Listen to This Ear Condition Coding Advice, Part 2
Here are all the codes you need for hearing tests and hearing loss conditions. Last month, we looked at some common ear infections and the coding knowledge you need to correctly document them. In the second article of the series, we look at some common hearing loss disorders and the various tests your provider may use to detect them. Know the Codes for These Hearing Loss Conditions The American Speech-Language-Hearing Association (ASHA) identifies three basic types of hearing loss: Conductive, where an issue such as a blockage, an infection, a perforated eardrum, a middle ear infection, otosclerosis, or a congenital malformation in the external ear canal or the middle ear prevents sound waves from traveling to the cochlea, or inner ear. Treatment can include medication, surgery, hearing aids, bone conduction implants, or middle ear implants. Sensorineural, which can be caused by aging, loud noise, infections, ototoxic medications, head trauma, autoimmune disorders, tumors, or genetic factors. It can range from mild to severe, with the most severe being total deafness. Treatment options include conventional hearing aids, middle ear implants, or cochlear implants. Mixed, which occurs when the inner and middle to outer ear are affected. A combination of medications, surgery, hearing aids, and hearing implants can be used to treat mixed hearing loss, depending on the patient’s needs. ICD-10-CM navigation tip: Both conductive and sensorineural hearing loss are coded to H90.- (Conductive and sensorineural hearing loss). But before assigning a code, make sure you read the medical record carefully to report laterality. Bilateral conditions are reported with 4th character codes. So, bilateral conductive hearing loss is coded to H90.0 (Conductive hearing loss, bilateral). But if the condition is unilateral, you must then determine if the hearing on the contralateral side, or the other ear, is restricted (less than normal) or unrestricted (normal). So, you would use H90.A31 (Mixed conductive and sensorineural hearing loss, unilateral, right ear with restricted hearing on the contralateral side) if the patient has mixed conductive and sensorineural hearing loss on the right side and hearing loss on the left, while H90.71 (Mixed conductive and sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side) would be appropriate if the patient has mixed conductive and sensorineural hearing loss on the right side but normal hearing on the left. Familiarize Yourself With These 3 Common Hearing Loss Disorders In addition to the general hearing loss codes mentioned above, you may find yourself coding patient encounters for the following common conditions: This is also known as age-related hearing loss and gradually occurs over time, ending in the inability to hear as people age. This is most common in those over 60 years old. It affects both ears and can begin in as early as someone in their 30s or 40s and continue to worsen. Providers may recommend hearing aids and cochlear implants to treat this type of hearing loss. This is described as complete deafness in one or both ears and can be caused by genetic factors, injuries, infections, or severe damage to the inner ear or auditory nerve. Otolaryngologists will recommend cochlear implants and bone conduction devices for treatment. This is a hearing disorder where sound is perceived differently in each ear and is called double hearing. This can make listening to music very difficult. This can be caused by asymmetric hearing damage, including noise exposure or infections. Treatment varies depending on the underlying cause; hearing protection, avoiding noise exposure, and wearing hearing aids can help with the symptoms. In more extensive cases, an otolaryngologist may recommend cochlear implants or audiological therapy. Last, Understand These Common Ear Condition Testing and Procedures Essentially, there are four different commonly used hearing tests, according to MedlinePlus. Audiometry tests gauge a patient’s “ability to hear tones or words at different pitches and volumes.” They include pure tone tests, which evaluate a patient’s ability to be able detect sounds at different pitches and volumes; and speech tests, which do the same thing with speech with and without background noise. The codes for these tests include the following: Remember: Code 92551 represents a screening examination, which results in the patient either passing or failing the exam and being referred for additional testing; whereas the other tests are more comprehensive diagnostic examinations, which result in a specific diagnosis. Bone conduction tests involve using a tuning fork or similar device to test hearing through bone vibrations, which may indicate a blockage preventing sound from reaching the cochlea. The test is conducted with a pure tone audiometry test and coded to 92553. Tympanometry tests use a device to assess how well the eardrum and middle ear bones are processing sound. The codes for these tests include: You’ll use 92567 when the provider performs a tympanometry test only, while you’ll use 92550 and 92570 when they perform the other tests specified in the descriptors in addition. Otoacoustic emissions (OAE) tests also use a device to check for damage in the hair cells in the cochlea. The codes for these tests include: Again, like 92551, 92558 is a screening test usually used on newborns that yields a pass/fail result. Codes 92587 and 92588, on the other hand, reflect different degrees of evaluation complexity. Remember: Most hearing tests described by a CPT® code are bilateral. Should a provider perform unilateral testing, you’ll append modifier 52 (Reduced services) to the code as appropriate. Cristin Robinson, CPC, CPMA, CCC, CRC, CEMC, AAPC Approved Instructor, Education Coding Consultant, Bristol,
Tennessee, with Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
