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Hearing and Swallowing Disorders ICD-9-CM Recommendations. American Speech-Language-Hearing Association September 29, 2006 Baltimore, MD. Kyle C. Dennis, PhD, CCC-A Department of Veterans Affairs National Audiology and Speech Pathology Program Office

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Hearing and swallowing disorders icd 9 cm recommendations l.jpg

Hearing and Swallowing Disorders ICD-9-CM Recommendations

American Speech-Language-Hearing Association

September 29, 2006

Baltimore, MD


Presenters l.jpg

Kyle C. Dennis, PhD, CCC-ADepartment of Veterans AffairsNational Audiology and Speech Pathology Program Office

Dee Adams Nikjeh, PhD, CCC-SLPSpeech-Language PathologistEar, Nose & Throat Associates

Presenters


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Hearing loss

  • This proposal extends the 2007 code revisions in Chapter 6, Nervous System and Sense Organs, Disease of the Ear and Mastoid (380-389), specifically in regard to the use of laterality and the use of the term sensorineural hearing loss.


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Hearing loss

  • Extend the use of the term sensorineural hearing loss to 389.18 (sensorineural hearing loss, combined type).


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Middle Ear

  • Normally air-filled

  • Structures include:

    • Tympanic Membrane

    • 3 ossicles (malleus, incus, stapes)

  • Sound is amplified via lever action of ossicles and transmitted to inner ear

  • Pressure-equalization via Eustachian tube


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Inner Ear

  • Encased in the temporal bone

  • Consists of fluid-filled membranous sacs and ducts within a bony labyrinth

  • 2 major structures:

    • Cochlea (hearing)

    • Semicircular canals (balance)

  • Sensory and supporting hair cells

  • Sound is transmitted via a “traveling wave” through the cochlea, which causes excitation of hair cells and stimulation of the auditory nerve


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The term “combined type” is redundant because “sensorineural” already conveys a disorder with sensory and neural components.

The term causes confusion and is inconsistent with use in the U.S.

We propose the consistent terminology used for 389.15 and 389.16 to the remaining sensorineural hearing loss code, 389.18.

Hearing loss


Central hearing loss l.jpg
Central Hearing Loss “sensorineural” already conveys a disorder with sensory and neural components.

  • Revision of central hearing loss (389.14) to remove references to laterality as such references are diagnostically inaccurate.


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Pathway of the Auditory Nerve “sensorineural” already conveys a disorder with sensory and neural components.


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Eliminate archaic term – “mutism” “sensorineural” already conveys a disorder with sensory and neural components.

  • 389.7 Deaf mutism, not elsewhere classifiable

  • Inaccurate and offensive

  • Nonspeaking is more descriptive


Acquired auditory processing disorder l.jpg
Acquired Auditory Processing Disorder “sensorineural” already conveys a disorder with sensory and neural components.

  • Add new code for acquired auditory processing disorders – distinct from developmental

  • Refers to difficulties in processing of auditory frequency, intensity and temporal information in CNS

  • Manifested in poor performance in sound localization, auditory discrimination, temporal integration, temporal discrimination…


Pathway of the auditory nerve13 l.jpg
Pathway of the Auditory Nerve “sensorineural” already conveys a disorder with sensory and neural components.


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Dual sensory impairment “sensorineural” already conveys a disorder with sensory and neural components.

  • Add a new code for dual sensory impairment (combined visual and hearing disorders)

  • Synergistic effect of two sensory losses compared to each one individually

  • Unique diagnostic entity that creates severe communication and learning condition


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Hearing Conservation “sensorineural” already conveys a disorder with sensory and neural components.

  • Add supplemental code

  • Hearing conservation includes:

    • hearing level monitoring

    • employee education

    • acoustic analysis of noise

    • hearing loss prevention


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Disability Examination “sensorineural” already conveys a disorder with sensory and neural components.

  • Add supplemental V code

  • Explains purpose of examination

  • Used in addition to codes for conditions found after study


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Speech & Language Delay due to Hearing Loss “sensorineural” already conveys a disorder with sensory and neural components.

  • Hearing is the major sense for learning speech and language

  • Children with hearing loss at risk for speech and language developmental delay

  • Separate from other etiologies for speech and language delay and requires separate diagnostic code


Proposed revisions to dysphagia code 787 2 l.jpg

PROPOSED REVISIONS TO DYSPHAGIA CODE “sensorineural” already conveys a disorder with sensory and neural components. 787.2

American Speech-Language-Hearing Association


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Dysphagia - Swallowing disorders “sensorineural” already conveys a disorder with sensory and neural components.

  • Revise 787.2 (dysphagia) to recognize phases of swallowing as distinct diagnostic and functional entities.


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WHY THE CHANGE REQUEST? “sensorineural” already conveys a disorder with sensory and neural components.

  • Dysphagia is a disorder of swallowing

  • Swallowing occurs in dynamic phases from mouth to stomach

  • Dysphagia symptoms significantly vary depending on the affected phase

  • Treatment strategies are specific to the affected phase of swallowing


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SWALLOWING PHASES “sensorineural” already conveys a disorder with sensory and neural components.

a. Oral Phase

b. Oropharyngeal Phase

c. Oropharyngeal Phase

d. Pharyngeal Phase

e. Pharyngoesophageal

Phase


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BENEFITS OF NEW CODES “sensorineural” already conveys a disorder with sensory and neural components.

  • Clarification of the disorder

  • Definitive diagnoses

  • Efficiency of treatment planning


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PROPOSED CHANGES TO 787.2 “sensorineural” already conveys a disorder with sensory and neural components.

  • 787.21 Oral Phase

    • Impaired structure/physiology of palate, tongue, lips, cheeks

  • 787.22 Oropharyngeal Phase

    • Impaired structure/physiology of tongue base and pharyngeal walls

  • 787.23 Pharyngeal Phase

    • Impaired structure/physiology of pharynx and larynx

  • 787.24 Pharyngoesophageal Phase

    • Impaired structure/physiology of upper esophageal sphincter

  • 787.25 Dysphagia, unspecified

  • New recommendation: Dysphagia, Combined type


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