Changes in ICD Codes

By Nan B. Ratner, Ph.D.

We still don’t know what causes stuttering, but some older theories, such as that stuttering is a bad habit, or that it results from emotional conflict or trauma, have been greatly discredited by recent research.

Unfortunately, influential health condition coding systems, such as the World Health Organization’s International Classification of Diseases (ICD) still place stuttering with such “mental disorders,” in proximity to often stigmatized conditions such as bedwetting, soiling, thumb sucking, eating disorders and insomnia.

Because there is evidence that such placement reinforces outdated beliefs about the nature of stuttering, Nan Bernstein Ratner (University of Maryland) and Luc de Nil (University of Toronto), Dr. Gerald Maguire (University of California, Irvine) worked jointly to present desired coding changes to the U.S. Centers for Medicare and Medicaid (CMS). One of their proposed changes for acquired/neurogenic stuttering is already in effect, 438.13 – Fluency disorder due to late effect of cerebro-vascular accident (CVA). This was approved last year and became effective October 2009.

Now, the American Speech-Language-Hearing Association and the American Psychological Association have agreed to jointly sponsor a proposal to move the typical or “developmental” form of stuttering that starts in childhood to another section of the ICD that describes other childhood communication disorders (the 315 series); importantly, the requested code would make clear that stuttering is not a typical developmental disorder often excluded from insurance coverage, since it has an obvious onset following previously typical speech development.

Stay tuned for updates on these ICD and DSM proposed changes.