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?
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
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
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
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
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
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
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
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 Materials!
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