cranial base) Anomalies of dental arch relationship Anomaly of dental arch M26.20 Unspecified anomaly of dental arch relationship Malocclusion, Angle s class I Neutro-occlusion Malocclusion, Angle s class II Disto-occlusion Division I Disto-occlusion Division II Malocclusion, Angle s class III Mesio-occlusion Open anterior occlusal relationship Anterior open bite Open posterior occlusal relationship Posterior open bite Excessive horizontal overlap Excessive horizontal overjet Reverse articulation Anterior articulation Crossbite Posterior articulation Anomalies of interarch distance Excessive interarch distance Inadequate interarch distance Other anomalies of dental arch relationship Other anomalies of dental arch Dentofacial function abnormality, unspecified M Malocclusion, Angle s class I Neutro-occlusion M Malocclusion, Angle s class II Disto-occlusion Division I Disto-occlusion Division II M Malocclusion, Angle s class III Mesio-occlusion M Open anterior occlusal relationship Anterior openbite M Open posterior occlusal relationship Posterior openbite M26.23 Excessive horizontal overlap Excessive horizontal overjet M26.24 Reverse articulation Crossbite (anterior) (posterior) M26.25 Anomalies of interarch distance M26.29 Other anomalies of dental arch relationship Midline deviation of dental arch Overbite (excessive) deep Overbite (excessive) horizontal Overbite (excessive) vertical Posterior lingual occlusion of mandibular teeth M26.50 Dentofacial functional abnormalities, unspecified Abnormal jaw closure M26.51 Abnormal jaw closure Limited mandibular range of M26.52 Limited mandibular range of motion motion Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 203

209 Appendix & Resources ICD-9-CM ICD-9-CM Description Code Deviation in opening and closing of the mandible ICD-10-CM ICD-10-CM Description Code M26.53 Deviation in opening and closing of the mandible Insufficient anterior guidance M26.54 Insufficient anterior guidance Insufficient anterior occlusal guidance Centric occlusion maximum intercuspation discrepancy M26.55 Centric occlusion maximum intercuspation discrepancy Excludes1: centric occlusion NOS (M26.59) Non-working side interference M26.56 Non-working side interference Balancing side interference Lack of posterior occlusal support M26.57 Lack of posterior occlusal support Other dentofacial functional abnormalities Abnormal swallowing Mouth breathing Sleep postures Tongue, lip, or finger habits Temporomandibular joint sounds on opening and/or closing the jaw (Temporomandibular joint disorders) Vertical displacement of alveolus and teeth (Dental alveolar anomalies) Occlusal plane deviation (Dental alveolar anomalies) Anterior soft tissue impingement (Other specified dentofacial anomalies) Posterior soft tissue impingement (Other specified dentofacial anomalies) Other specified dentofacial anomalies Other and unspecified diseases of the oral soft tissues Other specified conditions of the tongue M26.59 Other dentofacial functional abnormalities Centric occlusion (of teeth) NOS Malocclusion due to abnormal swallowing Malocclusion due to mouth breathing Malocclusion due to tongue, lip or finger habits M26.69 Other specified disorders of temporomandibular joint M26.79 Other specified alveolar anomalies M26.79 Other specified alveolar anomalies M26.81 Anterior soft tissue impingement Anterior soft tissue impingement on teeth M26.82 Posterior soft tissue impingement Posterior soft tissue impingement on teeth M26.89 Other dentofacial anomalies K13.70 Unspecified lesions of oral mucosa K13.79 Other lesions of oral mucosa K14.8 Other diseases of tongue Atrophy of tongue Crenated tongue Enlargement of tongue Glossocele Glossoptosis Hypertrophy of tongue Esophageal reflux K21.0 Gastro-esophageal reflux disease with esophagitis Reflux esophagitis K21.9 Gastro-esophageal reflux disease without esophagitis Esophageal reflux NOS Spina bifida with hydrocephalus Q05.4 Unspecified spina bifida with hydrocephalus (Unspecified region) Q05.9 Spina bifida, unspecified Microcephalus (Other congenital Q02 Microcephaly anomalies of nervous system) Web of larynx (Congenital anomalies of respiratory system) Q31.0 Web of larynx (Congenital malformations of larynx) Coding and Billing for Audiology and Speech-Language Pathology

210 ICD-9-CM ICD-9-CM Description Code Other anomalies of larynx, trachea and bronchus (Congenital anomalies of respiratory system) ICD-10-CM ICD-10-CM Description Code Q31.1 Congenital subglottic stenosis Q31.3 Laryngocele Q31.8 Other congenital malformations of larynx Q32.1 Other congenital malformations of trachea Q32.4 Other congenital malformations of bronchus Cleft palate, unspecified Q35.1 Cleft hard palate Q35.3 Cleft soft palate Q35.5 Cleft hard palate with cleft soft palate Q35.9 Cleft palate, unspecified Unilateral cleft palate, complete Q35.9 Cleft palate, unspecified Unilateral cleft palate, incomplete Q35.7 Cleft uvula Cleft uvula Q35.9 Cleft palate, unspecified Bilateral cleft palate, complete Q35.9 Cleft palate, unspecified Bilateral cleft palate, incomplete Q35.9 Cleft palate, unspecified Cleft lip, unspecified Q36.9 Cleft lip, unilateral Unilateral cleft lip, complete Q36.1 Cleft lip, median Q36.9 Cleft lip, unilateral Unilateral cleft lip, incomplete Q36.9 Cleft lip, unilateral Bilateral cleft lip, complete Q36.0 Cleft lip, bilateral Bilateral cleft lip, incomplete Q36.0 Cleft lip, bilateral Cleft palate with cleft lip, Q37.9 Unspecified cleft palate with unilateral cleft lip unspecified Unilateral cleft palate with cleft lip, Q37.1 Cleft hard palate with unilateral cleft lip complete Q37.3 Cleft soft palate with unilateral cleft lip Q37.5 Cleft hard and soft palate with unilateral cleft lip Q37.9 Unspecified cleft palate with unilateral cleft lip Unilateral cleft palate with cleft lip, Q37.1 Cleft hard palate with unilateral cleft lip incomplete Q37.3 Cleft soft palate with unilateral cleft lip Q37.5 Cleft hard and soft palate with unilateral cleft lip Q37.9 Unspecified cleft palate with unilateral cleft lip Bilateral cleft palate with cleft lip, Q37.0 Cleft hard palate with bilateral cleft lip complete Q37.2 Cleft soft palate with bilateral cleft lip Q37.4 Cleft hard and soft palate with bilateral cleft lip Q37.8 Unspecified cleft palate with bilateral cleft lip Bilateral cleft palate with cleft lip, Q37.0 Cleft hard palate with bilateral cleft lip incomplete Q37.2 Cleft soft palate with bilateral cleft lip Q37.4 Cleft hard and soft palate with bilateral cleft lip Q37.8 Unspecified cleft palate with bilateral cleft lip Other combinations (Cleft palate and cleft lip) Q37.9 Unspecified cleft palate with unilateral cleft lip Tongue tie Ankyloglossia Q38.1 Ankyloglossia Tongue tie Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 205

211 Appendix & Resources ICD-9-CM Code ICD-9-CM Description ICD-10-CM Code ICD-10-CM Description Anomalies of tongue, unspecified Q38.3 Other congenital malformations of tongue Aglossia Bifid tongue Congenital adhesion of tongue Congenital fissure of tongue Congenital malformation of tongue NOS Double tongue Hypoglossia Hypoplasia of tongue Microglossia Aglossia Q38.3 Other congenital malformations of tongue Aglossia Bifid tongue Congenital adhesion of tongue Congenital fissure of tongue Congenital malformation of tongue NOS Double tongue Hypoglossia Hypoplasia of tongue Microglossia Congenital adhesions of tongue Q38.3 Other congenital malformations of tongue Aglossia Bifid tongue Congenital adhesion of tongue Congenital fissure of tongue Congenital malformation of tongue NOS Double tongue Hypoglossia Hypoplasia of tongue Microglossia Fissure of tongue Q38.3 Other congenital malformations of tongue Aglossia Bifid tongue Congenital adhesion of tongue Congenital fissure of tongue Congenital malformation of tongue NOS Double tongue Hypoglossia Hypoplasia of tongue Microglossia Macroglossia Q38.2 Macroglossia Congenital hypertrophy of tongue Microglossia Hypoplasia of tongue Q38.3 Other congenital malformations of tongue Aglossia Bifid tongue Congenital adhesion of tongue Congenital fissure of tongue Congenital malformation of tongue NOS Double tongue Hypoglossia Hypoplasia of tongue Microglossia Coding and Billing for Audiology and Speech-Language Pathology

212 ICD-9-CM Code ICD-9-CM Description ICD-10-CM Code ICD-10-CM Description Other (Other anomalies of tongue) Q38.3 Other congenital malformations of tongue Aglossia Bifid tongue Congenital adhesion of tongue Congenital fissure of tongue Congenital malformation of tongue NOS Double tongue Hypoglossia Hypoplasia of tongue Microglossia Other specified anomalies of Q38.8 Other congenital malformations of pharynx pharynx Of skull, face, and jaw (Certain Q67.0 Congenital facial asymmetry congenital musculoskeletal Q67.1 Congenital compression facies deformities) Q67.2 Dolichocephaly Q67.3 Plagiocephaly Q67.4 Other congenital deformities of skull, face and jaw Congenital depressions in skull Congenital hemifacial atrophy or hypertrophy Deviation of nasal septum, congenital Squashed or bent nose, congenital Excludes1: dentofacial anomalies [including malocclusion] (M26-), syphilitic saddle nose (A50.5) Down s syndrome Mongolism Translocation Down s syndrome Trisomy: 21 or 22, G Q90.0 Trisomy 21, nonmosaicism (meiotic nondisjunction) (Down syndrome) Q90.1 Trisomy 21, mosaicism (mitotic nondisjunction) (Down syndrome) Q90.2 Trisomy 21, translocation (Down syndrome) Q90.9 Down syndrome, unspecified Trisomy 21 NOS Q91.0 Trisomy 18, nonmosaicism (meiotic nondisjunction) Edward s syndrome Trisomy: 18, E 3 Q91.1 Trisomy 18, mosaicism (mitotic nondisjunction) Q91.2 Trisomy 18, translocation Q91.3 Trisomy 18, unspecified Cri-du-chat syndrome Q93.4 Deletion of short arm of chromosome 5 Cri-du-chat syndrome Velo-cardio-facial syndrome Q93.81 Velo-cardio-facial syndrome Deletion 22q Other microdeletions Miller-Dieker syndrome Smith-Magenis syndrome Klinefelter s syndrome (males only) XXY syndrome Q93.88 Other microdeletions Miller-Dieker syndrome Smith-Magenis syndrome Q98.0 Klinefelter syndrome karyotype 47, XXY Q98.1 Klinefelter syndrome, male with more than two X chromosomes Q98.3 Other male with 46, XX karyotype Q98.4 Klinefelter syndrome, unspecified Q98.5 Karyotype 47, XYY Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 207

213 Appendix & Resources ICD-9-CM ICD-9-CM Description Code Feeding problems in newborn Slow feeding in newborn Memory loss Amnesia (retrograde) Memory loss NOS Lack of coordination Ataxia NOS Muscular incoordination ICD-10-CM ICD-10-CM Description Code P92.1 Regurgitation and rumination of newborn P92.2 Slow feeding of newborn P92.8 Other feeding problems of newborn P92.9 Feeding problem of newborn, unspecified R41.2 Retrograde amnesia R41.3 Other amnesia Amnesia NOS Memory loss NOS Excludes1: amnestic disorder due to known physiologic condition (F04), amnestic syndrome due to psychoactive substance use (F10-F19 with 5th character.6), mild memory disturbance due to known physiological condition (F06.8), transient global amnesia (G45.4) R27.0 Ataxia, unspecified Excludes1: ataxia following cerebrovascular disease (I69. with final characters -93) R27.8 Other lack of coordination R27.9 Unspecified lack of coordination Neurological neglect syndrome R41.4 Neurologic neglect syndrome Facial weakness Facial droop Feeding difficulties and mismanagement Feeding problem (elderly) (infant) Lack of normal physiological development, unspecified Inadequate development Lack of development Failure to thrive Failure to gain weight Delayed milestones Late talker Late walker R Facial weakness Facial droop Excludes1: Bell s palsy (G51.0), facial weakness following cerebrovascular disease (I69. with final characters-92) R63.3 Feeding difficulties Feeding problem (elderly) (infant) NOS Excludes1: feeding problems of newborn (P92.-), infant feeding disorder of nonorganic origin (F98.2-) R62.50 Unspecified lack of expected normal physiological development in childhood Infantilism NOS R62.51 Failure to thrive (child) Failure to gain weight Excludes1: failure to thrive in child under 28 days old (P92.6) R62.0 Delayed milestone in childhood Delayed attainment of expected physiological developmental stage Late talker Late walker Aphasia R47.01 Aphasia Excludes1: aphasia following cerebrovascular disease (I69. with final characters -20), progressive isolated aphasia (G31.01) Voice and resonance disorder, unspecified Aphonia Loss of voice Dysphonia Hoarseness R49.9 Unspecified voice and resonance disorder Change in voice NOS Resonance disorder NOS R49.1 Aphonia Loss of voice R49.0 Dysphonia Hoarseness Hypernasality R49.21 Hypernasality Coding and Billing for Audiology and Speech-Language Pathology

214 ICD-9-CM Code ICD-9-CM Description ICD-10-CM Code ICD-10-CM Description Hyponasality R49.22 Hyponasality Other voice and resonance R49.8 Other voice and resonance disorders disorders Change in voice R49.9 Unspecified voice and resonance disorder Dysarthria R47.1 Dysarthria and anarthria Excludes1: dysarthria following cerebrovascular disease (I69. with final characters -22) Fluency disorder in conditions classified elsewhere Stuttering in conditions classified elsewhere Other speech disturbance Dysphasia Slurred speech Speech disturbance NOS R47.82 Fluency disorder in conditions classified elsewhere Stuttering in conditions classified elsewhere Code first underlying disease or condition, such as: Parkinson s disease (G20) Excludes1: adult onset fluency disorder (F98.5), childhood onset fluency disorder (F80.81), fluency disorder (stuttering) following cerebrovascular disease (I69. with final characters-23) R47.81 Slurred speech R47.89 Other speech disturbances R47.02 Dysphasia Excludes1: dysphasia following cerebrovascular disease (I69. with final characters -21) R47.9 Unspecified speech disturbances Symbolic dysfunction, unspecified R48.9 Unspecified symbolic dysfunctions Alexia and dyslexia R48.0 Dyslexia and alexia Alexia (with agraphia) Other (Other symbolic dysfunction) Acalculia Agnosia Agraphia NOS Apraxia Other (Dyspnea and respiratory abnormalities) Respiratory distress Respiratory insufficiency R48.1 Agnosia Astereognosia (astereognosis) Autotopagnosia Excludes1: visual object agnosia (R48.3) R48.2 Apraxia Excludes1: apraxia following cerebrovascular disease (I69. with final characters -90) R48.8 Other symbolic dysfunctions Acalculia Agraphia R06.00 Dyspnea, unspecified R06.09 Other forms of dyspnea R06.3 Periodic breathing Cheyne-Stokes breathing R06.89 Other abnormalities of breathing Breath-holding (spells) Sighing Cough R05 Cough Excludes1: cough with hemorrhage (R04.2), smoker s cough (J41.0) Dysphagia, unspecified R13.10 Dysphagia, unspecified Difficulty in swallowing NOS Dysphagia, oral phase R13.11 Dysphagia, oral phase Dysphagia, oropharyngeal phase R13.12 Dysphagia, oropharyngeal phase Dysphagia, pharyngeal phase R13.13 Dysphagia, pharyngeal phase Dysphagia, pharyngoesophageal phase R13.14 Dysphagia, pharyngoesophageal phase Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 209

215 Appendix & Resources ICD-9-CM ICD-9-CM Description Code Other dysphagia Cervical dysphagia Neurogenic dysphagia Abnormal function study, unspecified (Brain and central nervous system) Other (Brain and central nervous system) Abnormal brain scan Abnormal auditory function studies (Peripheral nervous system and special senses) Abnormal vestibular function studies (Peripheral nervous system and special senses) Attention or concentration deficit (Signs and symptoms involving cognition) Cognitive communication deficit (Signs and symptoms involving cognition) Visuospatial deficit (Signs and symptoms involving cognition) Psychomotor deficit (Signs and symptoms involving cognition) Frontal lobe and executive function deficit (Signs and symptoms involving cognition) Other signs and symptoms involving cognition V13.64 Personal history of (corrected) congenital malformation of eye, ear, face and neck Corrected cleft lip and palate ICD-10-CM ICD-10-CM Description Code R13.19 Other dysphagia Cervical dysphagia Neurogenic dysphagia R94.09 Abnormal results of other function studies of central nervous system (Abnormal results of function studies of central nervous system) R94.02 Abnormal brain scan (Abnormal results of function studies of central nervous system) R94.09 Abnormal results of other function studies of central nervous system (Abnormal results of function studies of central nervous system) R Abnormal auditory function study (Abnormal results of function studies of peripheral nervous system and special senses) R Abnormal vestibular function study (Abnormal results of function studies of peripheral nervous system and special senses) R Attention and concentration deficit (Other specified cognitive deficit) Excludes1: attention-deficit hyperactivity disorders (F90.-) R Cognitive communication deficit (Other specified cognitive deficit) R Visuospatial deficit (Other specified cognitive deficit) R Psychomotor deficit (Other specified cognitive deficit) R Frontal lobe and executive function deficit (Other specified cognitive deficit) R41.89 Other symptoms and signs involving cognitive functions and awareness Anosognosia Z Personal history of (corrected) congenital malformations of ear Z Personal history of (corrected) cleft lip and palate Z Personal history of (corrected) congenital malformations of face and neck V15.52 History of traumatic brain injury Z Personal history of traumatic brain injury V40.1 Problems with communication Z86.59 Personal history of other mental and behavioral disorders (including speech) V44.0 Tracheostomy Z93.0 Tracheostomy status V49.85 Dual-sensory impairment Z73.82 Dual sensory impairment V52.8 Fitting and adjustment of prosthetic device and implant, Other specified prosthetic device Z44.8 Encounter for fitting and adjustment of other external prosthetic devices V52.9 Unspecified prosthetic device Z44.9 Encounter for fitting and adjustment of unspecified external prosthetic device V53.2 Fitting and adjustment of other Z46.1 Encounter for fitting and adjustment of hearing aid device, hearing aid V57.3 Speech-language therapy Z51.89 Encounter for other specified aftercare Coding and Billing for Audiology and Speech-Language Pathology

216 ICD-9-CM ICD-9-CM Description Code V72.11 Encounter for hearing exam following failed hearing screening V72.12 Encounter for hearing conservation and treatment V80.01 Special screening for neurological, eye, and ear diseases, traumatic brain injury ICD-10-CM ICD-10-CM Description Code Z Encounter for hearing examination following failed hearing screening Z01.12 Encounter for hearing conservation and treatment Z Encounter for screening for traumatic brain injury Appendix & Resources 2016 Coding and Billing for Audiology and Speech-Language Pathology 211

217 Appendix & Resources Resources Official ICD-10-CM Web Resources Centers for Medicare & Medicaid Services: ICD-10-CM Official Guidelines for Coding and Reporting: ICD-10-CM Tabular List of Diseases and Injuries: ASHA Resources ASHA ICD-9 to ICD-10 Mapping Tool for Audiologists and Speech-Language Pathologists: ASHA ICD-10-CM Diagnosis Codes for Audiology and Speech-Language Pathology: ASHA s Coding, Reimbursement, and Advocacy Modules: ASHA s Skilled Versus Unskilled Guidelines: Care-for-Medicare-Beneficiaries/ Documentation Functional Communication Measures: Inpatient Rehabilitation Therapy Services: Complying with Documentation Requirements: downloads/inpatient_rehab_fact_sheet_icn pdf Outpatient Rehabilitation Therapy Services: Complying with Documentation Requirements: downloads/outpatient_rehabilitation_fact_sheet_icn pdf Coding and Billing for Audiology and Speech-Language Pathology

218 Audiology Most Commonly Used Codes CPT Procedure Codes Audiological Assessment Procedures Tympanometry and reflex threshold measurements Screening test, pure tone, air only Pure tone audiometry (threshold); air only Pure tone audiometry (threshold); air and bone Speech audiometry threshold Speech audiometry threshold; w/speech recognition Comprehensive audiometry threshold evaluation and speech recognition Tympanometry (impedance testing) Acoustic reflex testing, threshold Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing Visual reinforcement audiometry (VRA) Conditioning play audiometry Auditory evoked potentials, comprehensive Auditory evoked potentials, limited Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report Evaluation of central auditory function, with report; initial 60 minutes each additional 15 minutes Assessment of tinnitus (includes pitch, loudness matching, and masking) Hearing Aid Assessment and Fitting Procedures Hearing aid exam and selection; monaural Hearing aid exam and selection; binaural Habilitative and Rehabilitative Services Evaluation of auditory rehabilitation status, 1st hour each additional 15 minutes Auditory rehabilitation; pre-lingual hearing loss Auditory rehabilitation; post-lingual hearing loss Cochlear Implant Diagnostic analysis of cochlear implant, patient younger than 7 years of age, with programming subsequent reprogramming Diagnostic analysis of cochlear implant, age 7 years or older, with programming subsequent reprogramming Diagnostic analysis with programming of auditory brainstem implant, per hour ICD-9-CM Diagnostic Codes Peripheral vertigo, unspecified Benign paroxysmal positional vertigo Presbyacusis Noise effects on inner ear, unspecified Acoustic trauma (explosive) to ear Noise-induced hearing loss Sudden hearing loss, unspecified Tinnitus, unspecified Subjective tinnitus Objective tinnitus Abnormal auditory perception, unspecified Impairment of auditory discrimination Recruitment Acquired auditory processing disorder Conductive hearing loss, unspecified Conductive hearing loss, external ear Conductive hearing loss, tympanic membrane Conductive hearing loss, middle ear Conductive hearing loss, inner ear Conductive hearing loss, unilateral Conductive hearing loss, bilateral Conductive hearing loss of combined types Sensorineural hearing loss, unspecified Sensory hearing loss, bilateral Neural hearing loss, bilateral Neural hearing loss, unilateral Central hearing loss Sensorineural hearing loss, unilateral Sensorineural hearing loss, asymmetrical Sensory hearing loss, unilateral Sensorineural hearing loss, bilateral Mixed hearing loss, unspecified Mixed hearing loss, unilateral Mixed hearing loss, bilateral Dizziness and giddiness ICD-10-CM Diagnostic Codes (Effective ) H81.10 Benign paroxysmal vertigo, unspecified ear H81.11 Benign paroxysmal vertigo, right ear H81.12 Benign paroxysmal vertigo, left ear H81.13 Benign paroxysmal vertigo, bilateral H83.3X1 Noise effects on right inner ear H83.3X2 Noise effects on left inner ear H83.3X3 Noise effects on inner ear, bilateral H83.3X9 Noise effects on inner ear, unspecified ear H90.0 Conductive hearing loss, bilateral H90.11 Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.12 Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side H90.2 Conductive hearing loss, unspecified H90.3 Sensorineural hearing loss, bilateral H90.41 Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.42 Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side H90.5 Unspecified sensorineural hearing loss H90.6 Mixed conductive and sensorineural hearing loss, bilateral H90.71 Mixed conductive and sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.72 Mixed conductive and sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side H90.8 Mixed conductive and sensorineural hearing loss, unspecified H91.10 Presbycusis, unspecified ear H91.11 Presbycusis, right ear H91.12 Presbycusis, left ear H91.13 Presbycusis, bilateral H93.11 Tinnitus, right ear H93.12 Tinnitus, left ear H93.13 Tinnitus, bilateral H93.19 Tinnitus, unspecified ear H Auditory recruitment, right ear H Auditory recruitment, left ear H Auditory recruitment, bilateral H Auditory recruitment, unspecified ear H93.25 Central auditory processing disorder R42 Dizziness and giddiness R Abnormal auditory function study R Abnormal vestibular function study R Abnormal results of other function studies of ear and other special senses

219 Speech-Language Pathology Most Commonly Used Codes CPT Procedure Codes Speech and Language Evaluation of speech fluency (e.g., stuttering, cluttering) Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) with evaluation of language comprehension and expression (e.g., receptive/expressive language) Behavioral and qualitative analysis of voice and resonance Treatment of speech, language, voice, communication, and/or auditory processing disorder, individual group, two or more individuals Development of cognitive skills to improve attention, memory, problem solving, direct one-on-one patient contact by the provider; each 15 minutes Assessment of aphasia Standardized cognitive performance testing (e.g., Ross Information Processing Assessment) per hour Swallowing Function Treatment of swallowing dysfunction and/or oral function for feeding Evaluation of oral & pharyngeal swallowing function Motion fluoroscopic evaluation of swallowing function by cine or video recording Augmentative and Alternative Communication Evaluation for use/fitting of voice prosthetic device to supplement oral speech Evaluation for prescription for speech-generating augmentative and alternative communication device; face-to-face with the patient; first hour each additional 30 minutes Therapeutic services for the use of speech-generating device, including programming and modification ICD-9-CM Diagnostic Codes Autistic disorder Other specified pervasive developmental disorders; Asperger s disorder Expressive language disorder Mixed receptive-expressive language disorder Central auditory processing disorder Speech and language developmental delay due to hearing loss Childhood onset fluency disorder Developmental articulation disorder Aphasia, per CVA Dysphasia, per CVA Dysarthria, per CVA Apraxia, per CVA Dysphagia, per CVA Use additional code to identify the type of dysphagia, if known ( ) Delayed milestones; Late talker; Late walker Aphasia, not related to CVA Aphonia; Loss of voice Dysphonia; Hoarseness Hypernasality Hyponasality Other voice and resonance disorders Dysarthria Other speech disturbance Symbolic dysfunction, unspecified Alexia and dyslexia Other symbolic dysfunction; agnosia, agraphia, apraxia Dysphagia, unspecified Dysphagia, oral phase Dysphagia, oropharyngeal phase Dysphagia, pharyngeal phase Dysphagia, pharyngoesophageal phase Attention or concentration deficit Cognitive communication deficit Visuospatial deficit Frontal lobe and executive function deficit ICD-10-CM Diagnostic Codes (Effective ) F80.0 Phonological disorder F80.1 Expressive language disorder F80.2 Mixed receptive-expressive language disorder F80.4 Speech and language development delay due to hearing loss F80.81 Childhood onset fluency disorder F84.0 Autistic disorder F84.5 Asperger s syndrome F84.8 Other pervasive developmental disorders I Aphasia following nontraumatic subarachnoid hemorrhage I Aphasia following nontraumatic intracerebral hemorrhage I Aphasia following other nontraumatic intracranial hemorrhage I Aphasia following cerebral infarction I Aphasia following other cerebrovascular disease (See entire I69 series, sequelae of cerebrovascular disease) Q38.3 Other congenital malformations of tongue R13.10 Dysphagia, unspecified R13.11 Dysphagia, oral phase R13.12 Dysphagia, oropharyngeal phase R13.13 Dysphagia, pharyngeal phase R13.14 Dysphagia, pharyngoesophageal phase R13.19 Other dysphagia R Attention and concentration deficit R Cognitive communication deficit R Visuospatial deficit R Frontal lobe and executive function deficit R47.01 Aphasia (not related to CVA) R47.02 Dysphasia R47.1 Dysarthria and anarthria R47.81 Slurred speech R47.82 Fluency disorder in conditions classified elsewhere R47.89 Other speech disturbances R48.0 Dyslexia and alexia R48.1 Agnosia R48.2 Apraxia R48.8 Other symbolic dysfunctions; acalculia; agraphia R49.0 Dysphonia; Hoarseness R49.1 Aphonia; Loss of voice R49.21 Hypernasality R49.22 Hyponasality R49.8 Other voice and resonance disorders R49.9 Unspecified voice and resonance disorder R62.0 Delayed milestone in childhood; Late talker; Late walker 10967

220 Coding and Billing for AUDIOLOGY and SPEECH-LANGUAGE PATHOLOGY This essential resource is a one-stop shop for billing and coding your services to file claims with health plans, including private health plans, Medicare, and Medicaid. Assigning codes to describe and bill for your services is a professional responsibility. This comprehensive reference guide provides all the details you need to code diagnoses and treatments in order to file claims and receive payment successfully. Inside, you ll find: Guidance on implementing ICD-10-CM diagnostic codes The most recent first-quarter Milliman charge data to help you evaluate how your fees compare nationwide New HCPCS codes and information New, more detailed descriptor text for specific codes Additional information about ICD-10-PCS, which provides procedures codes used in inpatient hospital settings only CPT procedure codes G-code outcomes reporting for Medicare claims Sample superbills PQRS information, which supports improvements in quality of care to Medicare patients Documentation guidance A pullout laminated sheet with the codes most commonly used by audiologists and speech-language pathologists Knowledge helps you code with confidence