Pitfalls of Generic Hearing Codes with Diagnostic Procedures

Question

Is it true that using the code 389.18 (sensorineural hearing loss, bilateral) with basic comprehensive audiometry (92557) will result in a denial of reimbursement?

Answer

Reimbursement is going to depend on the payer. 389.18 is a legitimate, recognized code, so it should not be problematic. If you are denied from Medicare for using 389.18, that's worth a report and appeal submission. However, 389.9 (hearing loss, unspecified) is a diagnosis code you need to stay away from. 389.9 and 389.10 (sensorineural hearing loss unspecified) were go-to codes years ago, but at that time we had far fewer diagnostic codes available to us. We have since added codes that increase specificity for sensory, neural, sensorineural, unilateral, bilateral, and asymmetrical designations. The general feeling among all payers, Medicare included, is that they want you to be as specific as you can. Some of them have gone on record to say that they will no longer recognize 389.9 or 389.10 because they are not specific enough. However, 389.18 is a specific, recognizable code.

Editor's Note: This Ask the Expert was taken from the eSeminar Reimbursement: The 2012 Perspective published on 2/9/2012. To access the recorded course, please go here: www.audiologyonline.com/ceus/recordedcoursedetails.asp?class_id=19955

Robert C. Fifer, Ph.D. is currently the Director of Audiology and Speech-Language Pathology at the Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine. He received his B.S. degree from the University of Nebraska at Omaha in Speech-Language Pathology with a minor in Deaf Education. His M.A. degree is from Central Michigan University in Audiology. And his Ph.D. degree is from Baylor College of Medicine in Audiology and Bioacoustics. Dr. Fifer's clinical and research interests focus on the areas of auditory evoked potentials, central auditory processing, early detection of hearing loss in children, and auditory anatomy and physiology. He is a Past-President of the Florida Association of Speech-Language Pathologists and Audiologists, a member of ASHA's Health Care Economics Committee, and the ASHA representative to the American Medical Association's Health Care Professions Advisory Committee for the Relative Value Utilization Committee in addition to being ASHA's representative to the AMA's Practice Expense Advisory Committee. Additional responsibilities at the state level include serving as a consultant to the Florida Department of Health's Children's Medical Services and the audiology representative to the Genetics and Newborn Screening Advisory Council.