The basics of ICD9-CM

ICD9-CM is an acronym for the International Classification of Diseases, 9th Revision. ICD9s are a listing of codes designed to classify diagnoses and symptoms. These codes typically consist of four to five digits. Those which apply to auditory problems begin with the numbers 38- . ICD9 code books are available for purchase through the AMA website.

ADA offers a list of Commonly used ICD9 codes used in audiology practices. (See note, below.) The list is not exhaustive, and special circumstances may require codes other than those listed, or one of the listed codes may be beyond your scope of practice. Avoid using diagnostic codes that are beyond your scope of practice, unless a physician provides the diagnosis. Refer to a current ICD-9 code book for details.

ICD9 TIPS: DO's & DONT'S

• Always use the most specific ICD9 code possible and avoid unspecified codes as they may result in a denied claim.
• Rank the diagnosis codes and link them to each procedure completed. Ranking involves putting the most relevant ICD-9 codes first that either caused the procedure to be administered, or that represent diagnostic information resulting from the procedure.

EXAMPLE
A patient comes into a practice reporting tinnitus and dizziness and the comprehensive audiogram (CPT 92557), tympanometry (CPT 92567), acoustic reflex testing (CPT 92568), and otoacoustic emissions (CPT 92588) revealed a sensory hearing loss. On the Superbill, the diagnosis codes might be ranked as follows:

Where the ICD9’s are listed, assign a numerical ranking, e.g.:

Show the ranking order for east test/procedure administered, e.g.:

• If you work in conjunction/cooperation with a physician or receive direct referrals from a physician, cross reference the hearing healthcare provider diagnosis to that of the physician; this action may provide the hearing healthcare provider with a more specific diagnosis for billing.
• Avoid using presbycusis (388.01) as a diagnosis.
• Try not to use sensorineural hearing loss (389.10) as the primary diagnosis when the patient presents another diagnosis and/or symptom (e.g. vertigo, tinnitus); (389.10) is an unspecified code more appropriate to use as the secondary diagnosis; try to determine if the hearing loss is sensory (389.11) or neural (389.12) when possible; Medicare accepts sensorineural hearing loss as a “reimbursable” diagnosis but it is advisable to use this code with caution as rejections are still occurring.
• Do not use ICD9 codes which are outside the scope of practice of the hearing healthcare provider, unless a physician provides the diagnosis.
• If a patient has normal hearing, use code V72.1 (Examination of ears and hearing) or V65.5 (Person with feared complaint in whom no diagnosis was made) or V19.2 (family history of deafness or hearing loss) plus any symptom code, if possible. Symptom codes are ICD-9s that deal with reported or observed symptoms, such as tinnitus (388.31), dizziness (780.4), otalgia (388.70) or hyperacusis (388.42). They are distinct from ICD-9s that are related to the diagnostic outcome of the test such as sensory hearing loss (389.11). Only use these codes when no other codes are possible; inform families that the services may not be covered unless they have wellness coverage.
• Contact your local Medicare intermediary to determine if there are any guidelines with regard to diagnosis codes that are allowed for specific procedures.

If you have any specific questions, visit the reimbursement forum or send an e-mail to the ADA Help Desk.

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