What is the difference between ICD-9 and CPT codes?
The difference between ICD-9 and CPT codes is that ICD-9 codes are used to describe the problem or the reason for the procedure. An example of an ICD-9 code is 315.35 which is a “childhood onset fluency disorder.” We are essentially describing the diagnosis, or the reason the person is coming to you.
That is different than a CPT code. A CPT code describes the treatment that was actually performed. This is the procedure code. It is what we actually did in our treatment session. A frequently used CPT code is 92507, which is the “treatment of speech, language, voice, communication, and/or auditory processing disorder, individual.”
How are these used in private practice? When you bill an insurance company, you will either be completing a 1500 form, which is actually a paper form that you fill in, or you will be completing electronic billing - you will go to a website and enter the information there. It does not matter whether you are doing the paper-based form or if you are submitting an electronic bill; the information that you need is the same. When you are doing that billing, you are going to be reporting both ICD-9 codes and CPT codes on every bill. These two codes have to make sense together. You cannot have an ICD-9 code that is a childhood onset fluency disorder and then have a CPT code that says that you worked on swallowing with any individual. That would not make sense to an insurance company and you will be denied because of that. That is the most important thing to remember; these ICD-9 codes and CPT codes have to go together.
Becca Jarzynski, MS, CCC-SLP, received her Master of Science Degree in Communication Disorders from the University of Wisconsin – Eau Claire in 2000. She has also earned a Graduate Certificate in Behavioral Intervention for Children with Autism through the University of Massachusetts – Lowell, and completed a year as a preparing mentor in family –centered care with the Wisconsin Birth-to-Three program. Becca has worked as a pediatric speech-language pathologist for fourteen years and currently owns a private practice, Child Talk Speech Therapy, L.L.C., in Eau Claire, Wisconsin.