# Presentation: 037907

## Hearing and Swallowing Disorders ICD-9-CM Recommendations

- American Speech-Language-Hearing Association
- September 29, 2006
- Baltimore, MD

## Presenters

- 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

## 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.

## Slide 4

## Hearing loss

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

## 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

## 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

## Hearing loss

- 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.

## Central Hearing Loss 

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

## Pathway of the Auditory Nerve

## Eliminate archaic term – “mutism”

- 389.7 Deaf mutism, not elsewhere classifiable
- Inaccurate and offensive
**Nonspeaking** is more descriptive

## Acquired Auditory Processing Disorder

- 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 Nerve

## Dual sensory impairment

- 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

## Hearing Conservation

- Add supplemental code
- Hearing conservation includes:
- hearing level monitoring
- employee education
- acoustic analysis of noise
- hearing loss prevention

## Disability Examination

- Add supplemental V code
- Explains purpose of examination
- Used in addition to codes for conditions found after study

## Speech & Language Delay due to Hearing Loss

- 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

- American Speech-Language-Hearing Association

## Dysphagia - Swallowing disorders

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

## WHY THE CHANGE REQUEST?

- 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

## SWALLOWING PHASES

- a. Oral Phase
- b. Oropharyngeal Phase
- c. Oropharyngeal Phase
- d. Pharyngeal Phase
- e. Pharyngoesophageal
- 	Phase

## BENEFITS OF NEW CODES

- Clarification of the disorder
- Definitive diagnoses
- Efficiency of treatment planning

## PROPOSED CHANGES TO 787.2

**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**