Voice, Reverberation, and Faltering Issue ICD-9-CM Proposals.

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Dee Adams Nikjeh, PhD, CCC-SLP. Ear, Nose & Throat Associates, ... an issue of phonation. Dysphonia is unmistakable and separate from an issue of reverberation ...
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Voice, Resonance, and Stuttering Disorders ICD-9-CM Recommendations Dee Adams Nikjeh, PhD, CCC-SLP Ear, Nose & Throat Associates, Clearwater FL Research Assistant Professor, University of South Florida September 25, 2008

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Proposal for Changes to ICD-9-CM Chapter 16: Symptoms, Signs, and Ill-Defined Conditions (780-799) (784) Symptoms including head and neck 784.4 Voice Disturbance 2 American Speech-Language-Hearing Association

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Current Listing in ICD-9-CM 784.4 Voice unsettling influences 704.40 Voice aggravation, unspecified 784.41 Aphonia, loss of voice 784.49 Other Change in voice Hypernasality Dysphonia Hyponasality Hoarseness 3 American Speech-Language-Hearing Association

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Voice Disturbance Disorder of phonation Known as "Dysphonia" Symptom of laryngeal issue Affects structure and/or capacity of larynx Examples: knobs, polyps, GERD, laryngeal malignancy, vocal line loss of motion 4 Resonance Disorder of reverberation and nasal wind current Symptom of velopharyngeal brokenness Affects structure and/or capacity of oral cavity, nasal aviation route, and/or the velopharyngeal port Examples: congenital fissure, submucous parted, hypertrophied adenoids American Speech-Language-Hearing Association Voice Disturbance versus Reverberation Disorder

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Resonance Disorders Hyponasality – reduced nasality Hypernasality – over the top nasality 5 American Speech-Language-Hearing Association

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Why Revise the Code? Dysphonia is a turmoil of phonation Dysphonia is unmistakable and separate from a confusion of reverberation and nasal wind stream Evaluation methods and administration methodologies are distinctive for disarranges of phonation versus reverberation 6 American Speech-Language-Hearing Association

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Benefits of the New Codes Clarifies and indicates the turmoil Provides a more authoritative conclusion Improves correspondence between orders Facilitates proficient treatment arranging 7 American Speech-Language-Hearing Association

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Proposed Changes to 784.4 784.4 Voice and reverberation issue 784.40 Voice issue, unspecified 784.41 Aphonia 784.42 Dysphonia Hoarseness 784.43 Hypernasality 784.44 Hyponasality 784.49 Other voice and reverberation issue 8 American Speech-Language-Hearing Association

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By the Way… Current ICD-10-CM (July 2007) R49 Voice unsettling influences Excludes1: psychogenic voice aggravation (F44.4) R49.0 Dysphonia Hoarseness R49.1 Aphonia Loss of voice R49.2 Hypernasality and Hyponasality R49.21 Hypernasality R49.22 Hyponasality R49.8 Other voice unsettling influences R49.9 Unspecified voice unsettling influences Change in voice NOS 9 American Speech-Language-Hearing Association

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