Audiology Coding Conundrums The correct CPT or ICD-10 code isn’t always clear. Try these tips to correctly document diagnoses and services. Bottom Line
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Bottom Line  |   July 01, 2018
Audiology Coding Conundrums
Author Notes
  • Neela Swanson is director of ASHA health care policy, coding and reimbursement. nswanson@asha.org
    Neela Swanson is director of ASHA health care policy, coding and reimbursement. nswanson@asha.org×
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Bottom Line
Bottom Line   |   July 01, 2018
Audiology Coding Conundrums
The ASHA Leader, July 2018, Vol. 23, 28-29. doi:10.1044/leader.BML.23072018.28
The ASHA Leader, July 2018, Vol. 23, 28-29. doi:10.1044/leader.BML.23072018.28
You’ve just done a VEMP (vestibular evoked myogenic potential) evaluation, but when you try to fill out the insurance form for reimbursement, you discover there’s no procedure code for the test. What?
Audiology diagnosis and procedure codes are not always obvious. New technology may develop more quickly than CPT codes (Current Procedural Terminology, © American Medical Association), leaving audiologists without codes to describe their services. Diagnosis codes in the ICD-10-CM code set (International Classification of Diseases, 10th Revision, Clinical Modification), for all its specificity, are not always precise enough to capture the nuances unique to hearing and vestibular disorders.
These tips can help audiologists appropriately report services on their claims, even when there isn’t a perfect coding solution.
Although ICD-10 coding guidelines are relevant in all settings, please note that the CPT coding guidance addressed here applies primarily to outpatient billing. (Inpatient settings may use CPT codes to track services for administrative and productivity purposes, but not for billing. Each facility has its own criteria for tracking services and determining productivity, but these rules are separate from payment policy.)
What codes should I use to report services related to hearing aids? There are multiple options.
Providers identify supplies, equipment and devices—including hearing aids or implants—through HCPCS (Healthcare Common Procedure Coding System) Level II codes. However, HCPCS codes can also be used to report some services or procedures—much like CPT codes—which can create confusion, especially for services related to hearing aids, which can be reported using either CPT or HCPCS codes.
Payers may opt to use either set of codes, so providers should be prepared to set a usual and customary fee schedule for each set of codes. Check with each patient’s payer to determine which code set to use on that patient’s claims. Note that Medicare does not pay for services related to hearing aids.
Following are examples of CPT and HCPCS codes that are used for services related to hearing aids.
  • V5010, Assessment for hearing aid

  • V5011, Fitting/orientation/checking of hearing aid

  • V5014, Repair/modification of a hearing aid

  • V5020, Conformity evaluation

  • V5090, Dispensing fee, unspecified hearing aid

  • V5299, Hearing service, miscellaneous

  • V5336, Repair/modification of augmentative communicative system or device (excludes adaptive hearing aid)

  • 92590, Hearing aid exam and selection, monaural

  • 92591, Hearing aid exam and selection, binaural

  • 92592, Hearing aid check, monaural

  • 92593, Hearing aid check, binaural

  • 92594, Electroacoustic evaluation for hearing aid, monaural

  • 92595, Electroacoustic evaluation for hearing aid, binaural

  • 92596, Ear protector attenuation measurements

If you receive a CPT code survey over the next few months, please complete it—in doing so, you are acting on behalf of the profession to establish the worth of your work.

There is no CPT code for a service or procedure I just provided. Does that mean I can’t get paid for it?
Not necessarily. If you provided a medically necessary service that doesn’t have an associated CPT code—such as a VEMP evaluation—you can consider submitting a claim using 92700 (unlisted otorhinolaryngological service or procedure).
You need to submit clear documentation with the claim that outlines the patient’s report and results, your qualifications, a detailed description of the service provided (including the effort required), a description of the clinical use of and efficacy for the service, and your usual and customary fee for the service or procedure.
Claims for CPT code 92700 are manually reviewed by the payer, and payment is not guaranteed. To increase chances for reimbursement, check with the payer to make sure the service you provided is covered under the patient’s benefits and that the accompanying documentation is clear and concise and demonstrates medical necessity.

To increase chances for reimbursement, check with the payer to make sure the service you provided is covered under the patient’s benefits and that the accompanying documentation is clear and concise and demonstrates medical necessity.

There is no CPT code specific to neural response telemetry (NRT) during cochlear implantation. Should I use CPT code 92700 (unlisted otorhinolaryngological service or procedure)?
No, in this case, do not use 92700. Although there is not a specific code for NRT, the July 2011 CPT Assistant recommends CPT 92584 (electrocochleography) because it broadly captures the method used to electrically stimulate the cochlea and record the electrical response.
I spend a significant amount of time counseling the patient or family after an audiologic evaluation or a hearing aid fitting. Can I use CPT codes 92626 (evaluation of auditory rehabilitation status, first hour) and 92627 (each additional 15 minutes) to capture the time spent in counseling?
No, it is not appropriate to report 92626 and 92627 for time spent in patient and family counseling.
According to the July 2014 issue of the CPT Assistant, codes 92626 and 92627 should be used to “determine the need for auditory rehabilitation following the fitting and verification of hearing devices and may also be used to monitor the progress of therapeutic intervention.”
The guidance is clear that it is inappropriate to use 92626 and 92627 for services other than the evaluation of auditory function to determine the need for rehabilitation. Learn more on the appropriate use of the evaluation codes online.
ICD-9 had a code for asymmetrical hearing loss, but I don’t see one in ICD-10. How should I code for different degrees of hearing loss?
There is no clear explanation for why the code for asymmetrical hearing loss was removed from the newest ICD code set. Audiologists should code asymmetrical hearing loss using an ICD-10 code that reflects bilateral hearing loss. For example, asymmetrical sensorineural hearing loss is reported using H90.3 (sensorineural hearing loss, bilateral).
How should I report a patient with asymmetrical hearing loss who also has abnormally poor speech perception in the poorer ear?
There is no ICD-10 code for impairment of auditory discrimination. Instead, consider using the appropriate code from the H93.2- series for abnormal auditory perception, in addition to the ICD-10 code to report the asymmetrical hearing loss. Find the full list of ICD-10 codes in the H93.2 series online.
There are so many diagnosis and procedure codes that aren’t appropriately captured in the CPT and ICD-10 code sets. Is ASHA going to try to get them added?
Adding codes to either the CPT or ICD-10 code set is a long and complex process that involves many stakeholders, including related specialty groups, the American Medical Association, and the Centers for Medicare and Medicaid Services (CMS). The benefits of adding or revising codes must be weighed carefully before initiating the process, especially for CPT codes, which are the basis of most outpatient fee schedules.
When a CPT code is added or revised, ASHA and other stakeholders work together to appropriately describe and value the service. An important component of this process is input from practicing clinicians who perform the service. That could be you!
Surveys on the time and complexity of a CPT service or procedure are sent to a random sample of audiologists. Results are submitted to CMS to inform the development of the annual Medicare Physician Fee Schedule. If you receive a CPT code survey over the next few months, please complete it—in doing so, you are acting on behalf of the profession to establish the worth of your work.
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July 2018
Volume 23, Issue 7