Otolaryngology Coding Alert

Question: We are not getting paid for V codes when they are used for ear and hearing exams. What diagnosis should we use after the tubes are removed and the patient no longer has otitis?

Gael Derouin
Effingham, Ill.

Answer: If the patient has a follow-up exam after tube placement, and the physician is examining the ears to determine if the tubes have been effective in treating the otitis media (381.xx-382.xx), you may code otitis as the reason for the visit, says Kathy Zmuda, CPC, CCS-P, lead inpatient coder for CIGNA Healthcare in Peoria, Ariz.

Your primary diagnosis is the reason for the visit, and the physician does not know that the otitis is gone until after the examination is performed. When performing hearing tests, you may code V41.2 (problems with hearing) with the otitis code as a secondary entry. If you try V41.2 and the claims still are being denied, contact the carrier and explain what is going on and why the test is necessary. The people who are denying claims are not medical personnel and may not understand that chronic ear infections can lead to hearing loss and that the patient needs to be tested after treatment.