Question
We have children referred to us by their primary care physician for delayed speech, asking for a hearing test to be done to make sure they have normal hearing. What diagnosis code do you use for these hearing tests? The V72.1 is not payable by most insurance companies and if we use delayed speech they say we are using a speech diagnosis code with a hearing test procedure code and it is not payable. The insurance companies say to use a hearing diagnosis code. Any suggestions on a diagnosis code?
Answer
The code ''V72.1'' comes from a section of the ICD-9 manual that represents codes for procedures unrelated to the primary purpose of a physician's office visit. For example, if a patient comes in to see the doctor for a follow-up visit for high blood pressure, and the patient requests a hearing test while in the office, the code would be V72.1. A hearing test was done, but it was not medically necessary for the primary reason the patient was in the office.
You are correct in noting that you cannot render the diagnosis for speech delay. Although that can be a secondary diagnosis because it is the presenting problem, your primary diagnosis must be hearing related. Typically the diagnosis code for normal hearing sensitivity is 389.9 (hearing loss, unspecified). The issue is that in the ICD-9 series, no one is allowed to be normal. The working assumption is that if you are seen in a health care provider's office, something must be wrong. Consequently, medicine has long established that when a patient arrives for an appointment with a complaint that turns out to be unfounded, the diagnosis code comes from the family of codes representing the possible disorder (in our case the 389 family of codes) followed by the suffix ''.9'' which almost always means ''unspecified''. In our situation, 389.9 could represent three scenarios: 1) You have evaluated a patient and think there exists a hearing loss, but you don't have sufficient information to support a more specific diagnosis; 2) You have sufficient test results to say that hearing loss exists, but the results are not sufficiently complete to say what kind of hearing loss the patient has; and 3) the primary concern regarding a potential hearing problem turns out to be unfounded (e.g., normal hearing sensitivity). Therefore, the diagnosis code I would recommend for a normal audiogram is 389.9.
Bob Fifer
Robert C. Fifer, Ph.D.
Director of Audiology and Speech-Language Pathology
Mailman Center for Child Development
1601 NW 12th Avenue
Miami, FL 33101
