How to code for speech therapy?

[Itshil]

When coding for speech therapy sessions, is the diagnosis based on what the MD puts on the Rx/referral or the treatment dx?

Ex MD wrote R47.89 - speech disturbance on Rx but therapist has the treatment dx as F80.0 - phonological disorder, which one is the primary dx

 

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When coding for speech therapy sessions, is the diagnosis based on what the MD puts on the Rx/referral or the treatment dx?

Ex MD wrote R47.89 - speech disturbance on Rx but therapist has the treatment dx as F80.0 - phonological disorder, which one is the primary dx

An R code such as R47.89 is a sign/symptom code. A referring provider may use these codes when a definitive diagnosis is undetermined. Hence, the provider refers the patient to a specialist for further evaluation/treatment. The specialist will evaluate the patient and then eventually establish a definitive diagnosis. A speech-language pathologist is generally able to diagnose patients within their scope of practice.

If the speech language pathologist (specialist) evaluates the patient and establishes a diagnosis, that diagnosis will be more specific than the sign/symptom R code. Therefore, you would use that diagnosis on your claim rather than the referring provider's R code.

Per ICD-10-CM guidelines,

https://www.cms.gov/files/document/fy-2024-icd-10-cm-coding-guidelines-updated-02/01/2024.pdf

Each healthcare encounter should be coded to the level of certainty known for that encounter.

Why did the referring provider use an R code for the diagnosis?

If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for sign(s) and/or symptom(s) in lieu of a definitive diagnosis.

Why can the speech language pathologist use a different diagnosis?

...specific diagnosis codes should be reported when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition...

Can I code both codes, the R code and the actual diagnosis?

Signs or symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.

No, you cannot, because the sign/symptom indicated by R47.89 is inherent to F80.0. For example, you would not code “chest pain” (a symptom) with a “myocardial infarction” (diagnosis), because chest pain is a symptom of myocardial infarction.