Otolaryngology Coding Alert

Question: Our otolaryngologist performed audiometric testing on a patient with a hearing problem. The test indicated normal hearing. Since the result of the test is negative, which diagnosis code should be used?
           
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Answer: There is no ICD-9 sign or symptom code that describes not finding a hearing problem upon testing. However, the ICD-9 book includes two codes that may be used in this situation: 388.40 (Abnormal auditory perception, unspecified) and 388.43 (Impairment of auditory discrimination). It should also be noted that Medicare carriers in some states recognize pretest diagnoses only. In those states, 388.40 or 388.43 should be used even if the test returned positive, because these codes most appropriately describe the patients pretest diagnosis. However, if your Medicare carrier prefers posttest diagnoses for tests (which provide a higher degree of specificity, as demanded by American Hospital Association diagnosis code guidelines), then 388.40 should be used only when the results of the test are negative. Code V72.1 (Examination of ears and hearing) may be included as a secondary code. Many payers do not pay for procedures that have a V code as the primary diagnosis.

  You Be the Coder and Reader Questions were answered by Randa Blackwell, financial specialist with the otolaryngology division of the department of surgery at the University of Maryland in Baltimore; Andrew Borden, CPC, CCS-P, CMA, reimbursement manager for the department of otolaryngology at the Medical College of Wisconsin in Milwaukee; Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J.; Lee Eisenberg, MD, an otolaryngologist in private practice in Englewood, N.J., and a member of CPTs editorial panel and executive committee; Chrissy Rogan, CPC, billing coordinator with Metropolitan ENT, a otolaryngology practice in Alexandria, Va.; and Teresa Thompson, CPC, an otolaryngology coding and reimbursement specialist in Sequim, Wa.