Coding Fact Sheet for Primary Care Pediatricians
While coding for hearing screening is relatively straightforward, ensuring that appropriate payment is received for such services is a more complicated matter. This Coding Fact Sheet will provide you with a guide to coding for pediatric hearing screening. While we have provided you with some suggested codes, it should be noted that payer recognition of codes might vary. Most plans are now required to cover hearing screen services under the Affordable Care Act, however, that may still vary.
Diagnosis Codes
International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Codes (Prior to October 1, 2015)
International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Codes (On or after October 1, 2015)
Commonly Reported Diagnosis Codes Related To Primary Care Pediatricians & Hearing Loss
ICD-9-CM | |
ICD-10-CM |
389.00 | Conductive hearing loss, unspecified |
H90.0 Conductive hearing loss, bilateral
H90.11 Conductive hearing loss, unilateral with unrestricted hearing on the contralateral side; right ear
H90.12 left ear
H90.2 Conductive hearing loss, unspecified |
389.10 | Sensorineural hearing loss, unspecified |
H90.41 Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateralside
H90.42 Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateralside
H90.5 Unspecified sensorineural hearing loss |
389.11 | Sensorineural hearing loss, bilateral |
H90.3 Sensorineural hearing loss, bilateral |
389.12 | Neural hearing loss, bilateral |
H90.3 Sensorineural hearing loss, bilateral |
389.14 | Central hearing loss, bilateral |
H90.3 Sensorineural hearing loss, bilateral |
389.15 | Sensorineural hearing loss, unilateral |
H90.41 Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateralside
H90.42 Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateralside |
389.16 | Sensorineural hearing loss, asymmetrical |
H90.5 Unspecified sensorineural hearing loss |
389.18 | Sensorineural hearing loss of combined types, bilateral |
H90.3 Sensorineural hearing loss, bilateral |
389.2 | Mixed conductive and sensorineural hearing loss |
H90.6 Mixed conductive and sensorineural hearing loss, bilateral
H90.71 Mixed conductive and sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
H90.72 Mixed conductive and sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side
H90.8 Mixed conductive and sensorineural hearing loss, unspecified |
389.9 | Unspecified hearing loss |
H91.9- Unspecified hearing loss For 5th digit use 0=unspecified ear; 1= Right ear; 2=Left ear; 3=Bilateral |
Other Diagnosis Codes Related To Hearing Loss
Nervous System and Sense Organs
380.10 | Infective otitis externa, unspecified |
H60.31- Diffuse otitis externa
H60.39- Other infective otitis externa For 6th digit use 1=Right ear; 2=Left ear; 3=Bilateral; 9=Unspecified |
380.12 | Acute swimmers' ear |
H60.33- Swimmer's ear For 6th digit use 1=Right ear; 2=Left ear; 3=Bilateral; 9=Unspecified |
380.4 | Impacted cerumen |
H61.2- Impacted cerumen For 5th digit use 0=unspecified ear; 1= Right ear; 2=Left ear; 3=Bilateral |
381.10 | Chronic serous otitis media, simple or unspecified |
H65.2- Chronic serous otitis media For 5th digit use 0=unspecified ear; 1= Right ear; 2=Left ear; 3=Bilateral |
381.4 | Nonsuppurative otitis media, not specified as acute or chronic |
H65.9- Unspecified nonsuppurative otitis media For 5th digit use 0=unspecified ear; 1= Right ear; 2=Left ear; 3=Bilateral |
381.81 | Dysfunction of Eustachian tube |
H69.8- Other specified disorders of Eustachian tube
H69.9- Unspecified Eustachian tube disorder For 5th digit use 0=unspecified ear; 1= Right ear; 2=Left ear; 3=Bilateral |
382.00 | Acute suppurative otitis media without spontaneous rupture of ear drum |
H66.00- Acute suppurative otitis media without spontaneous rupture of ear drum For 6th digit use 1= Right ear; 2=Left ear; 3=Bilateral; 4=Recurrent right ear; 5=Recurrent left ear; 6=Recurrent bilateral; 7=Recurrent unspecified; 9=unspecified ear |
382.01 | Acute suppurative otitis media with spontaneous rupture of ear drum |
H66.01- Acute suppurative otitis media with spontaneous rupture of ear drum For 6th digit use 1= Right ear; 2=Left ear; 3=Bilateral; 4=Recurrent right ear; 5=Recurrent left ear; 6=Recurrent bilateral; 7=Recurrent unspecified; 9=unspecified ear |
382.3 | Unspecified chronic suppurative otitis media |
H66.3X- Other chronic suppurative otitis media For 6th digit use 1=Right ear; 2=Left ear; 3=Bilateral; 9=Unspecified |
384.01 | Bullous myringitis |
H73.01- Bullous myringitis For 6th digit use 1=Right ear; 2=Left ear; 3=Bilateral; 9=Unspecified |
384.20 | Perforation tympanic membrane, unspecified |
H72.9- Unspecified perforation of tympanic membrane For 5th digit use 0=unspecified ear; 1= Right ear; 2=Left ear; 3=Bilateral |
386.30 | Labryinthitis, unspecified |
H83.0- Labyrinthitis For 5th digit use 1=Right ear; 2=Left ear; 3=Bilateral; 9=Unspecified |
388.30 | Tinnitus |
H93.1- Tinnitus For 5th digit use 1=Right ear; 2=Left ear; 3=Bilateral; 9=Unspecified |
388.60 | Otorrhea, unspecified |
H92.1- Otorrhea For 5th digit use 0=unspecified ear; 1= Right ear; 2=Left ear; 3=Bilateral |
388.70 | Otalgia, unspecified |
H92.0- Otalgia For 5th digit use 1=Right ear; 2=Left ear; 3=Bilateral; 9=Unspecified |
Congenital Anomalies
744.3 | Unspecified anomaly of the ear |
Q17.9 Congenital malformation of ear, unspecified (NOS) |
Injury and Poisoning
872.61 | Open wound of ear; ear drum |
S09.20- Traumatic rupture of unspecified ear drum
S09.21- Traumatic rupture of right ear drum
S09.22- Traumatic rupture of left ear drum
S09.91- Unspecified injury of ear [Requires a 7th character to indicate type of encounter] |
931 | Foreign body in ear |
T16.1- Foreign body in right ear
T16.2- Foreign body in left ear
T16.9- Foreign body in ear, unspecified ear [Use additional code to identify if there is a retained FB (Z18-)] [Requires a 7th character to indicate type of encounter] |
994.6 | Motion sickness |
T75.3- Motion sickness [Use additional external cause code to identify vehicle or type of motion (Y92.81-, Y93.5-)] [Requires a 7th character to indicate type of encounter] |
| | For codes
S09-,
T16- and
T75- a 7th character is required to define the
encounter.
A= initial encounter;
D = subsequent encounter;
S =sequel (Note use placeholder X for 5th and/or 6th characters as necessary) |
Symptoms, Signs, and Ill-Defined Conditions
780.4 | Dizziness and giddiness (vertigo NOS) |
R42 Dizziness and giddiness |
784.40 | Voice and resonance disorder, unspecified |
R49.9 Unspecified voice and resonance disorder |
784.42 | Dysphonia |
R49.0 Dysphonia |
784.43 | Hypernasality |
R49.21 Hypernasality |
784.44 | Hyponasality |
R49.22 Hyponasality |
784.49 | Other voice and resonance disorders (change in voice/hoarseness) |
R49.8 Other voice and resonance disorders |
784.51 | Dysarthria |
R47.1 Dysarthria and anarthria |
784.59 | Other speech disturbance |
R47.89 Other speech disturbances |
796.4 | Other abnormal clinical findings |
R68.89 Other general symptoms and signs |
796.6 | Abnormal findings on neonatal screening |
P09 Abnormal findings on neonatal screening (Use additional code to identify signs, symptoms and conditions associated with the screening) |
Other
NOTE: The ICD-9-CM codes below are used to deal with occasions when circumstances other than a disease or injury are recorded as "diagnoses" or "problems." Some carriers may request supporting documentation for the reporting of V codes.
V12.40 | Personal history of unspecified disorder of nervous system and sense organs |
Z86.69 Personal history of other diseases of the nervous system and sense organs |
V12.42 | Personal history of infections of the central nervous system |
Z86.61 Personal history of infections of the central nervous system |
V12.49 | Personal history of other disorders of nervous system and sense organs |
Z86.69 Personal history of other diseases of the nervous system and sense organs |
V19.2 | Family history of deafness or hearing loss |
Z82.2 Family history of deafness and hearing loss |
V41.2 | Problems with hearing |
Z97.4 Presence of external hearing-aid |
V41.3 | Other ear problems |
H93.8X- Other specified disorders of ear For 6th digit use 1=Right ear; 2=Left ear; 3=Bilateral; 9=Unspecified |
V45.89 | Other postprocedural status |
Z98.89 Other specified postprocedural states |
V49.89 | Other specified health conditions influencing health status |
Z78.9 Other specified health status |
V58.69 | Long-term (current) use of other medications |
Z79.899 Other long term (current) drug therapy |
V62.89 | Other psychological or physical stress not elsewhere classified; other |
Z60.8 Other problems related to social environment
Z73.3 Stress, not elsewhere classified |
V62.9 | Unspecified psychosocial circumstance |
Z65.9 Problem related to unspecified psychosocial circumstances |
V65.19 | Other person consulting on behalf of another person |
Z71.0 Person encountering health services to consult on behalf of another person |
V65.49 | Other specified counseling |
Z71.89 Other specified counseling |
V72.11 | Encounter for hearing examination following failed hearing screening |
Z01.110 Encounter for hearing examination following failed hearing screening |
V72.19 | Other examination of ears and hearing |
Z01.10 Encounter for examination of ears and hearing without abnormal findings
Z01.118 Encounter for examination of ears and hearing with other abnormal findings [Use additional code to identify abnormal findings] |
- Indicates an additional character is required
Procedure Codes
Current Procedural Terminology (CPT®) Codes
Commonly Reported Procedure Codes Related To Primary Care Pediatricians & Hearing Loss
92550 | Tympanometry and reflex threshold measurements |
92551 | Screening test, pure tone, air only |
92552 92558 | Pure tone audiometry (threshold); air only Evoked otoacoustic emissions, screening, automated analysis |
92567 | Tympanometry (impedance testing) |
92568 | Acoustic reflex testing, threshold |
92570 | Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing and acoustic reflex decay testing (Do not report with 92567, 92568) |
92587 | Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report |
92588 | Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum 12 frequencies |
69200 | Removal of foreign body from external auditory canal; without general anesthesia |
69210 | Removal impacted cerumen requiring instrumentation, unilateral (For bilateral removal, use modifier 50) |
69420 | Myringotomy including aspiration and/or eustachian tube inflation |
Health and Behavior Assessment/Intervention Codes
These codes cannot be reported by a physician.
96150 | Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; initial assessment |
96151 | Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; re-assessment |
The focus of the assessment is not on mental health but on the biopsychosocial factors important to physical health problems and treatments.
96152 | Health and behavior intervention, each 15 minutes, face-to-face; individual |
96153 | Health and behavior intervention, each 15 minutes, face-to-face; group (2 or more patients) |
96154 | Health and behavior intervention, each 15 minutes, face-to-face; family (with patient present) |
96155 | Health and behavior intervention, each 15 minutes, face-to-face; family (without patient present) |
The focus of the intervention is to improve the patient's health and well-being utilizing cognitive, behavioral, social, and/or psychophysiological procedures designed to ameliorate the specific hearing-related problems.
Healthcare Common Procedural Coding System (HCPCS) Level II Procedure and Supply Codes
CPT codes are also known as Healthcare Common Procedure Coding System (HCPCS) Level I codes. The Healthcare Common Procedure Coding System also contains Level II codes. These Level II codes (commonly referred to as HCPCS "hick-picks" codes) are national codes that are included as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) standard procedural transaction coding set along with CPT codes.
HCPCS Level II codes were developed to fill in the gaps in the CPT nomenclature. While they are reported in the same way as a CPT code, they consist of one alphabetic character (A-V) followed by four digits. In the past, insurance carriers did not uniformly recognize HCPCS Level II codes. However, with the advent of HIPAA, carrier software systems must now be able to recognize all HCPCS Level I (CPT®) and Level II codes.
HCPCS Hearing Services Codes
S9445 | Patient education, not otherwise classified, nonphysician provider, individual, per session |
S9446 | Patient education, not otherwise classified, nonphysician provider, group, per session |
T1023 | Screening to determine the appropriateness of consideration of an individual for participation in specified program, project, or treatment protocol, per encounter |
T1027 | Family training and counseling for child development, per 15 minutes |
T1028 | Assessment of home, physical, and family environment, to determine suitability to meet patient's medical needs |
T2022 | Case management, per month |
T2023 | Targeted case management, per month |
T2024 | Service assessment/plan of care development, waiver |
V5008 | Hearing screening |
V5362 | Speech screening |
V5363 | Language screening |
V5364 | Dysphagia screening |
Vignettes
Vignette #1
5-year-old male established patient presenting for pre-kindergarten health assessment, fails to pass the hearing screen, using a pure tone audiometer at the 30 decibels (dB) level from 500 to 4000 Hertz (Hz) in the left ear. He has a history of three ear infections in his second year. Tympanometry is normal for both ears, indicating no evidence of middle ear effusion. Parents deny any behaviors that would suggest hearing loss (does not turn up the TV, appears to hear voice commands, and does not speak loudly).
How is this service reported?
CPT Coding:
99393 | Preventive medicine service, established patient; late childhood (age 5 through 11 years) |
92551 | Screening test, pure tone, air only |
92567 | Tympanometry (impedance testing) |
ICD-9-CM and ICD-10-CM Coding:
V20.2 | Routine infant or child health check | Z00.121 Encounter for routine child health examination with abnormal findings | Link to 99393 and 92551 |
389.9 | Unspecified hearing loss | H91.92 Unspecified hearing loss, left ear | Link to 92551 and 92567 |
Note: Contrary to CPT® guidelines, some payers may inappropriately bundle the screening audiometry service(s) with the preventive medicine evaluation and management (E/M) code. Appending modifier 25 to the preventive medicine service may unbundle the services.
Health assessment should include information pertinent to hearing loss such as prenatal or perinatal risk factors, family history of hearing loss under 30 years of age, physical stigmata related to hearing loss.
The patient is then referred to an audiologist proficient in hearing testing of children for diagnostic testing. Audiologist report for pure tone audiometry (air and bone) and sound booth testing indicates he has sensorineural hearing loss at 50dB in the left ear and normal hearing at 20 dB in the right ear; his left ear speech threshold is 40 dB and right ear speech threshold is 15 dB.
How is this service reported?
CPT Coding:
92553 | Pure tone audiometry (threshold); air and bone |
92555 | Speech audiometry threshold |
ICD-9-CM and ICD-10-CM Coding:
389.15 | Sensorineural hearing loss, unilateral | H90.42 Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateralside | Link to 92553 and 92555 |
Pediatrician counsels parents for 15 minutes on the audiological diagnostic testing results, reviews possible etiologies for unilateral hearing loss, provides information on the effects of unilateral hearing loss on classroom learning, and refers the patient to an otolaryngologist.
How is this service reported?
CPT Coding:
99213 | Office or other outpatient visit, established patient (greater than 50 percent of visit spent counseling and code 99213 has a typical time of 15 minutes) |
ICD-9-CM and ICD-10-CM Coding:
389.15 | Sensorineural hearing loss, unilateral | H90.42 Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateralside | Link to 99213 |
Note: Otolaryngologist may request CT of left ear or BAER (ABR) testing. Patient should be considered for unilateral amplification in the classroom setting to reduce possible learning barrier.
Vignette #2
An infant is born to parents who both have hearing loss greater than 90 dB. The newborn hearing screen is normal, with no indication of hearing loss. There is a significant family history of congenital hearing loss in both families. Patient is recommended by the hospital hearing screener for repeat hearing testing at 6 months.
How is this service reported?
CPT Coding:
92587 | Evoked otoacoustic emissions; limited (single stimulus level, either transient or distortion products) |
ICD-9-CM and ICD-10-CM Coding:
V19.2 | Family history of deafness or hearing loss | Z82.2 Family history of deafness and hearing loss | Link to 92587 |
V72.19 | Other examination of ears and hearing | Z01.10 Encounter for examination of ears and hearing without abnormal findings | Link to 92587 |
Note: Payers may inappropriately bundle this procedure into the hospital care E/M code.
Six months later, patient sees hospital screener for repeat hearing testing. Options might include automated brain response (auditory evoked potentials) versus sound booth testing as OAE testing not possible in the active child. Because of the family history, parents are offered a referral to a geneticist for testing for the Connexin 26 gene and subsequent genetic counseling. Referral to an early intervention agency is provided so communication issues can be addressed as parents sign only and have no oral speech.
How is this service reported?
CPT Coding:
92586 | Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system, limited or |
92551 | Screening test, pure tone only |
ICD-9-CM and ICD-10-CM Coding:
V72.19 | Other examination of ears and hearing | Z82.2 Family history of deafness and hearing loss Z01.10 Encounter for examination of ears and hearing without abnormal findings | Link to 92586 or 92551 |
Physician sees patient to confirm audiological screening results. Recommends genetic assessment for Connexin gene for future pregnancy planning. Recommends family seek early intervention services to address communication issues for deaf parents who sign only and a hearing child.
How is this service reported?
CPT Coding:
99213 | Office or other outpatient visit, established patient, problem focused/low complexity |
ICD-9-CMand ICD-10-CM Coding:
V26.33 | Genetic Counseling | Z31.5 Encounter for genetic counseling | Link to 99213 |
V19.2 | Family history of deafness or hearing loss | Z82.2 Family history of deafness and hearing loss | Link to 99213 |
Vignette #3
An infant who was referred following an abnormal otoacoustic emission hearing test also fails diagnostic testing at age 5 weeks for both OAE and ABR. ABR indicates a pure tone threshold at about 80dB in both ears; hearing aids may improve auditory acuity. The parents have normal hearing.
How is this service reported?
CPT Coding:
92588 | Evoked acoustic emissions, comprehensive or diagnostic testing |
92585 | Auditory evoked potentials, for evoked response audiometry and or testing of the central nervous system, comprehensive |
ICD-9-CM and ICD-10-CM Coding:
389.11 | Sensory hearing loss, bilateral | H90.3 Sensorineural hearing loss, bilateral | Link to 92588 and 92585 |
Patient requires a medical workup for congenital hearing loss. History should assess prenatal or perinatal causes, family history of hearing loss, examination for stigmata associated with hearing loss, genetic testing, EKG (CPT code 93000), and ENT and ophthalmological exams.
How is this service reported?
CPT Coding:
99215 | Office or other outpatient visit, established patient, comprehensive/high complexity |
ICD-9-CM and ICD-10-CM Coding:
389.11 | Sensory hearing loss, bilateral | H90.3 Sensorineural hearing loss, bilateral | Link to 99215 |
At the 8-week well exam the parents inquire about the next steps to eventually obtaining a cochlear device so the patient can have oral communication. They want to know what is done during the waiting period for the cochlear implant to communicate effectively with their infant and whether there are any additional referrals to other physicians or studies needed.
How is this service reported?
CPT Coding:
99391 | Preventive medicine service, established patient; infant (age under 1 year) |
9921x-25 | Office or other outpatient visit, established patient (code level selected from 99211-99215 family depending on key components met or time spent counseling), appended with modifier 25 (significant, separately identifiable E/M service by same physician on same day of the procedure or other service) |
ICD-9-CM and ICD-10-CM Coding:
V20.2 | Routine infant or child health check | Z00.121 Encounter for routine child health examination with abnormal findings | Link to 99391 |
V65.40 | Other counseling, not otherwise specified | Z71.89 Other specified counseling | Link to 9921x-25 |
389.11 | Sensory hearing loss, bilateral | H90.3 Sensorineural hearing loss, bilateral | Link to 9921x-25 |
Patient needs referral to area cochlear implant service, early intervention agency to facilitate nonverbal communication pending cochlear implant by 3 months, and CT scan of ears to assess inner ear anatomy. Otolaryngologist and audiologist should refer patient for auditory amplification by age 6 months.
CPT Coding:
69930 | Cochlear device implantation, with or without mastoidectomy |
ICD-9-CM and ICD-10-CM Coding:
389.11 | Sensory hearing loss, bilateral | H90.3 Sensorineural hearing loss, bilateral | Link to 69930 |
Modifiers
25 Significant and separately identifiable evaluation and management service
50 Bilateral procedure
52 Reduced procedural service (can be used when a code indicates a bilateral hearing screen/test, but only one ear is tested)
59 Distinct procedural service