Otolaryngology Coding Alert

Question: Im having problems getting paid when I perform audiology and the tests reveal the patient has sensorineural hearing loss. I use ICD-9 code 389.1x. What is the problem? Without the audiology I wouldnt have known about the sensorineural hearing loss.

Ohio Subscriber

Answer: The problem is the diagnosis code, says Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C. Most Medicare carriers do not cover audiologic tests for patients with sensorineural hearing loss, on the grounds that such conditions cannot be treated. Because in this instance the audiologic testing was responsible for the sensorineural hearing loss diagnosis, however, you may link the pretest diagnosis (for example, 388.40, abnormal auditory perception, unspecified; 388.30, tinnitus, unspecified; and 388.01, presbyacusis; 388.43, impairment of auditory discrimination) to the appropriate CPT audiology code. Any subsequent testing would not be covered because the patient would have an existing sensorineural hearing loss diagnosis.

Note: Many Medicare carriers instruct their physicians to use only pretest diagnoses for diagnostic tests, even though it is widely accepted that using posttest diagnoses better fulfills the requirement to code to the highest level of specificity.