What New Audiology-Related ICD 10 Codes and Changes Went Into Effect on October 1, 2016?

Question

Answer

There are several new codes, but the ones with the biggest impact are those that affect coding for different type of hearing loss in different ears.  The new codes are:

• H90.A11: Conductive hearing loss, unilateral, right ear, with restricted hearing loss on the contralateral side
• H90.A12: Conductive hearing loss, unilateral, left ear, with restricted hearing loss on the contralateral side
• H90.A21: Sensorineural hearing loss, unilateral, right ear, with restricted hearing loss on the contralateral side
• H90.A22: Sensorineural hearing loss, unilateral, left ear, with restricted hearing loss on the contralateral side
• H90.A31: Mixed conductive and sensorineural hearing loss, unilateral, right ear, with restricted hearing loss on the contralateral side
• H90.A32: Mixed conductive and sensorineural hearing loss, unilateral, left ear, with restricted hearing loss on the contralateral side
  • Restricted means abnormal.
  • You would need to select two of the above codes to reflect different hearing losses in different ears.

Other new codes to consider are:

• H93.A1 Pulsatile tinnitus, right ear
• H93.A2 Pulsatile tinnitus, left ear
• H93.A3 Pulsatile tinnitus, bilateral
• H93.A9 Pulsatile tinnitus, unspecified ear
• H95.41 Postprocedural hemorrhage of ear and mastoid process following a procedure on the ear and mastoid process
• H95.42 Postprocedural hemorrhage of ear and mastoid process following other procedure
• H95.51 Postprocedural hematoma of ear and mastoid process following a procedure on the ear and mastoid process
• H95.52 Postprocedural hematoma of ear and mastoid process following other procedure  

Some other important ICD-10 coding considerations:

• The Medicare grace period for using unspecified codes ended on October 1, 2016.  As a result, you need to avoid the use of unspecified codes unless allowed by your Medicare contractor through their local coverage determination. Please consult guidance from private insurers related to whether or not they allow the use of unspecified codes. Sometimes you may need to contact the ordering/referring physician or primary care physician for guidance on specific diagnoses for medical necessity.
• Avoid the use of a Z code as a primary diagnosis. This can drive a denial.
• Do not use rule out diagnoses once you know the diagnosis does not exist (more information can be found here).
• Be aware of local coverage determinations from your Medicare contractors.  These policies determine what diagnoses are required for payment of specific codes.  Here are the current local coverage determinations that apply to audiology and their associated contactors:
  • Vestibular and Auditory Testing
    • Novitas
  • Tympanometry
    • First Coast
  • Vestibular Testing Only
    • First Coast
  • Vestibular Testing
    • Also affects 92557 completed with vestibular testing
    • Palmetto
    • Noridian

• Coding asymmetric hearing loss: It is recommended that you just code the loss(es) themselves and do not worry about documenting an asymmetry. For example, a bilateral, asymmetric sensorineural hearing loss is still a coded as a bilateral, sensorineural hearing loss or H90.3.
• Coding a routine hearing test: There is no CPT or HCPCS code for a “routine” hearing test.   It is recommended that you explore if the payer recognizes S0618. The best option diagnosis code option is ICD 10 code Z0.110.  Please remember though that it is sometimes the patient’s responsibility to fight for coverage. Audiologists can only code what they are reported, what they document, what they measure and what they see.  We cannot code for coverage.

More Information

ADA members can find more information in this webinar: audiologist.org/events/webinars.  ADA has also updated their superbill for 2017 to reflect these coding changes.  ADA members can purchase that form from the Practice Resource Catalog.  

Dr. Cavitt will present a live webinar on AudiologyOnline on this topic on Friday, December 9 - register here.  The webinar will be recorded for on-demand viewing.

For specific questions or concerns, Dr. Cavitt provides audiology consulting services through her practice Audiology Resources and can be contacted at: kim.cavitt@audiologyresources.com.