Hearing Loss in ICD-10
Hearing loss is a common problem caused by noise, aging, disease, and heredity. According to the National Institutes of Health, an estimated one-third of people in the U.S. between the ages of 65 and 75 have some degree of hearing loss, while close to one-half of people over 75 years of age are affected.
According to the American Speech-Language-Hearing Association, hearing loss can be categorized by which part of the auditory system is damaged.
Conductive hearing loss occurs when sound is not conducted efficiently through the outer ear canal to the eardrum and ossicles of the middle ear. Conductive hearing loss usually involves a reduction in sound level or the ability to hear faint sounds. This type of hearing loss can often be corrected medically or surgically.
Sensorineural hearing loss (SNHL) occurs when there is damage to the inner ear (cochlea), or to the nerve pathways from the inner ear to the brain. SNHL reduces the ability to hear faint sounds. Even when speech is loud enough to hear, it may still be unclear or sound muffled. Most of the time, SNHL cannot be medically or surgically corrected. This is the most common type of permanent hearing loss.
Mixed hearing loss is conductive hearing loss with sensorineural hearing loss. In other words, there may be damage in the outer or middle ear, and in the inner ear (cochlea) or auditory nerve. The emphasis is usually to treat medically and surgically those portions that can be treated.
Ototoxic hearing loss is drug-induced damage to the ear can result in sensorineural hearing loss, tinnitus, and dizziness. Any medication that damages the ear and causes hearing loss is considered ototoxic. The damage may be permanent, or may return to normal after the medication is stopped. It may occur in one or both ears, and may not be to the same degree in both ears.
Presbycusis is hearing loss that occurs gradually as a person ages. Hearing loss is usually more pronounced for high-pitched sounds. For example, a person with presbycusis may not be able to hear a bird chirp, but could hear a truck rumbling outside. Presbycusis is mainly caused by changes in the inner ear of a person as they age, but may also be due to changes in the middle ear, or changes along nerve pathways that lead to the brain. It is most often bilateral and affects both ears equally.
Documentation and Code Selection
Good clinical documentation should indicate the type of hearing loss, laterality and, if ototoxic hearing loss is present, the drug that caused the reaction and whether it was a poisoning or and adverse effect. Codes for hearing loss are H90-H94, Other disorders of the ear. There are unilateral (left or right) and bilateral choices. In addition, each subcategory contains a code for unspecified laterality. There is also a subcategory (H91.2) for sudden idiopathic hearing loss, which is for sudden hearing loss with no known no cause.
H90.0 Conductive hearing loss, bilateral
H90.1- Conductive hearing loss, unilateral with unrestricted hearing on the contralateral side
H90.3 Sensorineural hearing loss, bilateral
H90.4- Sensorineural hearing loss, unilateral with unrestricted hearing on the contralateral side
H90.6 Mixed conductive and sensorineural hearing loss, bilateral
H90.7- Mixed conductive and sensorineural hearing loss, unilateral with unrestricted hearing on the contralateral side
H91.0- Ototoxic hearing loss
H91.2- Sudden idiopathic hearing loss
For ototoxic hearing loss, an instructional note specifies: If the hearing loss is due to a poisoning, the code for the poisoning (including the drug) is listed first, followed by the code for ototoxic hearing loss. If the hearing loss is due an adverse effect of a drug, which is a drug that causes a reaction when taken correctly as prescribed, then the ototoxic hearing loss is listed first, followed by the adverse effect code.
Example 1: A 20-year-old patient presents with a history of progressive left hearing impairment for the past five years. There is no history of ear discharge, tinnitus, vertigo, or trauma. Otoscopic exam reveals both ear canals and TMs to be normal. Tuning for tests confirmed left conductive hearing loss. Proper coding is H90.12 Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side.
Example 2: A 55-year-old man presents with sudden profound hearing loss in his right ear a few days prior to his appointment. He denies vertigo, but does complain if ringing in the ear. Exam indicates normal ear canals, TMs, and vestibule-ocular reflexes. Audiogram revealed total loss of hearing on the right side. Tuning fork test confirms the hearing loss to be sensorineural and intra-tympanic dexamethasone treatment was started. Proper coding is H90.41 Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side.
Example 3: A toddler is evaluated with hearing loss. His tests reveal abnormal middle ear results with fluctuating hearing loss. He is diagnosed with bilateral mixed hearing loss. Coding is H90.6 Mixed conductive and sensorineural hearing loss, bilateral.