Apraxia ICD 10 is the code used for Childhood Apraxia of Speech (CAS), a motor speech disorder characterized by inconsistent sound errors, groping movements during speech, increased use of gestures, and vowel errors. Speech-language therapists need to be mindful of the specific conditions and codes associated with Apraxia and similar disorders to properly diagnose and treat a CAS client. In addition, specificity when using this code will aid in governmental and insurance compliance.
According to the American Speech-Language-Hearing Association (ASHA), Childhood Apraxia of Speech is “a neurological childhood (pediatric) speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits (e.g., abnormal reflexes, abnormal tone)”.
Speech-Language Pathologists are likely to have a client on their caseload with a diagnosis of Childhood Apraxia of Speech (CAS) at some point in their career. SLPs must understand the signs and symptoms of CAS.
Being familiar with the characteristics of CAS can help SLPs know when to accurately give this diagnosis and how to treat children with this particular speech disorder. It can also help Speech-Language Pathologists ensure they are following Medicaid and ASHA guidelines to document an ICD-10 code for certain clients to the highest degree of specificity.
Here’s what you need to know about Childhood Apraxia of Speech, including what ICD-10 code to use for the disorder, the criteria for symptoms of CAS, and the top-recommended resources to guide your treatment.
ICD-10 for Apraxia
As an SLP, you likely know that clinicians are required to use ICD-10 codes when diagnosing clients and charging for procedures. Therapists must use the appropriate codes to stay compliant with HIPAA regulations and for payment by Medicare, Medicaid, and private insurance companies.
R48.2 is the ICD-10 code to use when diagnosing a client with Childhood Apraxia of Speech. It is one of the few codes in the “R” series of ICD-10 codes that Speech-Language Pathologists can assign to a client in the absence of the client having any associated medical diagnosis.
According to the American Speech Language Hearing Association (ASHA), however, if the client’s diagnosis of Apraxia of Speech is secondary to another medical condition, that condition can be reported and could help support the speech diagnosis. Certain genetic disorders, syndromes, and neurological conditions or injuries can cause Apraxia. However, in many clients, the etiology of CAS is unknown.
ASHA recommends that if you are giving the diagnosis of ICD-10 R48.2 for Childhood Apraxia of Speech, you are knowledgeable about the diagnosis. This includes knowing how Apraxia differs from other speech sound disorders, such as an Articulation Disorder or Phonological Disorder.
Here is a handy table that lists types of Apraxia ICD 10:
| Disorder | ICD – 10 Code |
|---|---|
| Apraxia | R48.2 |
Signs and Symptoms of Apraxia
When giving a diagnosis of CAS, SLPs need to remember that Apraxia is a motor planning disorder and sound errors are typically inconsistent and may be atypical. This differs from an Articulation Disorder, in which a client demonstrates errors in producing individual sounds.
Apraxia also differs from a Phonological Disorder, which includes consistent sound errors that are rule-based (like Fronting, in which the glottal sounds /k/ or /g/ are produced in the front of the mouth, as /t/ or /d/).
Characteristics of Apraxia of Speech include:
- Inconsistent sound errors when an individual repeats the production of syllables or words
- coarticulatory transitions between sounds and syllables are lengthened and disrupted (longer pauses between certain sounds within words).
- Atypical intonation (putting an emphasis or stress on the incorrect syllable within a word).
- Increased use of gestures to compensate for speech production difficulties.
- Groping movements of oral musculature (including the lips, tongue, and jaw) during speech production.
- Vowel distortions.
- Voicing errors (such as saying “bye” for “pie”).
A child does not have to demonstrate all of the above characteristics to have a diagnosis of Childhood Apraxia of Speech. Clients with CAS may demonstrate any number of these signs. And some of these characteristics may not appear until the child is over 3 years old.
Signs of Apraxia in earlier years (approximately 18 months to 2 years old) may be:
- Delayed Expressive Language milestones (including saying first words later than what is developmentally expected)
- Limited expressive vocabulary
- Restricted phonemic repertoire (producing a limited variety of consonant and vowel sounds).
Prevalence of CAS
More research is needed to more accurately determine the prevalence of Childhood Apraxia of Speech. According to the national organization Apraxia Kids and research, CAS may affect 1 in 1000 children, and some sources believe this has recently increased.
Differential Diagnosis: When Not to Use the ICD-10 Code for Apraxia
Childhood Apraxia of Speech could be confused with other speech sound disorders or oral musculature disorders. To comply with ASHA guidelines and Medicaid guidelines, as outlined by the World Health Organization (WHO), clinicians must be confident in their ability to differentiate when it is appropriate to give the ICD-10 diagnosis for Apraxia.
Speech Language Pathologists must be sure not to use the code ICD-10 R48.2 for the following diagnosis:
- Articulation Disorder
- Phonological Disorder
- Dysarthria
- Oral Myofacial Disorder
The ICD-10 code for Apraxia can, however, be used for a client in conjunction with codes that indicate language disorders, such as F80.1 Expressive Language Delay or F80.2 Mixed Receptive Expressive Language Disorder.
Assessment & Treatment for Children with Apraxia
As mentioned, SLPs should differentiate Apraxia from other speech sound disorders. Assessing a child for Apraxia before age 3 is possible but can present certain challenges which make it difficult for a clinician to accurately and confidently give this diagnosis.
An assessment for a client who is suspected to have Childhood Apraxia of Speech may include:
- Oral Motor Examination (the clinician should take note of discoordination or difficulty consistently executing certain oral muscle movements).
- Speech sample
- Phonemic inventory
- Standardized Language Assessment (a formal assessment, such as the PLS-5 or REEL-3)
- Informal Language Assessment
- Formal Apraxia Assessment (such as the Kaufman Speech Praxis Test (KSPT)).
Treatment for children with Apraxia includes Speech Therapy. Due to the nature of Apraxia and motor learning principles, frequent weekly sessions are typically recommended. In some cases, Speech Therapy may be recommended 3 to 5 times per week for a client with Childhood Apraxia of Speech.
Some children with severe Apraxia of Speech may benefit from the use of Augmentative Alternative Communication, also known as AAC. AAC can help certain clients with CAS communicate effectively with others when their verbal speech intelligibility is significantly reduced.
