Early Hearing Detection and Intervention Coding Fact Sheet

While coding for hearing screening is relatively straightforward, ensuring that appropriate payment is received for such services is a more complicated matter. This Coding Fact Sheet will provide you with a guide to coding for pediatric hearing screening. While we have provided you with some suggested codes, it should be noted that payer recognition of codes might vary. Most plans are required to cover hearing screen services under the Affordable Care Act, however, that may still vary. The codes listed here are commonly reported not an exhaustive list.

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10 CM) Codes

Hearing Loss

Other Diagnosis Codes Related To Hearing Loss

Congenital Anomalies

Injury and Poisoning

Symptoms, Signs, and ILL-Defined Conditions

Z Codes

Z codes represent reasons for encounters. Categories Z00–Z99 are provided for occasions when circumstances other than a disease, injury, or external cause classifiable to categories A00–Y89 are recorded as 'diagnoses' or 'problems'. This can arise in 2 main ways.

(a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem is in itself not a disease or injury.

(b) When some circumstance or problem is present which influences the person’s health status but is not in itself a current illness or injury.

(c) When a social determinant of health is identified during an encounter and it is either addressed or shown to complicate the encounter, it should be coded.

Current Procedural Terminology (CPT®) Codes

The audiometric tests listed below require the use of calibrated electronic equipment, recording of results, and a report with interpretation. Hearing tests (such as whispered voice, tuning fork) that are otorhinolaryngologic evaluation and management services are not reported separately. All services listed are bilateral. Use modifier 52 if a test is applied to one ear only.

Health and Behavior Assessment/Intervention Codes

These codes are not reported by a physician.

Assessment

The focus of the assessment is not on mental health but on the biopsychosocial factors important to physical health problems and treatments.

Intervention

The focus of the intervention is to improve the patient's health and well-being utilizing cognitive, behavioral, social, and/or psychophysiological procedures designed to ameliorate the specific hearing-related problems.

Healthcare Common Procedural Coding System (HCPCS) Codes

CPT codes are also known as Healthcare Common Procedure Coding System (HCPCS) Level I codes. The HCPCS also contains Level II codes. These Level II codes (commonly referred to as HCPCS "hick-picks" codes) are national codes that are included as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) standard procedural transaction coding set along with CPT codes.

HCPCS Level II codes were developed to fill in the gaps in the CPT nomenclature. While they are reported in the same way as a CPT code, they consist of one alphabetic character (A-V) followed by four digits. In the past, insurance carriers did not uniformly recognize HCPCS Level II codes. However, with the advent of HIPAA, carrier software systems must now be able to recognize all HCPCS Level I (CPT®) and Level II codes.

HCPCS Hearing Services Codes

Vignettes

Vignette #1

5-year-old male established patient presenting for pre-kindergarten health assessment, fails to pass the hearing screen, using a pure tone audiometer at the 30 decibels (dB) level from 500 to 4000 Hertz (Hz) in the left ear. He has a history of three ear infections in his second year. Tympanometry is normal for both ears, indicating no evidence of middle ear effusion. Parents deny any behaviors that would suggest hearing loss (does not turn up the TV, appears to hear voice commands, and does not speak loudly).

How is this service reported?

CPT Coding:

ICD-10-CM Coding:

Note: Contrary to CPT® guidelines, some payers may inappropriately bundle the screening audiometry service(s) with the preventive medicine evaluation and management (E/M) code. Appending modifier 25 to the preventive medicine service may unbundle the services. Health assessment should include information pertinent to hearing loss such as prenatal or perinatal risk factors, family history of hearing loss under 30 years of age, physical stigmata related to hearing loss.

The patient is then referred to an audiologist proficient in hearing testing of children for diagnostic testing. Audiologist report for pure tone audiometry (air and bone) and sound booth testing indicates he has sensorineural hearing loss at 50dB in the left ear and normal hearing at 20 dB in the right ear; his left ear speech threshold is 40 dB and right ear speech threshold is 15 dB.

How is this service reported?

CPT Coding:

ICD-10-CM Coding:

Pediatrician counsels parents for 15 minutes on the audiological diagnostic testing results, reviews possible etiologies for unilateral hearing loss, provides information on the effects of unilateral hearing loss on classroom learning, and refers the patient to an otolaryngologist.

How is this service reported?

CPT Coding:

ICD-10-CM Coding:

Note: Otolaryngologist may request CT of left ear or BAER (ABR) testing. Patient should be considered for unilateral amplification in the classroom setting to reduce possible learning barrier.

Vignette #2

An infant is born to parents who both have hearing loss greater than 90 dB. The newborn hearing screen is normal, with no indication of hearing loss. There is a significant family history of congenital hearing loss in both families. Patient is recommended by the hospital hearing screener for repeat hearing testing at 6 months.

How is this service reported?

CPT Coding:

ICD-10-CM Coding:

Note: Payers may inappropriately bundle this procedure into the hospital care E/M code. Six months later, patient sees hospital screener for repeat hearing testing. Options might include automated brain response (auditory evoked potentials) versus sound booth testing as OAE testing not possible in the active child. Because of the family history, parents are offered a referral to a geneticist for testing for the Connexin 26 gene and subsequent genetic counseling. Referral to an early intervention agency is provided so communication issues can be addressed as parents sign only and have no oral speech.

How is this service reported?

CPT Coding:

ICD-10-CM Coding:

Vignette #3

Physician sees patient to confirm audiological screening results. Recommends genetic assessment for Connexin gene for future pregnancy planning. Recommends family seek early intervention services to address communication issues for deaf parents who sign only and a hearing child. How is this service reported?

CPT Coding:

ICD-10-CM Coding:

Vignette #4

An infant who was referred following an abnormal otoacoustic emission hearing test also fails diagnostic testing at age 5 weeks for both OAE and ABR. ABR indicates a pure tone threshold at about 80dB in both ears; hearing aids may improve auditory acuity. The parents have normal hearing. How is this service reported?

CPT Coding:

ICD-10-CM Coding:

Vignette #5

Patient requires a medical workup for congenital hearing loss. History should assess prenatal or perinatal causes, family history of hearing loss, examination for stigmata associated with hearing loss, genetic testing, EKG (CPT code 93000), and ENT and ophthalmological exams. How is this service reported?

CPT Coding:

ICD-10-CM Coding:

Vignette #6

At the 8-week well exam the parents inquire about the next steps to eventually obtaining a cochlear device so the patient can have oral communication. They want to know what is done during the waiting period for the cochlear implant to communicate effectively with their infant and whether there are any additional referrals to other physicians or studies needed. How is this service reported?

CPT Coding:

ICD-10-CM Coding:

Vignette #7

Patient needs referral to area cochlear implant service, early intervention agency to facilitate nonverbal communication pending cochlear implant by 3 months, and CT scan of ears to assess inner ear anatomy. Otolaryngologist and audiologist should refer patient for auditory amplification by age 6 months.

CPT Coding:

ICD-10-CM Coding:

Last Updated

01/31/2024

Source

American Academy of Pediatrics