Re: Help! Need correct Neurological terms, Ins. codes, therapy methods...

[Guest guest]

--- In @y..., " bargainmomof2 " <Momof2girls@c...>

wrote:

> I need to know the correct Neurological terms for

Apraxi/Dyspraxia,

> and for sensory integration dysfunction (DSI)

There's developmental verbal dyspraxia or developmental apraxia of

speech or there's developmental coordination disorder (fancy name

for dyspraxia, but this might only get you PT) I don't know codes,

but our SLP told us these were the names to use. An OT would provide

therapy for DSI/SID. I'm not sure about the code there, but you can

visit the SID group and ask there.

So, what therapy methods are

> best for a 30 month old girl?

I would assume a SLP trained in apraxia treatment would know the

best method to use. So far our SLP uses some PROMPT. When she

attempts sounds we touch the part of her face that she should

position. It's hard to explain, but for " o " we squeeze her cheeks

together using our thumb and forefinger so that her mouth would make

the " fish face " . Our military SLP who monitors her progress for the

military's EFMP program used an " icing " method where you touch the

articulators with an iced swab to try to get her to put her tongue

in the right place. But, you can't do this at home because you might

touch the wrong spot and then you would be totally be messing her

up! I only let her SLP do this one. I think it depends on the age,

attention span, and manner of the child.

Traci

[Guest guest]

Also, refer to post 10137. Traci

From: " kiddietalk " <kiddietalk@...>

Date: Sun May 19, 2002 11:54 am

Subject: Re: insurance YEAH!!!

Hi Deborah,

I'm sorry if I didn't get back to you. I really try to keep up with

the phone calls and emails - sometimes I feel like Lucy in the

chocolate factory.

I see Eileen told you about Deborah L. Van den Beemt, MS CCC-SLP, who

is in the NH/VT area and sends wonderful informative posts to this

list when she can -I copied her on here and her email is

van@... (She's working on something very exciting right now!!)

And already told you the address to post to our group -

and you can search archives as

well at this site at

/ For example (now

this is funny!!) -here is an oldie but goodie post to answer an

insurance question for Eileen (yes the same Eileen who just posted

about the good news from insurance that is now helping you too!) from

Marilyn Agin MD - another professional that used to post often and

now she's crazy busy and we are all wishing there was a way to clone

her and the few professionals out there that really understand our

children! So lets all hope that Dr. Laveman doesn't book himself up

too much as well!!

From: " Marilyn Agin M.D. "

Date: Thu Nov 29, 2001 11:46 am

Subject: Re: insurance (repost)

From: Marilyn Agin M.D.

-Dear Kari, I wanted to respond to your insurance code

question for apraxia. In the ICD 9 medical code book, #315.4 is

Dyspraxia Syndrome. The confusion is that is that many of the

#315 codes are developmental, but not this one. #784.69 is

probably the safer code to use in that it comes from the section

where the codes are neurologic. I am also adding to this a

previous post (#263) which further elucidates this:

One of the forces that most of our families with apraxic children

have had to deal at some time or another is the medical

insurers. If a medical professional or speech pathologist writes a

report or a bill for submssion to the insurance company, here are

some important tenets to follow:

-Oral/verbal apraxia is a neurologic disorder so never use the

word developmental or a code that is " developmental " in the report or

on the bill.

-Useful ICD codes for Apraxia of Speech are #315.40 or #781.3.

The latter code is also one used for Hypotonia, Sensorimotor

Integraton Disorder, and Coordinaton disorder, which may be

associated with apraxia of speech.

-If there is an associated expressive language disorder with the

apraxia, which is commonly the case, use #784.6 which is " other

symbolic dysfunction. " If #315.3, 315.31, 315.39, or 315.9 are used,

these are developmental codes and may not be reimbursed.

Often the insurance co. will ask your doctor to write a Letter of

Medical Necessity of Letter of Predetermination. This needs to

state the appropriate diagnosis and code number, state that the

diagnosis(ses) have a neurologic basis and are not

developmental, and intensive treatment by qualified, experienced

speech and occupational therapists is required. Often you need to

state the specialized nature of the therapy (PROMPT, oromotor,

sensory integration, etc.) and explain why your therapist is more

qualified than the one who is " in network " for provider. Have your

therapists state their specialized credentials and certifications.

-Define apraxia as a speech disorder where the brain signals

that go to the muscles and structures of the speech mechanism are

disrupted.

-Without therapy, children do not outgrow apraxia of speech.

Speech therapy is needed at least 4x week by experienced oral motor

speech therapists. Without this therapy, prognosis for improvement

is poor.

-The provider may only provide therapy for 2 months or 6 months

of therapy. Accept it and reapply with new goals set by your speech

pathologist.

Don't be discouraged by a rejection. That's what they want, They

want to wear you down, but don't let them. This is your child and

you have to continue the fight and go to the top person in the

plan. If they tell you this is a preexisting condition, this is

absolutely absurd when talking about a child.

Be advised though, that some insurers are better than others.

Some will never offer speech services unless your child has had a

stroke or accident. (What a horrible thought). If you have a choice

of insurers, make sure you choose one wisely. Look at the

benefits before you sign up.

Good luck!

Marilyn Agin, M.D.

Medical Director CHERAB Foundation

http://www.apraxia.cc

> Hello Everyone,

> I am trying to find out about what should be covered on my

> insurance. We have a private union insurance who basically does not

> cover anything. My son has Oral Apraxia, SI and pdd-nos. He is 2

1/2...

=====

[Guest guest]

I need to correct this advice after reading post 10137 from DR Agin.

Do not use a code which contains developmental or use the word

developmental. If you read post 10137 you will find the codes for

apraxia and DSI/SID.

Good luck because I am in the same boat right now, Traci

> > I need to know the correct Neurological terms for

> Apraxi/Dyspraxia,

> > and for sensory integration dysfunction (DSI)

>

> There's developmental verbal dyspraxia or developmental apraxia of

> speech or there's developmental coordination disorder (fancy name

> for dyspraxia, but this might only get you PT) I don't know codes,

> but our SLP told us these were the names to use. An OT would

[Guest guest]

--- bargainmomof2 <Momof2girls@...> wrote:

> I need to know the correct Neurological terms for

> Apraxi/Dyspraxia,

> and for sensory integration dysfunction (DSI) as

> will be seeing

> her Neurologist again on Monday, June 3rd? We know

> that has

> Hypotonia and a severe speech delay, but we have no

> other diagnosis.

> As he scoffed at the term Apraxia (he said it was a

> therapist's term)

> the last time I mentioned it (prior to knowing

> myself what it was), I

> want to go in prepared with terms he will

> understand. In a

> neurologist's language, how will I suggest to him to

> look into

> Apraxia/Dyspraxia and Sensory Integration

> Dysfunction as a possible

> diagnosis for ?

> Jill,

I am concerned that 's Neruologist is saying that

apraxia is a Therapist term. As far as I know Apraxia

is just that Apraxia, don't know any other name for

it.

> Also, I had read back to some posts regarding

> insurance codes and was

> confused as to the meaning of some...specially:

> 784.6 (or is it

> 784.69?)? What is the name of that code? Also, is

> the code 315.40

> for Dyspraxia Syndrome better than the other code

> above (I am

> assuming it means verbal dyspraxia)? Lastly, is the

> code 781.3 for

> Hypotonia and Sensory Dysfunction or just Hypotonia?

> I don't know if

> the codes will help much as I have a HMO

> (HealthNet), but I thought

> it might help validate my concerns with the

> Neurologist....

> To Answer your question to the insurance code I can

only respond to what we personally used to get our

insurance to cover. We used the 784.69 code and

finally our insurance covered speech, this code is

neurologic. Code 315.4 is Dyspraxia syndrome which is

fine except alot of 315 codes are developmental, so to

be safe it is best to use. If you are looking for

insurance to cover. My insurance was very specific as

to not covering developmental delays. That

" Developmental Delay " is a sure no no! Especially if

your child has apraxia.

If she is not diagnosed then it won't matter now until

she is. I made sure that the developmental ped. and

SLP used the code 784.69 which they were happy to do.

But his slp from EI on her session report uses the 315

codes but I don't fuss about it since it does not

affect our coverage for insurance, because they don't

see those reports.

Please go to message # 8923 in the archives from Dr.

Marilyn Agin. It is all there in 1 post. And truly one

you and everyone should print out and put in a place

that you can refer to it.

> Finally, the speech therpist at the center that

> Regional Center (our

> Cailifornia EI) sends to is not familiar

> really with Apraxia

> and was asking me what kind of therapy I had read

> about for Apraxia

> (which didn't make me feel confident). So, what

> therapy methods are

> best for a 30 month old girl? This center doesn't

> even have the

> Kaufman Speech Praxis test at their center...

> I am not all that surprised that the therapist does

not know about apraxia, there are many who do but alot

don't. What is good is that she is willing to learn

and has admitted that she does not know, I got rid of

3, who tried to convince me they knew how to treat

Jack and did not until I finally went to the prompt

institute web-site and found a prompt therapist who

had worked with apraxic children.

Has your daughter been diagnosed with apraxia, it

would be helpful if you suspect it and your

neurologist is poo-pooing the apraxia thing to go to

someone else to get that diagnosis, a SLP at a

hospital, developmental ped. Someone who can help you

get that diagnosis.

Hope this was helpful,

Eileen mom to Jack 3 and 17 months

> If I can ask one more question... Is the Kaufman

> Speech Praxis Test

> the most accurate test for Apraxia for a 30 month

> old child, or are

> there other tests available? I want the best

> one.... Also, if my

> child can not necessarily respond to questions, will

> this test work

> for her? Sometimes she'll repeat a word for me or

> say something

> spontaneous, but more so no than yes. Does this

> test only work if

> the child can cooperate?

>

> Thanks! If you need more info. on see my

> original into. post

> at:

>

/message/10291

>

> Jill

> Mom to (almost 30 months) with Hypotonia and

> speech delay

>

>

>

__________________________________________________

[Guest guest]

I'm not certain I've fully followed this thread, but I'd like to see if i

have...

So, in order to get this covered under insurance, we should first see a

neurologist and have a formal dx. Then we should discourage and or make sure,

the word developmental is not included? Is this correct? I'm going down this

road soon. The little bit of checking I've done said that developmental would

not be covered on my insurance. If it's an issue of my sons disability,

blindness, then it would. It's not likely that it is as that would only be

developmental anyway. But I do believe the person I spoke with indicated that

neurological is covered, which is why i've interpreted the conversation the way

i typed above.

Anyone have good recommendations in North Texas, Fort Worth area? I have a list

of ST in our area that will be covered thru Principal, our insurer.

Lynn

[ ] Re: Help! Need correct Neurological terms, Ins.

codes, therapy methods...

I need to correct this advice after reading post 10137 from DR Agin.

Do not use a code which contains developmental or use the word

developmental. If you read post 10137 you will find the codes for

apraxia and DSI/SID.

Good luck because I am in the same boat right now, Traci

> > I need to know the correct Neurological terms for

> Apraxi/Dyspraxia,

> > and for sensory integration dysfunction (DSI)

>

> There's developmental verbal dyspraxia or developmental apraxia of

> speech or there's developmental coordination disorder (fancy name

> for dyspraxia, but this might only get you PT) I don't know codes,

> but our SLP told us these were the names to use. An OT would