Otolaryngology Coding Alert

You'll need side-specific details to use new hearing loss codes

If you love attention, ICD-9 2008 is for you. With only 146 new codes this fall, ENTs get the lion's share of the focus with more than 20 percent of the diagnoses--30 to be exact--pertaining to them.

The Centers for Disease Control & Prevention has released the new ICD-9 codes for 2008. They take effect Oct. 1, 2007, with no grace period. CDC may add some more codes to the list between now and September, but most of 2008's new additions are already available. Here are the changes you can't afford to overlook.

Ask Bilateral or Unilateral Before Using 7 New 389.xx Codes

When coding hearing loss using ICD-9 2008 diagnoses, you-re going to have to look for more details in the medical record. The trend toward side-specific loss codes started in 2007 with the additions of ICD-9 codes 389.15 (Sensorineural hearing loss, unilateral) and 389.16 (Sensorineural hearing loss, asymmetrical), says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, director of outreach programs for the American Academy of Professional Coders based in Salt Lake City. ICD-9 2008 continues the trend with further granularity. 

The hearing loss category (389) will allow you to differentiate between bilateral and unilateral loss. This added specificity could considerably improve -epidemiology, public policy (e.g., prevalence of hearing loss in children), and hearing loss research efforts,- say Kyle C. Dennis, PhD, CCC-A, FAAA, and Dee Adams Nikjeh, PhD, CCC-SLP, with the American Speech-Language-Hearing Association (ASHA).

Meet new codes 1 and 2: ICD-9 2008 increases the possible conductive hearing loss diagnoses from six to eight codes. The two additional codes include:

- 389.05 for unilateral conductive hearing loss
- 389.06 for bilateral conductive hearing loss.

Lowdown on new codes 3 and 4: You-ll gain one ICD-9 code in both the neural and sensory hearing loss families. Codes 389.13 and 389.17 will represent these types unilaterally. Use 389.13 for -Neural hearing loss, unilateral,- and identify -Sensory hearing loss, unilateral- with 389.17.

Get acquainted with new codes 5-7: Three new codes debut in the 389.2 subcategory. These additions will allow you to identify the specific types of losses. You now  have to lump these under one code: 389.2 (Mixed conductive and sensorineural hearing loss).

For unilateral mixed hearing loss, you will assign 389.21, and you-ll report 389.22 for -mixed hearing loss, bilateral.- When the physician needs to order additional testing as a result of the audiogram to further evaluate the hearing loss, you will be able to use the code for unspecified mixed hearing loss (389.20), says Janet Agemian, CPC, administrator at Regional Otolaryngology Associates LLC in Voorhees, N.J.

Benefit: The new terms will allow you to -more accurately and precisely describe the patient's hearing loss,- Agemian says. This ensures the validity of the office documentation and insurance company information.

To eliminate overlap of introduced codes with current codes, ICD-9 2008 will revise two 389.1x (Sensorineural hearing loss) codes. When you revamp the diagnoses on your superbill, make sure to take -bilateral- off 389.14. Starting Oct. 1, the code will refer to -Central hearing loss.- The expansion of the 389.2 subcategory makes the phrase -of combined types- in 389.18 (Sensorineural hearing loss of combined types, bilateral) unnecessary. The revised code will refer simply to -sensorineural hearing loss, bilateral.-

Squeeze in Specific Codes for APD, Delay

You should also make room on your superbill for two disorders that come into their own this fall. ICD-9  2008 will allow you to specify -Acquired auditory processing disorder- with 388.45. Cram in 315.34 for -Speech and language developmental delay due to hearing loss.-

Reason: Although ICD-9 2005 added -central auditory processing disorder- to the disease index for 315.32 (Mixed receptive-expressive language disorder), the code didn't appropriately capture auditory processing disorder (APD). Individuals can acquire APD through neurological problems caused by tumors, head injury (postconcussive injury or traumatic brain injury), surgical mishaps, stroke or degenerative neurological conditions, bacterial or viral infections, or oxygen deficiency. Therefore, ASHA proposed creating a unique code for acquired APD in Chapter 6, Diseases of Nervous System and Sense Organs.

Code 315.34's addition is aimed at benefiting an unlikely group: children. A significantly greater risk for not acquiring normal, age-appropriate language and speech abilities exists for children born with hearing loss or deafness, whether permanent or intermittent. The new code -will assist researchers and epidemiologists to improve the accuracy of tracking, communicating, and allocating resources to those with this condition,- Dennis and Nikjeh said during ASHA's recommendations for additions and revision to the ICD-9.

Update 389.7 With More PC Term

Look forward to a term change to 389.7 (Deaf mutism, not elsewhere classifiable), which will eliminate the reference to -deaf mutism---an inaccurate and archaic term--and replace it with the more descriptive diagnosis of -nonspeaking.- -Deaf and hard-of-hearing people can vocalize but have difficulty modulating their voices,- Dennis and Nikjeh say. Because people who are deaf and hard of hearing may use other means of communication rather than speech, they should not be identified as mute.

Break Out These Visits From V70.5

If you-ve been hoping for a better way to classify encounters for hearing conservation and disability examination than the catchall V70.5, ICD-9 2008 grants your wish with two new V codes.

You will be able to describe -an encounter for hearing conservation and treatment- with V72.12. This code will allow you -to differentiate hearing conservation and occupational hearing tests from V70.5 (Health examination of defined subpopulations),- says Steven C. White, PhD, ASHA-s director of healthcare economics and advocacy in -New diagnoses recommended for the International Classification of Diseases- in The ASHA Leader, 11(15), 3.

You-ll also finally have a specific code for a disability examination: V68.01. These exams determine compensation and pension payments for disabling conditions incurred in or aggravated by military service. -Other codes (e.g., examination for medical and legal reasons) do not specifically cite disability examination,- White says. The new code means you can avoid lumping these encounters under V70.5, which identifies a wide array of subpopulations, including armed-forces personnel, prisoners, preschool children, students, refugees and prostitutes.

Apply These Terms to V49.85

 Another V code you-ll want to add to your superbill is V49.85 (Dual sensory impairment). Watch for other terms, including -deaf-blindness- or -multi-sensory impairment- that your otolaryngologist might use for dual sensory impairment.