Vocal nodules treatment
Vocal nodules treatment is used to treat the callus-like growths that form on the vocal folds in the larynx. These bumps interfere with the vibration of the vocal cords when we speak. This causes changes in vocal quality which can negatively impact an individual’s quality of life.
According to the American Speech-Language-Hearing Association (ASHA), vocal cord nodules (also known as vocal nodules or vocal fold nodules) are one of the most common causes of Dysphonia. Dysphonia is a voice disorder that occurs when the pitch, quality, or loudness differs from what is considered appropriate for an individual.
Vocal nodules can be caused by a variety of factors. Typically, the cause of the nodules is vocal abuse.
Vocal abuse includes:
- Yelling
- Exposure to certain allergens
- Smoking
- Excessive caffeine and/or alcohol use
- Singing
- Muscle tension
- Thyroid problems
- Reflux
If there are concerns for vocal nodules, the recommended course of treatment is to see an Otolaryngologist (Ear, Nose, and Throat doctor or “ENT”) and a Speech-Language Pathologist (SLP). To achieve the best outcome, timely diagnosis and vocal nodules treatment is critical.
The SLP has a crucial role in the evaluation and vocal nodules treatment. Voice therapy with a Speech Language Pathologist can help clients by providing them with education on vocal hygiene, relaxation strategies, and techniques for coordinating breathing and speech.
Here’s how vocal nodules are diagnosed, and what speech therapy techniques can be used for vocal nodules treatment. We’ll also guide you through billing protocols and best practices for developing a vocal nodules treatment plan for your client.
Diagnosis
Vocal nodules treatment starts after an accurate diagnosis is made.
The following are possible signs and symptoms of vocal nodules:
- Hoarse vocal quality
- Harsh voice
- Breathiness
- Raspy voice
- Neck pain
- A shooting pain from ear to ear
- Loss of voice
- Breaks in voice or sudden changes in pitch
Individuals should refer to a doctor if they have had a hoarse voice for more than 2 to 3 weeks. At that time, he or she may be referred to an ENT, SLP, or another specialist that can help.
Timely intervention can help prevent or lessen further vocal abuse that can worsen vocal nodules or cause vocal polyps, which are typically larger than nodules.
If indicated, an Otolaryngologist (ENT) can perform an imaging study known as a Laryngoscopy. This is an endoscopy of the vocal cords.
During a Laryngoscopy, a small, spaghetti-like tube with a camera is directed through the individual’s nose, downward to the level of the larynx. Through this, the ENT is able to view the vocal cords to determine if there is a presence of vocal nodules.
An ENT may choose to perform a different evaluation known as a Stroboscopy to help determine if there is a presence of vocal nodules. During a Stroboscopy, a camera on a small tube with a flashing light is placed through the individual’s nose and is sent past the Pharynx to the level of the vocal cords. The imaging on a Stroboscopy shows the movement of the vocal cords as they vibrate.
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A Speech Therapy Evaluation for an individual with vocal nodules may include:
- Case History
- Clinical assessment of vocal quality during speech
- Assessment of the client’s ability to change pitches and alter vocal volume
- Evaluation of sustained phonation (how long the client can produce a vocalization at a time)
- Review of evaluations and imaging from other specialists, such as ENT
Speech therapy for vocal nodules
Vocal nodules treatment
Speech Therapy is typically recommended for children or adults with vocal cord nodules. The Speech Therapist’s role includes completing an evaluation and providing voice therapy to improve the individual’s vocal quality.
These techniques are often used in vocal nodules treatment:
- Recommendations for behavioral modifications The SLP may recommend changes to the client’s lifestyle that can improve vocal quality. Known as improving vocal hygiene, this may include drinking more water, avoiding alcohol or caffeine, quitting smoking, or avoiding allergens.
- Voice therapy Techniques like easy onset, light contact, and reduced vocal volume can reduce harsh vocal use. Reducing the length of sentences spoken and increasing pauses during speech can prevent pitch breaks.
- Breathing exercises
Breathing exercises may be used, such as paused breathing and belly breathing as part of vocal nodules treatment.
- In paused breathing, the client sits upright, breathes in gently through the nose, then sticks his or her tongue out of the mouth, past the bottom lip while exhaling through the mouth. The tongue stretching forward in this way can help open the airway at the level of the vocal cords.
- Belly breathing involves the client sitting with their neck and shoulders relaxed, then placing their hands on their belly. The client breathes in gently through the nose, concentrating on having their belly push against their hand. He or she produces an “S” sound while slowly exhaling.
Duration and frequency of speech therapy sessions depends on the severity of the impact of the vocal cord nodules on the client’s voice. Vocal nodules treatment and therapy may be recommended one to two times per week for several months.
After that time, the SLP may recommend that the client work on a home program to generalize the strategies and techniques learned in therapy. Speech Therapy sessions might then be reduced in frequency to involve the client checking in once per month.
Billing for vocal nodules treatment
J38.2 is the ICD-10 code to use for nodules of the vocal cords.
When diagnosing a voice disorder due to vocal cord nodules, the SLP may use one of the following ICD-10 codes:
- R49.9: Unspecified voice and resonance disorder
- R49.0: Dysphonia; Hoarseness
- R49.1: Aphonia; Loss of voice
- R49.8: Other voice and resonance disorders
- R49.9: Unspecified voice and resonance disorder; change in voice NOS; Resonance disorder NOS
To code a Speech Therapy session that includes voice therapy for vocal nodules, the SLP can use the CPT code 92507: Speech, language, voice, communication, and/or auditory processing disorder treatment.
Speech Therapy Evaluations of voice and resonance (ex: vocal quality, pitch, loudness, resonance, and respiration) should be coded with CPT 92524.
SLPs can refer to ASHA’s 2023 ICD-10-CM Diagnosis Codes list for details and guidance on coding treatment and evaluation for voice disorders.
Mistakes to avoid in billing for vocal nodules treatment
Speech-Language Pathologists should be careful not to charge the CPT 92524 for evaluation of voice in conjunction with another speech-language evaluation CPT code, such as 92521 (speech fluency evaluation) or 92522 (evaluation of speech sound production).
The CPT code 92507 for a speech therapy session that includes voice therapy is procedure based (not time based), and should only be used once per day.
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Resources through TheraPlatform
Vocal cord nodules can affect an individual’s vocal quality, causing it to sound harsh, hoarse, breathy, or marked by pitch changes and breaks. This can negatively impact a client’s quality of life.
Speech Therapy is a crucial aspect of a team approach to vocal nodules treatment. With specialized techniques and the appropriate client and family education, symptoms from vocal cord nodules can improve.
SLPs should stay current on best practices for working with a client who has vocal cord nodules. It’s also important for therapists to use the most accurate ICD10 and CPT codes for documentation. This will help ensure reimbursement and prevent denials from payors.
Resources
SLPs working with individuals who have a diagnosis of vocal cord nodules can utilize TheraPlatform, an all-in-one EHR, practice management and teletherapy tool built specifically for therapists. Sign up for a 30-day, free trial of TheraPlatform with no credit card required. Cancel anytime.
More resources
- CPT code 92507
- Expressive disorder
- Ultimate teletherapy ebook
- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Practice
