Otolaryngology Coding Alert

V codes are your key to more options and better specificity, experts say

Just because your CPT manual doesn't offer any specific codes for hearing aid supplies doesn't mean you can't distinguish a monaural HA from a binaural HA in your coding. For more specificity and a better chance at appropriate reimbursement, pick up your HCPCS manual.

Ignoring these supply codes could cost you payment. But many coders don't know that the Healthcare Common Procedure Coding System (HCPCS) offers an array of specific HA codes that many Medicaid programs and private insurers accept.

Audiology experts offer the lowdown on using these 60-plus codes.

Boost Specificity With HCPCS Codes

Whenever CPT doesn't define a service, you should look to the HCPCS manual for a code. Often, HCPCS contains codes for supplies or offers more specificity than CPT does, says Debbie Abel, Au.D., director of reimbursement and practice compliance, American Academy of Audiology in Reston, VA.

Example: An audiologist dispenses a monaural, in-ear hearing aid to a 5-year-old boy. The only option CPT offers is 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]), a catchall supply code.

Better way: You should choose HCPCS supply code V5050 (Hearing aid, monaural, in the ear) instead. The HCPCS code is more specific than 99070 and may render better reimbursement, Abel says. And you may need to use V5090 (Dispensing fee, unspecified hearing aid) for your service in providing that instrument to that patient for most third-party payers, she adds.

3 Steps to Coding Expertise

Use these three steps as a life preserver to keep you from drowning in the sea of HCPCS HA codes:

Step 1: Use the HA's description to find the right V code. You'll need several pieces of information to track down the right supply code. For instance, you should know the HA's style/size. Is it an in-the-ear (ITE) model (such as V5130, Binaural, in the ear) or a behind-the-ear (BTE) model (such as V5140, Binaural, behind the ear)?

Step 2: Determine whether the audiologist recommends one (monaural) or two (binaural) hearing aids for the patient. Possible codes include V5050 (Hearing aid, monaural, in the ear), V5130 (Hearing aid, binaural, in the ear), V5140 (Hearing aid, binaural, behind the ear) and V5060 (Hearing aid, monaural, behind the ear), Abel says.

Step 3: Look at the hearing aid type, such as digitally programmable analog (for example, V5247, Hearing aid, digitally programmable analog, monaural, BTE [behind the ear]) or digital (as in V5256, Hearing aid, digital, monaural, ITE).

Tip: Check whether the HA box contains HCPCS coding instruction. Minnesota Medicaid publishes a handy list of HA model numbers with corresponding V codes. Visit http://www.dhs.state.mn.us/main/groups/business_partners/documents/pub/dhs_id_026709.pdf.

These 6 Codes Capture More Hearing Services

You should also use HCPCS codes when performing several HA-related services.

Audiologists may provide initial services such as a comprehensive hearing evaluation (92557, Comprehensive audiometry threshold evaluation and speech recognition [92553 and 92556 combined]) and an HA assessment (92590, Hearing aid examination and selection; monaural, or 92591, ... binaural).

HCPCS offers V5010 (Assessment for hearing aid) for an HA evaluation, but only if your third-party payer prefers it, Abel says.

When you initially fit the hearing aid, you should charge a dispensing fee. Submit V5241 (Dispensing fee, monaural hearing aid, any type) for monaural HA dispensing, and V5160 (Dispensing fee, binaural) for binaural dispensing.

Check your top insurers' hearing service V code inclusions. Medicaid and other insurers that accept V codes may implement individual coding guidelines.

Most Payers Recognize Hearing-Related V Codes

If your patient's visit does not fall under a defined service/warranty period, you should code any HA checks or repairs. Report a hearing aid fitting or check with V5011 (Fitting/orientation/checking of hearing aid), Abel says. When you repair a hearing aid or perform any modifications, use V5014 (Repair/modification of a hearing aid).

Before using HCPCS codes, check payer recognition and coverage. Most insurers accept the V codes for HA-related services, Abel says.

Even though Medicaid coverage varies by state, many programs consider the V codes valid for submission.

To get details on state hearing-related coverage.

In the unlikely event that a payer doesn't accept the V codes, you may have to use CPT's general supply code: 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]).