Otolaryngology Coding Alert

Knowing your throat anatomy could keep you in the game.

When a patient presents with common neck/throat conditions, you should be able to code the symptoms being treated, and any disorder causing the symptoms. Along with the primary diagnosis, make sure you report the patient's signs and symptoms or else risk an audit.

Consider this scenario: An ENT diagnoses a patient with dysphonia (voice disorder), and also locates a benign growth on the vocal folds. How should you report it?

These two steps show you how to free up your claim from unnecessary excess baggage.

Know When Dysphonia Code Should Take A Front Seat

In the scenario given, dysphonia identifies as the symptom, and the vocal nodules as its cause. Thus, you should list 784.42 (Dysphonia) as your primary code, and 478.32 (Complete unilateral paralysis of vocal cords) as secondary. Remember, you should code for more specific diagnoses for any pathologies your ENT would find, such as vocal nodules.

When evaluating a patient for dysphonia, the ENT would take on a different approach from that of a speech language pathologist (SLP), but both contribute to the diagnosis. As a general rule, ENTs and SLPs work hand-in-hand in the diagnosis of dysphonia. The collaborative role of the SLP in the assessment process begins after the patient has had an evaluation from the ENT. This evaluation may include an examination of the larynx for any pathologies.

Idea: As a coding technique, you can always link 784.42 with its anatomical counterpart: the larynx (voice box). The larynx is an outline of cartilage containing vocal cords. These structures vibrate to produce the sound of your voice " and dysphonia, as you know, refers to a voice disorder.

Upon the ENT's order, the SLP will perform a clinical assessment, perhaps using rating scales such as the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) to quantify the different aspects of dysphonia. Also, the SLP might note down other terms describing dysphonia, particularly its characteristics (e.g., harsh, breathy, diplophonia, strained).

FYI: The ENT must approve a therapy program for the patient performed by an SLP. Working together, the ENT and SLP must decide if therapy alone will be most beneficial for the patient, or if medications would be needed. The SLP should regularly inform the ENT of the therapeutic progress.

No More Using 784.49 For Lumped Up Voice-Resonance Disorders

In the past, you lumped voice disturbance conditions into just one code: 784.49 (Voice disturbance; other). However, since Oct. 1, 2009, ICD-9-CM has directed three additional codes to specify a patient's voice and resonance disorder. These split-out codes include:

The previous grouping was inappropriate, says Dee Nikjeh, PhD, CCC-SLP, member of American Speech Language Hearing Association and Florida Association of Speech Pathologists and Audiologists, because dysphonia relates to voice, while hypernasality/hyponasality relate to resonance.

While you would associate dysphonia with the larynx, you should relate 784.43 and 784.44 to the oral palate. Hypernasality and hyponasality are problems of resonance or sound quality, and resonance indicates something is wrong with the soft palate.