Question
If testing children either for the first time or following medical treatment for a conductive loss, and test results show that hearing is now normal, what code should be used?
Answer
You should use one of the conductive hearing loss codes. We often think of the ICD-9 code as telling the world what we found. That is a little hard to do when things are normal only because there is no code for "normal". The system assumes that there was a medically necessary reason that services were sought in order for any coding to go through. The use of the ICD-9 code then shifts to justify the medical necessity of the procedure rather than a declaration of what was found. Although I hate to use this term, but the best way to describe this is that the ICD-9 code then becomes a "reason" code to describe, in essence, what you were looking for on the basis of the referral. The diagnosis code becomes a way to tell the world what that reason was why you were seeing the child. The rationale why the code needs to be from the hearing family of codes is because third parties will want to see that we were looking for something that occurs within our scope of practice. The diagnosis of otitis media is not exactly within our scope of practice to the same magnitude that diagnosis of hearing loss is within our scope of practice. The otitis media codes can be listed as secondary codes, but the primary code, always listed first, must be a code that is associated with what we do by third party payers.
For many years, Medicine tried to set the example by using the 3 digit code representing the family of diagnosis codes dealing with a certain entity. They would then put ".9" following the first three digits to specified. For us, the example would be 389.9 (Hearing loss, unspecified). To say that this caused all kinds of consternation is a gross understatement. CMS took the bull by the horns in 2001 when they published Bulletin AB-01-144 (available on the CMS website, www.cms.hhs.gov/). This became the first authoritative document to describe how everyone in health care selects a diagnosis code, especially when the outcomes are normal.
Robert C. Fifer, Ph.D. is currently the Director of Audiology and Speech-Language Pathology at the Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine. He received his B.S. degree from the University of Nebraska at Omaha in Speech-Language Pathology with a minor in Deaf Education. His M.A. degree is from Central Michigan University in Audiology. And his Ph.D. degree is from Baylor College of Medicine in Audiology and Bioacoustics. Dr. Fifer's clinical and research interests focus on the areas of auditory evoked potentials, central auditory processing, early detection of hearing loss in children, and auditory anatomy and physiology. He a Past-President of the Florida Association of Speech-Language Pathologists and Audiologists, a member of ASHA's Health Care Economics Committee, and the ASHA representative to the American Medical Association's Health Care Professions Advisory Committee for the Relative Value Utilization Committee in addition to being ASHA's representative to the AMA's Practice Expense Advisory Committee. Additional responsibilities at the state level include serving as a consultant to the Florida Department of Health's Children's Medical Services and the audiology representative to the Genetics and Newborn Screening Advisory Council.
