 Reimbursement for health care services is dependent upon the use of codes to identify:
- Procedures performed (CPT codes)
- Diagnosis or diagnoses (ICD-9-CM codes)
- Certain devices, supplies and equipment acquired for the client (HCPCS Codes)
Accurate
coding is essential for claims submitted to third payers. The health
care services coding system that
is used is regulated by the Centers of
Medicare
and Medicaid Services (CMS). CMS established recognized code
sets under the Health Insurance Portability and Accountability Act
(HIPAA):
- CPT (Current Procedural Terminology)
The CPT coding system describes how to report procedures or services performed
such as a hearing screening test. The CPT system is maintained and
copyrighted by the American Medical Association. Each CPT code has five
digits.
- ICD-9-CM (International Classification of Diseases, 9th revision, Clinical Modification)
The ICD-9 coding system describes how to report diagnoses and disorders.
The ICD-9-CM is maintained by the National Center for Health Statistics
of
the U.S. Public Health Service. Each ICD-9 code has 3 numeric digits
followed by decimal point. (smaller font)Note that ICD-9-CM V codes
are used to record a condition influencing health status or broad types
of procedural, administrative or
screening encounters. They are often
not accepted for billing purposes by third party payers.
- HCPCS (Healthcare Common Procedures Coding System)
HCPCS codes are used to report supplies, equipment, and devices
provided to patients such as hearing aid. A limited number of
procedures not otherwise
contained in the CPT system are also found
here. HCPCS is alphanumeric and is administered by the Centers for
Medicare and Medicaid Services (CMS) in cooperation with other third
party payers.
Billing and Reimbursement Codes for Newborn Hearing Screening
What are the infant hearing testing codes?
There are several codes that are used to describe early hearing
detection testing to a payer. The procedure code you use depends on:
- Whether
you are conducting an initial infant hearing screening (limited test)
or performing a more comprehensive test on the infant.
- The testing method you use to evaluate infants.
If you test infants using auditory evoked potentials, the two codes available are:
- 92586 Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system, limited. Use this code for screening.
- 92585
Auditory evoked potentials for evoked response audiometry and/or
testing of the central nervous system, comprehensive.
Use this code for diagnostic testing.
If you test infants using otoacoustic emissions, the two codes available are:
- 92587 Evoked otoacoustic emissions; limited (single stimulus level, either transient or distortion product). Use this code for screening.
How should "normal hearing" results be coded when performing a hearing screening or an audiological evaluation?
Medicare's
policy is that you should code for the sign(s) or symptom(s) that
prompted the test to be ordered. For instance, a newborn fails an
infant hearing
screening and is referred for follow up testing which
results in normal findings. In this situation, 389.9 (Unspecified
hearing loss) would be appropriate.
Private health plans often do follow Medicare policies. It is important that you check with the plan in question.
Billing and Reimbursement Codes for Early Childhood Periodic Hearing Screening
The primary codes most often needed for billing and reimbursement purposes related to OAE and tympanometry screening are:
- Procedure code (CPT)
- 92587 OAE Limited
- 92567 Tympanometry
- Commonly Used
- 315.31 Delayed Speech and Language Development
- Diagnosis Codes (ICD-9)
- 315.34 Speech and Language Development Delay due to Hearing Loss
- 315.39 Articulation Errors
- 384.20 History of Tympanic Membrane Perforation, Perforation of the Tympanic Membrane, Unspecified
- 388.6 Discharging Ear Otorrhea, Unspecified
- 388.7 Ear Pain Otalgia, Unspecified
- 388.8 Aural Fullness, Other Disorders of the Ear
- 389.9 Unspecified Hearing Loss
- 783.42 Delayed Milestones, Late Talker
- V72.11 Encounter for hearing examination following a previously failed hearing screening
- V72.19 Examination of ears and hearing
Example of Diagnosis Codes Used for Hearing Screening
Reason for Screening |
Screening Outcome |
Coding Example |
Child receives OAE rescreen due to refer on previous screening. |
Refer on OAE |
389.9 |
| Pass OAE |
389.9 V72.11 |
Child recieves OAE screen in response to specific concern(s) |
Refer on OAE |
389.9, and code for concern such as 315.31 Delayed Speech |
| Pass OAE |
389.9, and code for concern such as 315.31 |
Child recieves OAE screen as a routine part of well-child checkup; no specific concern(s) |
Refer on OAE |
389.9 |
| Pass OAE |
V72.19 |
Why
is the 389.9 code used for a screen or rescreen (in the
first two examples above) that results in a pass? Because
Medicare's policy is that you should code for the sign(s) or symptom(s)
that prompted the test to be ordered. Children who refer
on OAE screening can typically be coded as 389.9—unspecified hearing
loss—based on the following: “If the diagnosis documented at the
time is qualified as ‘probable,’ ‘suspected', 'likely,’ ‘questionable,’
‘possible,’ or ‘still to be ruled out,’ code the condition as if it
existed or was established. ”
ICD-9-CM Official Guidelines for Coding and Reporting, p. 48.
Notes of V codes:
As shown above, whenever possible,
other ear, hearing and communication disorder diagnosis codes should be
used before using a V code. Children with high-risk factors can
be coded on that basis. In these cases, the signs and symptoms,
chief complaint, or reason(s) for the encounter should be reported as
the primary diagnosis. The provider can also use additional
codes that describe any coexisting or chronic conditions. (Do not
code conditions previously treated that no longer exist – although
history codes may be used as secondary codes if the historical
condition or family history has an impact on current care or influences
treatment.) Medicaid and most private insurance providers will
cover one hearing screening annually.
V
codes are contained in a separate ICD-9-CM chapter and are a
“supplementary classification of factors influencing health status and
contact with health services. They range from V01 t-
V86. (ICD-9-CM Official Guidelines for Coding and Reimbursement effective Nov. 2006)
ASHA
says, “Frankly, private health plans appear to ignore V codes as
diagnoses, so we do not recommend their use unless the plan requires
it” ASHA May 29, 2007.
Downloads
Title: Private Health for Childrens Hearing Services
File Type: PDF
File Size: 1.8 MB
Title: Medicaid Hearing Services for Children
File Type: PDF
File Size: > 0.1MB
Title: Manage Care for Childrens Hearing Services
File Type: PDF
File Size: > 0.1MB
Title: 2007 Updates for ICD9 Codes Related to Children's Hearing Services
File Type: PDF
File Size: > 0.1MB
Title: AAP Coding Fact Sheet for Childrens Hearing Services
File Type: DOC
File Size: 0.2MB
Title: EHDI CPT ICD-9 Codes
File Type: DOC
File Size: 0.4MB
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