Choose with Clarity Hearing Loss Supply Codes

With so many devices to choose from,
knowing what’s out there is key to proper reimbursement.

By Marita Cable-Camilleis, CPC

 

You would think that someone who has a vested interest in audiology would be an authority on the subject. While attending a four-day National Hearing Loss Association of America (HLAA) Convention in Providence, R.I., June 21-24, 2012, however, I quickly realized that there is no such thing as too much information, and that I had a lot more to learn. I’d like to share with you some valuable tips for reporting hearing-assistance technology supplies that I picked up at the convention so that you, too, may code hearing loss equipment with clarity.

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Many Aid Choices, Many Code Choices

Most familiar hearing aid HCPCS Level II codes are classified to V5030–V5267, but many prosthetic implant/hearing assist supply codes also fall into categories L8613–L8629 and L8690–L8693.

For example, new sound processor devices for cochlear implants and cochlear bone-anchored hearing aid (BAHA) implants are reported with L8614 Cochlear device, includes all internal and external components and L8690 Auditory osseointegrated device, includes all internal and external components, respectively. Replacement implants are reported with L8619 Cochlear implant, external speech processor and controller, integrated system, replacement and L8691 Auditory osseointegrated device, external sound processor, replacement.

Bonus tip: Report surgical implantation of cochlear implants with CPT® 69930 Cochlear device implantation, with or without mastoidectomy. For BAHA, 69714 Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy or 69715 Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; with mastoidectomy. When implants are placed in both ears, you may append modifier 50 Bilateral procedure. A child under the age of five would wear a headband for BAHA (or Ponto Pro) without surgery.

In other examples for different body locations, HCPCS Level II code V5095 Semi-implantable middle ear hearing prosthesis is for Vibrant Soundbridge® (VSB), a semi-implantable electromagnetic hearing aid. Another middle ear implant, called Envoy Esteem®, is fully implantable with no external components. This implant is also coded like the VSB semi-implant with CPT® 69799 Unlisted procedure, middle ear. For an in-the-mouth (ITM) device called SoundBite, used for bone conductive loss, report L9900 Orthotic and prosthetic supply, accessory, and/or service component of another HCPCS L code.

According to Consumer Reports (“How To Buy a Hearing Aid,” July 2009), you cannot truly “compare” hearing aids because no two people have the same kind of hearing loss (type, severity, and configuration). With so many hearing aids—classified as monaural, binaural, and bilateral—it is easier to keep track of them using a chart, like the one shown in Table A. If a patient is diagnosed as having unilateral hearing loss and one deaf ear, a choice of bilateral contra-lateral routing of signals (BICROS) may be appropriate. Contra-lateral routing of signals (CROS) is used when a patient has one ear with normal hearing and one deaf ear.

One side of chart has the body-location variable and the other side lists hearing loss diagnosis variables mixed with manufacturers’ variables. Some hearing aids may be adjusted for high and/or low frequency hearing losses.

V5298 Describes Aids NOC

Several increasingly popular hearing aids are not yet specifically described by HCPCS Level II codes, such as receiver-in-the-canal or receiver-in-the-ear (ITE) devices. A small version of ITE is called half shell. Slim-tubing behind the ear (BTE) devices without ear molds are called open fit or over the ear; they are also called mini-BTE aids. These new hearing aids have microphones located in the ear, rather than on the hearing aid itself, and create a more natural sound and less wind noise. The newest, smallest completely in-the-canal (CIC) devices are called mini-CICs or invisible in the canals. If these new hearing aids are not classified, they could be coded as V5298 Hearing aid, not otherwise classified.

Alternate Hearing Assistance Technologies

Not all assistive listening devices are specifically coded because of multi-functionality. Captioned telephones such as CapTel® and CaptionCall® may be included in the HCPCS Level II code V5274 Assistive listening device, not otherwise specified, or simply reported with V5268 Assistive listening device, telephone amplifier, any type. These codes may also include hearing aid compatible smartphones. A modern digital hearing aid may have the ability to be controlled remotely by the patient’s cell phone.

Some assisted listening devices have not yet been coded because they are geared more toward groups, rather than individuals. One example is the increasingly popular “looping” system that is more common in Great Britain and Scandinavia. In this setting, an electromagnetic wire is looped around a room (or a ticket booth) to the speaker microphone, so anyone nearby can turn on the telecoil (t-coil) switch of his or her custom-made hearing aid (or cochlear implant) to hear the speaker more clearly. Approximately 69 percent of all hearing aids have a t-coil, which can be turned on for hearing-aid compatible phones with optional neck loops plugged in. T-coils (including related batteries, feedback-suppression capability, and directional microphones) are not currently specified in HCPCS Level II codes for hearing aids.

Even a non-deaf person can hear better with a headphone and inductive loop receiver, which picks up signals from a loop system while cutting off background noise. There are also personal loops just for television, which may be reported with V5270 Assistive listening device, television amplifier, any type.

New Receivers, Transmitters, and Microphones

For 2013, the descriptor for V5267 Hearing aid or assistive listening device/supplies/accessories, not otherwise specified was revised and new codes V5281–V5290 were added to accommodate personal FM/DM auditory devices, which are most often used with hearing aids to improve the signal-to-noise ratio. This allows the listener to better hear in the presence of background noise.

FM/DM auditory devices direct sound from a transmitting device (FM/DM transmitter) via a frequency or digitally modulated signal to a receiving device (FM/DM receiver), which may be coupled to a hearing device. A complete FM/DM system typically consists of a transmitter and a receiving device. If the receiver is built into a new hearing aid, you may report V5288 Assistive listening device, personal FM/DM transmitter assistive listening device for the transmitter only.

Another system creates a “public address-type” system with a wireless microphone, transmitting sound to receivers attached to loudspeakers and/or to those attached to hearing aids. For example, Inspiro® is an FM transmitter for teachers to wear in the classroom, and the DynaMic is a cordless microphone designed to be used with it. To combine all three components (receiver(s), transmitter, and microphone), use V5281 Assistive listening device, personal FM/DM system, monaural, (1 receiver, transmitter, microphone), any type for one receiver or V5282 Assistive listening device, personal FM/DM system, binaural, (2 receivers, transmitter, microphone), any type for two receivers (one for each ear).

Personal amplifiers (V5274), such as Pocketalkers®, are useful when FM systems, infrared systems, and hearing loop (or induction loop) systems are not available.

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Table A
TYPE OF HEARING AID OR IMPLANT CONDUCTIVE LOSS: MIXED LOSS: CONTRALATERAL ROUTING OF SIGNAL BILATERAL CROS DIGITAL PROGRAM DIGITAL
AIR  BONE SENSORI-NEURAL CROS BICROS ANALOG ANALOG PROGRAM DIGITAL DISPOSABLE
SITE ON BODY
In the Mouth (ITM) L9900
Inner Ear:
Cochlear Implant
L8690

L8691

L8614

L8619

Middle Ear:
Semi-implant (VSB)
V5095
Completely In the Canal (CIC) V5242*

V5248**

V5244*

V5250**

V5254*

V5258**

V5262*

V5263**

In the Canal (ITC) V5243*

V5249**

V5245*

V5251**

V5255*

V5259**

V5262*

V5263**

In the Ear (ITE) V5050*

V5130**

V5170 V5210 V5246* V5252** V5256*

V5260**

V5262*

V5263**

Behind the Ear (BTE) V5060*

V5140**

V5180 V5220 V5247* V5253** V5257*

V5261**

V5262*

V5263**

Body Worn V5030* V5040* V5100***

V5120**

In Eyeglasses V5070 V5080 V5150 V5190 V5230
Hearing Aids
Not Classified
V5298
Key:           * = monaural  ** = binaural   *** = bilateral

 

Marita Cable-Camilleis, M.Ed., CPC, is treasurer of HLAA’s Cape Cod chapter. She has severe hearing loss and has worn hearing aids since the age of three. She has done considerable research in the field of audiology.

 

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One Response to “Choose with Clarity Hearing Loss Supply Codes”

  1. Andrew@MyHearGear says:

    Hearing aids usually improve the user’s social, psychological and physical sense of well-being.

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