Commonly Used Codes for Speech-Language Pathology

F80.0 – Phonological or Articulation Disorders

Used when a child attempts to communicate thoughts/ideas but exhibits speech errors, ranging from mild to severe, which make it difficult to understand the child’s intended message

What might this look like?

• Distortion errors on certain sounds, such as difficulty producing the /r/ or /l/ sounds
• Omitting or substituting entire classes of sounds, such as omitting final consonants or consistently using “stop” consonants (such as /b/ or /t/) in place of “fricative” sounds (such as /s/ or /f/)
• Reduced speech intelligibility resulting in caregivers having to “interpret” for the child

When to refer:

• By 24 months (age 2;0), children should be nearly 75% intelligible to caregivers and at least 50% intelligible to unfamiliar listeners (strangers).
• By 36 months (age 3;0), children should be nearly 100% intelligible to their caregivers and at least 75% intelligible to unfamiliar listeners (strangers).

**NOTE: Even though some articulation or phonological errors may persist past this time, they should not generally impact the listener’s ability to understand the child’s message

F80.1 Expressive Language Disorder

Used when a child is able to effectively understand spoken language and age-appropriate concepts but has a marked delay in ability to express their own ideas/messages

What might this look like?

• A child who “understands everything” and is able to participate in daily activities but often does so quietly
• Child may have a limited or basic vocabulary compared to same aged peers
• Child may often leave out words or use poor/incomplete sentences with frequent grammatical errors
• Overuse of generic or nonspecific vocabulary such as “this” “that” or “thing”
• Difficulty telling or re-telling a story or relaying information in a clear and organized manner

When to refer:

• Child is not meeting milestones related to expressive language such as # of words
  • Expressive vocabulary (words used independently and with meaning, not imitated)
    • 18 months: minimum 10 words, average 50 words, high 170+ words
    • 2 years: minimum 50 words, average 250 words, high 440+ words
    • 3 years: minimum 250 words, average 1,000 words
    • 4 years: minimum 900 words, average 1,600 words
• Child is exhibiting frustrating from inability to communicate their thoughts/ideas
• Child has difficulty answering questions or talking about their day using vocabulary and sentence structures appropriate for their age

F80.2 – Mixed Receptive/Expressive Language Disorders

Used when child is delayed in both their UNDERSTANDING and EXPRESSION of language (this includes both spoken and written modalities)

What might this look like?

• Young child who does not demonstrate understanding of simple directions/requests or express basic wants/needs appropriate for their age
• Child who rarely initiates interactions with others – may not appear to understand the purpose of communication or may not appear motivated to engage with others
• Child who has difficulty understanding and using age-appropriate concepts such as spatial, quantitative, and temporal concepts
• School age children who may appear to not be listening or generally not understand assignments or expectations – could indicate difficulty with comprehension
• School age children who struggle to comprehend information in a written text despite ability to read the words

When to refer:

• Child is not meeting milestones related to comprehension and/or use of language
• Child’s communication difficulties are impacting their independence with routine daily activities
• Child shows limited interest or engagement in play or communication with peers or adults

F80.4 – Speech Delay due to Hearing Loss

Child is late to begin speaking and/or may exhibit speech sound errors (e.g., omissions, distortions) due to diagnosed hearing impairment; if this code is used, the hearing loss must be coded FIRST

F80.81 – Childhood Onset Fluency Disorder (includes stuttering & cluttering)

What might this look like?

• Child may exhibit one or more of the following types of stuttering like dysfluencies: repetitions (repeating part of a word); prolongations (stretching a word out); or blocks (difficulty getting a word out).
• Child may experience negative feelings/attitudes about their speech or talking in general.
• Child may exhibit behaviors

When to refer:

• Refer immediately if there is a family history of stuttering
• If no family history of stuttering, then refer if the stuttering persists for at least 6+ months.
• Onset of stuttering is after the age of 3½ years.
• Child tenses up, struggles when talking, says talking is hard, or avoids talking.

R48.2 – Apraxia, Childhood Apraxia of Speech

What might this look like?

• Often a notable discrepancy between what child a understands and what a child is able to express
• May see “groping” behaviors during speech; speech may appear very effortful
• Errors are often inconsistent; may say the same word a different way each time when asked to repeat it
• Words that are more familiar or frequently used are often clearer; new words are often more difficult for the child
• Child may experience difficulty with coordination of motor skills, as well; often co-occurs with dyspraxia

When to refer:

ASAP if child exhibits any potential signs of apraxia. Apraxia requires frequent and intensive skilled therapy services – early identification is key!

R63.31/R63.32 – Pediatric Feeding Disorder (acute/chronic)

What might this look like?

• Infant:
  • Difficulty latching to breast or bottle
  • Inefficient milk transfer resulting in long feeding times
  • Poor seal, resulting in loss of milk/formula on sides during feedings
  • Poor or slow weight gain
  • Mom may experience a low/poor supply or episodes of mastitis due to ineffective milk removal
• Child:
  • History of difficulty with feeding
  • Gagging, choking, or vomiting while eating or drinking
  • Limited diet or refusal to eat
  • Poor oral control, possible loss of liquid from mouth or nose
  • Poor or slow weight gain, low percentile in weight

When to refer:

For ALL suspected feeding disorders or feeding-related concerns, please refer immediately for further evaluation to ensure safe eating and maintain nutrition & hydration.