Note: A comprehensive list of relevant ICD-10 Codes for audiologists is provided in the Superbill Template on the Academy Website under Practice Resources.
Introduction
The ICD-10 (International Classification of Diseases, 10th Revision) is an alphanumeric coding system used internationally to classify diseases and health conditions for health reporting and insurance purposes. Accurate ICD-10 coding is crucial for audiologists as it directly impacts reimbursement from insurance companies and government programs. Proper coding ensures that services rendered are appropriately documented and billed, reducing the risk of claim denials and payment delays. Additionally, accurate coding contributes to reliable data collection, which is essential for ensuring consistency in medical records and facilitating effective treatment planning. ICD-10 codes may also be used for quality improvement initiatives, epidemiological studies, and healthcare policy development.
Basics of ICD-10 Coding
ICD-10 codes are organized into a hierarchical structure comprising categories, subcategories, and codes. Codes have varying depths of specificity. Each of the 21 chapters represent a broad classification of diseases and health conditions. Many hearing related ICD-10 codes are found in the H chapter, but others related to dizziness and other audiology-related diagnosis may be found in different chapters.
Reporting of ICD-10 codes should be as specific as possible. This is made possible through subcategories which provide further specificity and are indicated by additional characters (e.g., H90.3 for bilateral sensorineural hearing loss). Full codes can have up to seven characters, which allow for precise documentation of a patient's condition, including laterality, severity, and other clinical details.
An example of the ICD-10 code structure is presented in Table 1. Each chapter is uniquely identified by a letter, but this letter is not indicative of the content. The first digit is always alphabetic, while the second and third digits are numeric. There is always a decimal after the first three digits (definition of the code category). The fourth through sixth digits indicate etiology, anatomical site, or severity and may be letters, numbers, or ‘X’ as a placeholder. The ‘X’ placeholder is commonly used as a 5th character in certain 6 digit codes to allow for future expansion. The ‘X’ must be included as part of the code to be considered valid for reporting. The seventh digit is called an “extension” which describes the encounter type (initial, subsequent, sequelae) for certain conditions such as traumatic brain injury.
Table 1. ICD-10 Coding Structure Example: O41.1231
| 0 | 4 | 1 | . | 1 | 2 | 3 | 1 |
| Chapter O (pregnancy and childbirth) | Disorders of amniotic fluid and membranes | Chorioamnionitis | Trimester | Fetus | |||
| Alpha (denoting ICD-10 Chapter) | Numeric | Numeric or Alpha |
Numeric or Alpha |
Numeric or Alpha |
Numeric or Alpha |
Numeric or Alpha |
|
| Category (or Section) | Etiology, Site, Laterality, Etc. | Extension | |||||
ICD-10 Coding Conventions
Other codes (NEC, not elsewhere classified)
Codes titled “other” or “other specified” are for use when the information in the medical record provides detail for which a specific code does not exist. “Other” or NEC codes represent specific disease entities for which no specific code exists so the term is included within an “other” code.
Unspecified codes (NOS, not otherwise specified)
Codes titled “unspecified” are for use when the information in the medical record is insufficient to assign a more specific code. For those categories for which an unspecified code is not provided, the “other specified” code may represent both other and unspecified.
Exclusion terms
Type 1 Excludes = NOT CODED HERE.
This is a clear exclusion which indicates that the listed Type 1 Excludes codes should not be reported together. This is noting that these two conditions cannot occur together (e.g., cannot have congenital and acquired syphilis from the same condition). Codes cannot occur together.
Type 2 Excludes = NOT INCLUDED HERE.
This is a note that the diagnosis is not part of the condition, but it is possible for the patient to have both conditions at the same time. Under a Type 2 Excludes note, it is acceptable to report the two ICD-10 codes together. An example of Type 2 Excludes would be for congenital malformations that would not be captured as part of coding of hearing loss within the H Chapter. But, because there can be congenital malformations associated with hearing loss, the congenital malformations codes (e.g., Q00-Q99) could be reported as a secondary diagnosis code.
Code first
Many conditions specify the underlying etiology and its manifestations. Indicates proper sequencing of codes. Sometimes the underlying diagnosis code should be coded first. For example, otitis media could be considered part of the “etiology” that resulted in a tympanic membrane perforation. In practice, hearing loss codes should generally be listed first and then use others if no other code exists and/or if the other diagnoses have already been reported/coded by ENT.
Additional information on ICD-10 Z-Code Family
There is another family of codes which are highly relevant to audiologic practice found in the Z chapter (Z00-Z99: Factors influencing health status and contact with health services. It is not generally recommended to report Z codes as a primary diagnosis code. Rather, Z codes can be used to further supplement and provide more specific information about the health encounter (e.g., Z97.4 - Presence of external hearing aid).
Frequently Asked Questions
What ICD-10 codes do I report when I performed a comprehensive audiologic assessment and had no abnormal findings?
- There is no ICD-10 code for ‘normal hearing.’ Instead consider use of H91.8X3 (Other specified hearing loss, bilateral) to indicate there is some audiologic issue, but your testing was not able to specifically discern the locus or cause of the issue. Other codes such as Z01.10 (Encounter for examination of ears and hearing without abnormal findings) may also be relevant to report, but Z codes are not typically reimbursed when used as a primary diagnosis code. Providers are encouraged to seek payer-specific guidance on how to report ICD-10 codes when the testing results in no abnormal findings.
ICD-10 Documentation Best Practices and Avoiding Common Pitfalls
Audiologists should ensure that all patient encounters are thoroughly documented, including the patient's medical history, presenting symptoms, clinical findings, diagnostic test results, and treatment plans. Specificity in documentation is key: document the exact nature, laterality, and severity of the condition. For example, instead of noting "hearing loss," specify "bilateral sensorineural hearing loss."
Additionally, coding for diagnostic tests should be consistent with the following guidelines:
- Code for the result of the diagnostic test.
- In the case of a normal result, the next choice would be to choose a diagnosis code that reflects the reason for the referral and/or the chief presenting complaint.
- It is helpful to include other secondary diagnosis codes that will help paint a clear clinical picture of why the test(s) are being performed.
Several common pitfalls can lead to inaccurate coding, affecting both reimbursement and patient care. One major pitfall is under-coding, where a code lacks the necessary specificity to fully describe the patient's condition, potentially resulting in lower reimbursement. Over-coding, or using codes that exaggerate the condition's severity, can also lead to claim denials and audits. Ensure that codes are supported by clinical documentation; if a diagnosis is not clearly documented, it should not be coded. Another common issue is not adhering to the "code first" or "use additional code" instructions, which can lead to incomplete coding.
Resources
- Centers for Disease Control ICD Browser Tool: https://www.cdc.gov/nchs/icd/icd10cm_browsertool.htm
- Centers for Disease Control ICD Information: https://www.cdc.gov/nchs/icd/icd-10-cm.htm
- Medicare ICD-10 Guidance: https://www.cms.gov/medicare/coding-billing/icd-10-codes?redirect=/icd10/
- ICD-10 Data: http://www.icd10data.com/
Need more help? Contact us at reimbursement@audiology.org.
