Question
What is the appropriate way to assign a diagnosis code when audiologic testing is suggestive of normal peripheral hearing, and there are no complaints of tinnitus or dizziness. V72.19 and 389.9 are not included in our LCD.
Answer
For many years, the precedent was well established across all of healthcare to select a diagnosis family (the first three digits of the diagnosis code) followed by ".9" when the outcome was nonspecific or was normal. However, a movement began in 2008 to be more specific with regard to the diagnosis code. United Healthcare systems began this movement, and it has since caught on with other insurers. At the present time, there are a number of third-party payers who will not recognize the ICD-9 codes 389.10 and 389.9. The practical implication of this change is that the audiologist must be more specific in listing the diagnosis code based upon the presenting concern and/or the reason for the test. Another way of stating this is, based on the history and the patient's presenting complaints, what were you looking for as you did your evaluation. If you were suspicious of a sensory problem only, then the ICD-9 codes such as 389.11 (sensory hearing loss, bilateral) or 389.17 (sensory hearing loss, unilateral) would be appropriate. If you are not sure whether there could have been both sensory and neural components then diagnostic code possibilities could include 389.15 (sensorineural hearing loss, unilateral), 389.16 (sensorineural hearing loss, asymmetrical), or 389.18 (sensorineural hearing loss, bilateral). The same principle would apply to the neural hearing loss codes and the conductive hearing loss codes. You did well to look at the LCD for your particular insurance carrier to know what ICD-9 codes are recognized and accepted. The bottom line is that the principle of choosing a diagnostic code has not changed. The primary difference is a desire on the part of the third-party payers to be more specific in describing either what you found or the primary concern that caused you to perform the test which, in our case, will typically have something to do with hearing.
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 the immediate 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.
