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):

1. 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.
2. 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.
3. 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:

1. Whether you are conducting an initial infant hearing screening (limited test) or performing a more comprehensive test on the infant.
2. 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

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
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Title: Medicaid Hearing Services for Children
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Title: Manage Care for Childrens Hearing Services
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Title: 2007 Updates for ICD9 Codes Related to Children's Hearing Services
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Title: AAP Coding Fact Sheet for Childrens Hearing Services
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Title: EHDI CPT ICD-9 Codes
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