Question
When we see children for UNHS follow-up testing, we frequently see normal OAEs at both ears after failing the initial screening from either ear in the hospital. There is some disagreement regarding the Dx code used there: Should it be conductive hearing loss, as that is what likely caused the initial failure, or V72.1 normal hearing? The V code would result in many rejected billings; while some audiologists argue that we should do that & submit them to our UNHS state system, we're still up in the air. Advice?
Answer
The diagnosis for an evaluation is determined by the outcome of that evaluation. For example, if a child failed a hearing screening in the nursery, one possibility for diagnosis could be 389.9 on the basis that if the child has hearing loss, the type and degree of hearing loss are unknown. Typically, there is insufficient evidence to point to conductive hearing loss or sensorineural at the time of the initial screening.
Many times when the child returns for repeat testing, the result is normal hearing sensitivity. In that case, I recommend using 389.9 (hearing loss, unspecified) as the diagnosis. This recommendation is based on following the protocol established by our medical colleagues.
First, there is no diagnosis code, including V72.1 that represents normal hearing. Under the ICD-9 system, one is "not allowed" to be normal. Therefore, professionals must come as close to truth as possible. In the example of medicine, if a child comes to a pediatrician with health concerns that turn out to be unfounded and the examination reveals normal health, the physician codes the visit as the disease process or symptom represented by the reason for the visit and a ".9" suffix meaning unspecified.
Since we deal with hearing, our ''code to use'' when we don't know precisely whether hearing loss exists is 389.9. But also, when we find normal auditory function, we still use 389.9 representing the primary concern for which we saw the individual.
The "V" codes do not represent normal function. V72.1 is the code for "hearing test". "V" codes are used when procedures are performed that have nothing to do with the primary reason the patient is in the office. For example, if someone sees a physician for blood pressure problems and requests a hearing test while there, the code would be V72.1 which would document that the procedure was done but was not medically necessary. The aspect of not being medically necessary is why V72.1 most often is not reimbursable. That is why I do not recommend use of that code unless it was performed under similar conditions described in the example above.
There is one exception that I know of regarding the use of V72.1 associated with UNHS. In the state of Florida, Medicaid has made special arrangements for that code to become the diagnosis code for children who are Medicaid eligible and are being tested under the requirements of Florida law. Use of that code identifies the child as a UNHS child with payment arrangements that are different from a routine doctor's visit. To my knowledge, the use of V72.1 by Florida Medicaid is the only exception to the recommendation of not using V72.1. And this was a special arrangement initiated by Florida Medicaid only for the purpose of identifying UNHS babies under Florida law.
Most importantly, the diagnosis should not be based on "presumed" reasons why the child failed the initial screen. It should only be based on the outcome of the current evaluation.
Robert C. Fifer, Ph.D. is the Director of Audiology and Speech-Language Pathology at the Mailman Center for Child Development, University of Miami School of Medicine, Miami, Florida. Dr. Fifer serves on the Health Care Economic Committee for ASHA which deals with creation, editing, and appropriate use of CPT and ICD-9 codes.
