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How To Make A Fast & Accurate Speech Therapy Diagnosis

You are THE expert at diagnosing speech, language, and swallowing disorders. But not all diagnoses are useful in your day-to-day job.

Instead of spending your precious time stressing over the exact type of aphasia or dysarthria you’re seeing, use this guide to help you make a fast and accurate speech therapy diagnosis.

To give you peace of mind, we asked a specialist what insurance providers look for when they approve—or deny—therapists’ billing codes and notes.

Ready to simplify your diagnosis process? Keep scrolling!

And for everything you need to assess, treat, and document, check out The Adult Speech Therapy Starter Pack!

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But Will I Get Denied?

speech therapy diagnosis

Be sure to choose a diagnosis and ICD-10 code that are accurate and relate to the area you’re addressing.

For example, if you’re treating a patient only for acute dysphagia, you wouldn’t use their previous diagnosis of chronic aphasia.

While insurance providers prefer that your ICD-10 codes are as precise as possible, our insurance specialist assured us that you won’t be denied if they’re not super specific—as long as they’re:

  • Accurate
  • And relate to the area you’re addressing
  • And you’re following their other parameters

Of course, check with your specific employer and payers first!

She adds that having strong documentation is very important for reimbursement success. Read more about how to write defensible treatment notes and evaluation reports.

Adult Speech Therapy’s Diagnosis Formula

speech disorders adults

Yes, diagnosing has a formula! And here it is:

Diagnosis = Signs & Symptoms + Severity

1. Assess the signs & symptoms of the disorder
2. Determine the severity of the disorder
3. Combine these to decide the speech therapy diagnosis

For example, a patient demonstrates minimal mastication and oral residue (signs & symptoms) some of the time but demonstrates less residue with softer foods (severity), leading to a diagnosis of mild oral dysphagia.

How Do You Determine Severity?

Determine severity by looking at the signs and symptoms of the disorder.

  • How often do they occur?
  • How much do they impact the patient’s functioning?
  • How much do they impact the patient’s safety?

Generating a severity is based on your clinical experience and can sometimes feel subjective. But as you work with more patients, the process gets easier and faster.

Keep reading for plenty of examples of severity levels.

How to Diagnosis Dysarthria

Dysarthria: Assess the Signs & Symptoms

Dysarthria Signs & Symptoms
Weakness of the tongue, lips, jaw, cheeks, tongue, and/or palate
Facial droop causing slurred speech
Decreased ROM of the lips, jaw, cheeks, tongue, and/or palate
Difficulty with breath support when talking or trouble trying to control their breath when speaking
Slurred or difficult-to-understand speech
Too slow or too fast when speaking
Too quiet or too loud speech due to weakness or difficulties with breath control
Consistent error patterns
Sound/syllable repetitions
Sound prolongations

Dysarthria: Determine the Severity

In general:

  • Mild dysarthria
    • Symptoms of dysarthria that slightly affect speech
    • Symptoms occur some of the time
    • And/or their communication is fair-good

  • Moderate dysarthria
    • Symptoms of dysarthria that moderately affect speech
    • Symptoms occur some to most of the time
    • And/or their communication is poor-fair

  • Severe dysarthria
    • Symptoms of dysarthria that greatly affect speech
    • Symptoms occur most of the time
    • And/or their communication is poor

How To Diagnosis Dysphonia or Voice Disorder

how to diagnose voice disorder

Voice: Assess the Signs & Symptoms

Voice Signs & Symptoms
Aphonia or no voice
Strangled or strained/tense vocal quality (like speaking on little breath or holding their breath)
Hoarse or rough-sounding voice
Weak or breathy quality, often losing their breath when speaking
Too low or high of a pitch, or pitch breaks
Abnormal resonance – hypernasal (everything sounds like they are speaking through their nose), hyponasal (a plugged nose sound), or cul-de-sac resonance
Too loud or too soft of a voice
Frequent coughing/throat clearing when speaking
Complains of losing their voice often or vocal fatigue
May run out of breath when talking
Feels like they have to really strain or ‘work hard’ to talk
Reports throat pain or stiffness
Voice changes throughout the day

Voice: Determine the Severity

In general:

  • Mild voice disorder
    • Symptoms of a voice disorder slightly affect vocal quality
    • Symptoms occur some of the time
    • And/or their communication is fair-good
  • Moderate voice disorder
    • Symptoms of a voice disorder moderately affect vocal quality
    • Symptoms occur some to most of the time
    • And/or their communication is poor-fair
  • Severe voice disorder
    • Symptoms of a voice disorder greatly affects vocal quality
    • Symptoms occur most of the time
    • And/or their communication is poor

How To Diagnosis Dysphagia

how to diagnose dysphagia

If your patient has only oral symptoms, they may have oral dysphagia. If they have only pharyngeal symptoms, they may have pharyngeal dysphagia.

If they have a combo of both oral and pharyngeal dysphagia, they may have oropharyngeal dysphagia.

If you’re uncertain how to categorize your patient’s symptoms, it’s okay to land on, “the patient demonstrates dysphagia.”

What About Esophageal Dysphagia?

Speech-language pathologists don’t diagnose esophageal dysphagia. But if a qualified specialist (radiologist, gastroenterologist, etc.) already made the diagnosis, you can use it.

If the patient doesn’t yet have the diagnosis, note your observations (“suspect esophageal dysphagia”) and make referrals as needed (“recommend referral to GI”).

Oral Dysphagia: Assess the Signs & Symptoms

Oral Dysphagia Signs & Symptoms
Food or liquid spilling from the mouth
Pocketing or residue of food or liquid in the mouth
Food or liquid in the mouth, oral stasis after the swallow
Difficulties closing lips when eating/drinking
Unable to fully chew food properly
Chews for an excessively long time
Spitting food or liquids out
Food or liquids coming out of the nose
Drooling or difficulties managing saliva

Pharyngeal Dysphagia: Assess the Signs & Symptoms

Pharyngeal Dysphagia Signs & Symptoms
Coughing or throat-clearing during or after eating or drinking
Delay in initiation of the swallow
Decreased hyolaryngeal elevation upon palpation
Vocal quality changes during or after eating or drinking
Difficulties with breath coordination and swallowing
History of recurrent aspiration pneumonia

Esophageal Dysphagia: Assess the Signs & Symptoms

While we don’t diagnose esophageal or pharyngoesophageal dysphagia, it’s best practice to document your observations and refer your patients to a specialist for diagnosis and treatment.

Esophageal Dysphagia Signs & Symptoms
Food sticking or feeling stuck in the neck
Weight loss, dehydration, or unable to eat enough (could be pharyngeal-related, too)
Complaints of esophageal pain or discomfort
History of GERD or acid reflux

Determine the Severity

In general:

Mild dysphagia

  • Symptoms of dysphagia slightly affect chewing and/or swallowing
  • Symptoms occur some of the time
  • And/or their nutritional intake, hydration, and/or swallowing safety is fair-good

Moderate dysphagia

  • Symptoms of dysphagia moderately affect chewing and/or swallowing
  • Symptoms occur some to most of the time
  • And/or their nutritional intake, hydration, and/or swallowing safety is poor-fair

Severe dysphagia

  • Symptoms of dysphagia greatly affect chewing and/or swallowing
  • Symptoms occur most of the time
  • And/or their nutritional intake, hydration, and/or swallowing safety is poor

How To Diagnosis Acquired Apraxia of Speech

how to diagnose acquired apraxia of speech

Apraxia: Assess the Signs & Symptoms

Acquired Apraxia of Speech Signs & Symptoms
Distortions of sounds & sound substitutions
Increased distortions with increased speech rate, utterance length, and/or complexity
Slow rate of speech
Difficulties with increased syllables and sequencing of words and sounds
Use of equal stress in syllables or words when speaking
Inconsistent errors
Difficulties initiating speech
May have groping of the mouth, tongue, lips when attempting to imitate or speak
Voicing errors of sounds
May try to self-correct
Repetitions of sounds and syllables
Sound prolongations

Apraxia: Determine the Severity

In general:

Mild apraxia of speech

  • Symptoms of apraxia slightly affect speech
  • Symptoms occur some of the time
  • And/or their communication is fair-good

Moderate apraxia of speech

  • Symptoms of apraxia moderately affect speech
  • Symptoms occur some to most of the time
  • And/or their communication is poor-fair

Severe apraxia of speech

  • Symptoms of apraxia greatly affect speech
  • Symptoms occur most of the time
  • And/or their communication is poor

How To Diagnosis Fluency Disorders

how to diagnose fluency disorder

Fluency Disorder: Assess the Signs & Symptoms

Fluency Disorders Signs & Symptoms
Whole single-syllable word repetitions
Part-word or sounds/syllable repetitions
Prolongations of consonants
Excess tension when trying to produce sounds/words
Rapid or irregular rate
Avoiding certain sounds, words when speaking
Excessive use of filler such as ‘uh’ or ‘um’

Fluency Disorder: Determine the Severity

In general:

Mild fluency disorder

  • Symptoms of the fluency disorder slightly affect speech
  • Symptoms occur some of the time
  • And/or their communication is fair-good

Moderate fluency disorder

  • Symptoms of the fluency disorder moderately affect speech
  • Symptoms occur some to most of the time
  • And/or their communication is poor-fair

Severe fluency disorder

  • Symptoms of the fluency disorder greatly affect speech
  • Symptoms occur most of the time
  • And/or their communication is poor

How To Diagnosis Cognitive Communication Deficit

how to diagnosis cognitive communication disorders

Cognitive Communication Deficits: Assess the Signs & Symptoms

Cognitive Communication Deficits Signs & Symptoms
Difficulties with immediate, short-term, or long-term memory tasks
Difficulties sustaining, alternating, or dividing attention during tasks or even in conversation
Trouble with problem-solving that affects daily safety or during therapy tasks
Impulsivity
Difficulties multitasking
Difficulties organizing thoughts; appears scattered when speaking
Has trouble sequencing
Difficulties with visual-spatial tasks such as scanning
Disoriented

Cognitive-Communication Deficits: Determine the Severity

In general:

Mild cognitive-communication deficits

  • Symptoms of the cognitive-communication disorder slightly affect memory, attention, and/or executive functioning
  • Symptoms occur some of the time
  • And/or their safety and/or independence in daily life is fair-good

Moderate cognitive-communication deficits

  • Symptoms of the cognitive-communication disorder moderately affect memory, attention, and/or executive functioning
  • Symptoms occur some to most of the time
  • And/or their safety and/or independence in daily life is poor-fair

Severe cognitive-communication deficits

  • Symptoms of the cognitive-communication disorder greatly affect memory, attention, and/or executive functioning
  • Symptoms occur most of the time
  • And/or their safety and/or independence in daily life is poor

How To Diagnosis Aphasia

how to diagnose aphasia

If your patient has a combo of both receptive and expressive aphasia, they may have receptive-expressive aphasia or mixed receptive-expressive aphasia.

Receptive Aphasia: Assess the Signs & Symptoms

Receptive Aphasia Signs & Symptoms
Difficulties with reading comprehension
Unable to fully understand what is said to them or what they heard
Difficulties with matching tasks
Difficulties following directions, both written or spoken

Expressive Aphasia: Assess the Signs & Symptoms

Expressive Aphasia Signs & Symptoms
Word-finding difficulties
Reduced sentence length when speaking
Lack of nouns, verbs when speaking
Errors with syntax
Excessive amount of fillers
Writing difficulties related to spelling, forming letters, words
Unable to communicate wants or needs verbally or by writing

Aphasia: Determine the Severity

In general:

Mild aphasia

  • Symptoms of aphasia slightly affect language
  • Symptoms occur some of the time
  • And/or their communication is fair-good

Moderate aphasia

  • Symptoms of aphasia moderately affect language
  • Symptoms occur some to most of the time
  • And/or their communication is poor-fair

Severe aphasia

  • Symptoms of aphasia greatly affect language
  • Symptoms occur most of the time
  • And/or their communication is poor

Speech Therapy Diagnosis ICD-10 Codes PDF

ASHA maintains an updated list of ICD-10 codes related to speech, language, and swallowing disorders.

Click on the image below to be directed to their PDF download.

speech therapy diagnostic codes
Image by ASHA.org

Speech Therapy Materials!

The Adult Speech Therapy Starter Pack includes 900+ pages of functional, evidence-based materials (PDFs).

It’s designed for Speech-Language Pathology professionals working with adults in Hospitals, Residential Care Facilities, Home Health, Telehealth, and Outpatient Clinics.

Who Is The Starter Pack For?

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