Otolaryngology Coding Alert

Question: Our speech-language pathologist (SLP) diagnosed a singer with diplophonia. What ICD-9 code should I use for this condition?

Michigan Subscriber

Answer: If the date of service is after Oct. 1, 2009, and the insurer is accepting ICD-9 2010 codes, use 784.42 (Dysphonia). ICD-9 2009 lumps "dysphonia" under 784.49 (Voice disturbance, other). ICD-9 2010 revises this code to "other voice and resonance disorders". Diplophonia is a condition in which the voice simultaneously produces two sounds of different pitch. It is a characteristic of dysphonia.

Don't get tripped up by other terms that might be listed with a diagnosis of 784.42. The SLP can explain the characteristics of the dysphonia (for instance, harsh, breathy, diplophonia, strained), notes Nancy Swigert, MA, CCC-SLP, BRS-S, with ENT Associates in Clearwater, Fla. You might also see the SLP use rating scales such as the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) that can help quantify the different aspect of the dysphonia.

Generally, the ENT will make the dysphonia diagnosis  in a patient's order for speech-language pathology. Support for dysphonia (782.42) would include an otolaryngologist to assess the larynx to determine if there are any pathologies.

The ENT would then also use more specific diagnoses for any pathologies found, such as vocal nodules. A speech-language pathologist would perform a clinical and instrumental assessment. You can expect her to provide in-depth description of the dysphonia as mentioned above.