Eli's Rehab Report

SLPs: Phonation and resonance disorders get better distinction.

Speech-language pathologists need to watch the new ICD-9 codes that go into effect this fall. The Centers for Medicare & Medicaid Services published its proposed payment updates for inpatient hospital services (IPPS) and long-term care hospitals (LTCH PPS), and within this document is a slew of new ICD-9 codes for all providers.

Proposed changes affecting SLPs are as follows:

• New ICD-9 codes: 784.42 (Dysphonia), 784.43 (Hypernasality), 784.44 (Hyponasality), 784.51 (Dysarthria), 784.59 (Other speech disturbance).

• Invalid ICD-9 code: 784.5 (Other speech disturbance).

• Revised ICD-9 codes: 784.40 (Voice and resonance disorder, unspecified), adding the phrase "resonance disorder" to the old code; 784.49 (Other voice and resonance disorders), adding the phrase "voice and resonance disorders" to the old code. Another revised code was V57.3 (Care involving speech-language therapy), adding the word "language" to the code.

The American Speech-Language Hearing Association recommended these changes to clarify the difference between disorders of phonation and disorders of resonance, which are currently included in code 784.49 (Voice disturbance; Other; Change in voice, Dysphonia, Hoarseness, Hypernasality, Hyponasality), according to Steven C. White, PhD, CCC-A, director of health care economics advocacy for ASHA.

Reasoning: "Evaluation techniques and management strategies are different for disorders of phonation versus resonance," says a PowerPoint presentation of ICD-9-CM recommendations by Dee Adams Nikjeh, PhD, CCC-SLP, research assistant professor at the University of South Florida Department of Communication Sciences & Disorders. The presentation is on the Centers for Disease Control and Prevention at www.cdc.gov/nchs/ppt/icd9/att3AdamsNikjehSep08/att3AdamsNikjehSep08.htm.

In addition to better clarifying the voice disorders, the new codes would improve communication between disciplines and facilitate efficient treatment planning, said Nikjeh, who also practices with ENT Associates in Clearwater, Fla.

Important: "Remember that these codes aren't effective until Oct. 1, 2009," White says. CMS plans to publish the final rule for IPPS/LTCH PPS in July. To view the proposed rule online, visit www.cms.hhs.gov/AcuteInpatientPPS/. Click on the "FY 2010 Proposed Rule Home Page" on the left, go to page "2" of the highlighted links, click on the "Tables 6A-6F" link, then click on the link under "Downloads."