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Early Hearing Detection and Intervention Coding Fact Sheet

​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
389.00Conductive 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

389.10Sensorineural 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

389.11Sensorineural hearing loss, bilateral H90.3  Sensorineural hearing loss, bilateral
389.12Neural hearing loss, bilateral H90.3  Sensorineural hearing loss, bilateral
389.14Central hearing loss, bilateral H90.3  Sensorineural hearing loss, bilateral
389.15Sensorineural 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

389.16Sensorineural hearing loss, asymmetrical H90.5  Unspecified sensorineural hearing loss
389.18Sensorineural hearing loss of combined types, bilateral H90.3  Sensorineural hearing loss, bilateral
389.2Mixed 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

389.9Unspecified 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

380.10Infective 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

380.12Acute swimmers' ear

H60.33-  Swimmer's ear

For 6th digit use 1=Right ear; 2=Left ear; 3=Bilateral; 9=Unspecified

380.4Impacted cerumen

H61.2-  Impacted cerumen

For 5th digit use 0=unspecified ear; 1= Right ear; 2=Left ear; 3=Bilateral

381.10Chronic 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

381.4Nonsuppurative 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

381.81Dysfunction 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

382.00Acute 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

382.01Acute 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

382.3Unspecified 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

384.01Bullous myringitis

H73.01-  Bullous myringitis

For 6th  digit use 1=Right ear; 2=Left ear; 3=Bilateral; 9=Unspecified

384.20Perforation 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

386.30Labryinthitis, unspecified

H83.0-  Labyrinthitis

For 5th  digit use 1=Right ear; 2=Left ear; 3=Bilateral; 9=Unspecified

388.30Tinnitus

H93.1-   Tinnitus

For 5th  digit use 1=Right ear; 2=Left ear; 3=Bilateral; 9=Unspecified

388.60Otorrhea, unspecified

H92.1-   Otorrhea

For 5th digit use 0=unspecified ear; 1= Right ear; 2=Left ear; 3=Bilateral

388.70Otalgia, unspecified

H92.0-   Otalgia

For 5th  digit use 1=Right ear; 2=Left ear; 3=Bilateral; 9=Unspecified

 

Congenital Anomalies

744.3Unspecified anomaly of the ear Q17.9  Congenital malformation of ear, unspecified  (NOS)

 

Injury and Poisoning

872.61Open 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]

931Foreign 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]

994.6Motion 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

780.4Dizziness and giddiness (vertigo NOS) R42  Dizziness and giddiness
784.40Voice and resonance disorder, unspecified R49.9   Unspecified voice and resonance disorder
784.42Dysphonia R49.0   Dysphonia
784.43Hypernasality R49.21   Hypernasality
784.44Hyponasality R49.22   Hyponasality
784.49Other voice and resonance disorders (change in voice/hoarseness) R49.8   Other voice and resonance disorders
784.51Dysarthria R47.1   Dysarthria and anarthria
784.59Other speech disturbance R47.89   Other speech disturbances
796.4Other abnormal clinical findings R68.89   Other general symptoms and signs
796.6Abnormal 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.

V12.40Personal history of unspecified disorder of nervous system and sense organs Z86.69   Personal history of other diseases of the nervous system and sense organs
V12.42Personal history of infections of the central nervous system Z86.61   Personal history of infections  of the central nervous system
V12.49Personal history of other disorders of nervous system and sense organs Z86.69   Personal history of other diseases of the nervous system and sense organs
V19.2Family history of deafness or hearing loss Z82.2   Family history of deafness and hearing loss
V41.2Problems with hearing Z97.4  Presence of external hearing-aid
V41.3Other ear problems

H93.8X-   Other specified disorders of ear

For 6th  digit use 1=Right ear; 2=Left ear; 3=Bilateral; 9=Unspecified

V45.89Other postprocedural status Z98.89   Other specified postprocedural states
V49.89Other specified health conditions influencing health status Z78.9   Other specified health status
V58.69Long-term (current) use of other medications Z79.899   Other long term (current) drug therapy
V62.89Other psychological or physical stress not elsewhere classified; other

Z60.8   Other problems related to social environment

Z73.3   Stress, not elsewhere classified

V62.9Unspecified psychosocial circumstance Z65.9   Problem related to unspecified psychosocial circumstances
V65.19Other person consulting on behalf of another person Z71.0   Person encountering health services to consult on behalf of another person
V65.49Other specified counseling Z71.89   Other specified counseling
V72.11Encounter for hearing examination following failed hearing screening Z01.110   Encounter for hearing examination following failed hearing screening
V72.19Other 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

92550Tympanometry and reflex threshold measurements
92551Screening test, pure tone, air only

92552

92558

Pure tone audiometry (threshold); air only

Evoked otoacoustic emissions, screening, automated analysis

92567Tympanometry (impedance testing)
92568Acoustic reflex testing, threshold
92570Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing and acoustic reflex decay testing (Do not report with 92567, 92568)
92587Distortion 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
92588Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum 12 frequencies
69200Removal of foreign body from external auditory canal; without general anesthesia
69210Removal impacted cerumen requiring instrumentation, unilateral  (For bilateral removal, use modifier 50)
69420Myringotomy including aspiration and/or eustachian tube inflation

​Health and Behavior Assessment/Intervention Codes

These codes cannot be reported by a physician.

96150Health 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
96151Health 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.

96152Health and behavior intervention, each 15 minutes, face-to-face; individual
96153Health and behavior intervention, each 15 minutes, face-to-face; group (2 or more patients)
96154Health and behavior intervention, each 15 minutes, face-to-face; family (with patient present)
96155Health 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

S9445Patient education, not otherwise classified, nonphysician provider, individual, per session
S9446Patient education, not otherwise classified, nonphysician provider, group, per session
T1023Screening to determine the appropriateness of consideration of an individual for participation in specified program, project, or treatment protocol, per encounter
T1027Family training and counseling for child development, per 15 minutes
T1028Assessment of home, physical, and family environment, to determine suitability to meet patient's medical needs
T2022Case management, per month
T2023Targeted case management, per month
T2024Service assessment/plan of care development, waiver
V5008Hearing screening
V5362Speech screening
V5363Language screening
V5364Dysphagia 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:

99393Preventive medicine service, established patient; late childhood (age 5 through 11 years)
92551Screening test, pure tone, air only
92567Tympanometry (impedance testing)

 

ICD-9-CM and ICD-10-CM Coding:

V20.2Routine infant or child health checkZ00.121  Encounter for routine child health examination with abnormal findingsLink to 99393 and 92551
389.9Unspecified hearing lossH91.92   Unspecified hearing loss, left earLink 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:

92553Pure tone audiometry (threshold); air and bone
92555Speech audiometry threshold

 

ICD-9-CM and ICD-10-CM Coding:

389.15Sensorineural hearing loss, unilateralH90.42  Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateralsideLink 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:

99213Office 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:

389.15Sensorineural hearing loss, unilateralH90.42  Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateralsideLink 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:

92587Evoked otoacoustic emissions; limited (single stimulus level, either transient or distortion products)

 

ICD-9-CM and ICD-10-CM Coding:

V19.2Family history of deafness or hearing lossZ82.2  Family history of deafness and hearing lossLink to 92587
V72.19Other examination of ears and hearingZ01.10   Encounter for examination of ears and hearing without abnormal findingsLink 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:

92586Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system, limited or
92551Screening test, pure tone only

 

ICD-9-CM and ICD-10-CM Coding:

V72.19Other 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:

99213Office or other outpatient visit, established patient, problem focused/low complexity

 

ICD-9-CMand ICD-10-CM Coding:

V26.33Genetic CounselingZ31.5  Encounter for genetic counselingLink to 99213
V19.2Family history of deafness or hearing lossZ82.2  Family history of deafness and hearing lossLink 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:

92588Evoked acoustic emissions, comprehensive or diagnostic testing
92585Auditory evoked potentials, for evoked response audiometry and or testing of the central nervous system, comprehensive

 

ICD-9-CM and ICD-10-CM Coding:

389.11Sensory hearing loss, bilateralH90.3  Sensorineural hearing loss, bilateralLink 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:

99215Office or other outpatient visit, established patient, comprehensive/high complexity

 

ICD-9-CM and ICD-10-CM Coding:

389.11Sensory hearing loss, bilateralH90.3  Sensorineural hearing loss, bilateralLink 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:

99391Preventive medicine service, established patient; infant (age under 1 year)
9921x-25Office 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:

V20.2Routine infant or child health checkZ00.121  Encounter for routine child health examination with abnormal findingsLink to 99391
V65.40Other counseling, not otherwise specifiedZ71.89   Other specified counselingLink to 9921x-25
389.11Sensory hearing loss, bilateralH90.3  Sensorineural hearing loss, bilateralLink 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:

69930Cochlear device implantation, with or without mastoidectomy

 

ICD-9-CM and ICD-10-CM Coding:

389.11Sensory hearing loss, bilateralH90.3  Sensorineural hearing loss, bilateralLink 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