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Coding and Billingfor AUDIOLOGY and SPEECH-LANGUAGE PATHOLOGY

Coding and Billing for Audiology and Speech-Language Pathology

Coding and Billingfor AUDIOLOGY and SPEECH-LANGUAGE PATHOLOGY

Prepared by

ASHA Health Care Economics & Advocacy Team

ii 2016 Coding and Billing for Audiology and Speech-Language Pathology

2016 Coding and Billing for Audiology and Speech-Language Pathology is published by the American Speech-Language-Hearing Association (ASHA). ASHA publications are designed to support practitioners in administrative and clinical areas. Opinions contained herein are views of contributors and do not reflect the official views of ASHA.

ASHA DisclaimerAssigning codes to describe and bill for your services is a professional responsibility. The information contained in this book is designed as a resource for audiologists and speech-language pathologists and their staff in using various coding systems. Every effort has been made to ensure the accuracy of the information contained in this book. However, the service provider is ultimately responsible for correct coding.

American Medical Association (AMA) CPT Codes

CPT Copyright 2015 American Medical Association. All rights reserved.

CPT is a registered trademark of the American Medical Association.

CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians.

This presentation includes only CPT descriptive terms and numeric identifying codes and modifiers for reporting medical services and procedures that were selected by ASHA for inclusion in this publication.

Copyright 2015, American Speech-Language-Hearing Association

ISBN: 978-0-910329-86-6

Copies may be ordered from:

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2016 Coding and Billing for Audiology and Speech-Language Pathology i ii

Table of ContentsChapter 1: CPT Codes .....................................1 General ..................................................................... 1

Use of Codes............................................................ 1

ASHA’s Health Care Economics Committee .............. 1

CPT Procedure Codes ........................................... 1

Special Otorhinolaryngologic Services ................... 1

Additional CPT Codes ........................................... 4

Case Management Services ................................. 5

Chapter 2: ICD-9-CM Diagnostic Codes ........9 General ..................................................................... 9

Use of Codes............................................................ 9

Classification of Diseases and Injuries Related to Speech and Hearing Disorders (from Volume 1) ........................................ 9

Volume 2: V Codes................................................ 29

Volume 3: Procedures .......................................... 31

Code to the Highest Degree of Specificity .......... 32

Chapter 3: ICD-10-CM Diagnostic Codes ....33 General ................................................................... 33

Use of Codes.......................................................... 33

Overview ............................................................. 33

Scope ................................................................. 33

Purpose .............................................................. 33

ICD-10-CM Guidelines ........................................ 33

Official ICD-10-CM Websites ............................... 34

ASHA Resources ................................................ 34

ICD-10-CM Diagnostic Codes: Audiology ........... 35

ICD-10-CM Tabular List of Diseases and Injuries (Related to hearing and vestibular disorders) .......... 35

ICD-10-CM Diagnostic Codes: Speech-Language Pathology .............................. 67

ICD-10-CM Tabular List of Diseases and Injuries (Related to speech, language, and swallowing disorders) ...............................................................67

Coding Normal Results Frequently Asked Questions................................................. 105

ICD-10-PCS (Procedure Coding System) for Audiologist and SLPs ......................................... 106

Chapter 4: HCPCS ........................................107 General ................................................................. 107

Use of codes ........................................................ 107

Audiology Related HCPCS Codes ..................... 107

Speech-Language Pathology Related HCPCS Codes .................................................... 108

Chapter 5: G-codes ......................................111 G-codes and Severity Modifiers for Speech-Language Pathology Claims-Based Outcomes Reporting for Medicare Part B Therapy Services ................................................ 111

Background ...................................................... 111

Reporting .......................................................... 111

Speech-Language Pathology Related G-codes ........................................................... 112

Severity Modifiers .............................................. 113

Case Scenarios and Sample Claim Form Entries for Outcomes Reporting for Medicare Part B Therapy Services ................................................ 114

Chapter 6: Physician Quality Reporting System (PQRS) for Audiology ......................125 Background .......................................................... 125

2016 Benchmark Requirements ........................... 125

2016 Reporting Requirements .............................. 126

Chapter 7: Physician Quality Reporting System (PQRS) for Speech-Language Pathology ......................................................129 Background .......................................................... 129

2016 Benchmark Requirements ........................... 129

2016 Reporting Requirements .............................. 129

Chapter 8: National Correct Coding Initiative (NCCI) Edits ...................................131 Audiology Procedures ........................................ 131

Speech-Language Pathology Procedures ........ 133

Chapter 9: ASHA Model Superbills .............135 Model Superbill for Audiology ........................... 135

Model Superbill for Speech- Language Pathology .......................................... 140

Chapter 10: 1500 Claim Form ......................143

Chapter 11: Fee Data ...................................145 Determining Fees .................................................. 145

Medicare Fee Schedule ...................................... 145

Current Milliman Data ......................................... 145

Chapter 12: Documentation Guidance .......169 Documentation Tips ........................................... 169

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Documentation for Audiology, Based on Medicare Requirements ..................................... 169

Documenting Audiological Tests ........................ 169

Medicare Documentation for Speech- Language Pathology .......................................... 170

Electronic Health Records ................................. 172

Appendix & Resources .................................173 ICD-9-CM Conversion to ICD-10-CM ................ 173

Audiology .......................................................... 173

Speech-Language Pathology ............................ 193

Resources ........................................................... 212

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2016 Coding and Billing for Audiology and Speech-Language Pathology 1

Chapter 1: CPT CodesGeneralCurrent Procedural Terminology (CPT) is a listing of descriptive terms and identifying codes for reporting medical and health care services; CPT was developed by the American Medical Association (AMA) to provide health care professionals with a uniform language for communication. CPT is continually reviewed and revised to reflect changes in health care services. A number of procedures included in CPT are routinely performed by audiologists and speech-language pathologists.

Use of CodesSelect the name of the procedure that accurately identifies the service performed. Any service should be adequately documented in the medical record. AMA/CPT notes that, “Throughout the CPT code set the use of terms such as ‘physician,’ ‘qualified health care professional,’ or ‘individual’ is not intended to indicate that other entities may not report the service.” Any procedure or service in any section may be used to designate the services provided by any qualified health care professional. AMA/CPT indicates that a qualified health care professional is “an individual who is qualified by education, training, licensure/regulation (when applicable),” who performs a “professional service within his/her scope of practice and independently reports that professional service.”

ASHA’s Health Care Economics CommitteeASHA’s Health Care Economics Committee (HCEC) monitors current payment and coding concerns and works to ensure equitable coverage and reimbursement for audiology and speech-language pathology services. The Committee develops recommendations for coding and relative values of relevant codes. HCEC consists of six audiologists and six speech-language pathologists, three of whom serve as official representatives on the AMA Health Care Professional Advisory Committees to the CPT Editorial Panel and the Relative Value Update Committee.

CPT Procedure Codes

Special Otorhinolaryngologic ServicesThe following language can be found in the AMA’s Current Procedural Terminology—CPT 2016 (CPT).

Diagnostic or treatment procedures that are reported as evaluation and management services (e.g., otoscopy, anterior rhinoscopy, tuning fork test, removal of non-impacted cerumen) are not reported separately.

Special otorhinolaryngologic services are those diagnostic and treatment services not included in an evaluation and management service, including office

or other outpatient services (99201-99215), or office or other outpatient consultations (99241-99245).

Codes 92507, 92508, 92520, 92521, 92522, 92523, 92524, and 92526 are used to report evaluation and treatment of speech sound production, receptive language, and expressive language abilities, voice and resonance production, speech fluency, and swallowing. Evaluations may include examination of speech sound production, articulatory movements of oral musculature, oral-pharyngeal swallowing function, qualitative analysis of voice and resonance, and measures of frequency, type, and duration of stuttering. Evaluations may also include the patient’s ability to understand the meaning and intent of written and verbal expressions, as well as the appropriate formulation and utterance of expressive thought. In contrast, 92626 and 92627 are reported for an evaluation of auditory rehabilitation status determining the patient’s ability to use residual hearing in order to identify the acoustic characteristics of sounds associated with speech communication.

92502 Otolaryngologic examination under general anesthesia

92504 Binocular microscopy (separate diagnostic procedure)

92506 has been deleted. To report, see 92521, 92522, 92523, 92524

92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual

92508 group, two or more individuals

92511 Nasopharyngoscopy with endoscope (separate procedure)

ASHA Note: Please see CPT codes 31575 and 31579 (p. 2) for additional information regarding supervision requirements.

92512 Nasal function studies (e.g., rhinomanometry)

92516 Facial nerve function studies (e.g., electroneuronography)

92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing) (For performance of a single test, use modifier 52)

92521 Evaluation of speech fluency (e.g., stuttering, cluttering)

92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria)

92523 with evaluation of language comprehension and expression (e.g., receptive and expressive language)

92524 Behavioral and qualitative analysis of voice and resonance

92525 has been deleted as of 2003; see 92610-92617

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92526 Treatment of swallowing dysfunction and/or oral function for feeding

92597 Evaluation for use and/or fitting of voice prosthetic to supplement oral speech

92598 has been deleted as of 2003

31575 Laryngoscopy, flexible fiberoptic; diagnostic

31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy

ASHA Note: There is no level of supervision designated in the Medicare Physician Fee Schedule for laryngoscopy (CPT 31575), videostrobscopy (CPT 31579), and nasopharyngoscopy (CPT 92511). However, state and/or Medicare Administrative Contractor (MAC) supervision requirements may supersede Medicare’s requirement. Some states have endoscopy laws/regulations specific to speech-language pathologists, including California, New Jersey, Illinois, Michigan, and Tennessee. Other states such as Maryland, New York, and Virginia have policy statements and/or guidance documents. In some cases, the licensure laws and regulations may refer only to fiberoptic endoscopic evaluation of swallowing (FEES) or to all forms of endoscopy. For further information, see; www.asha.org/Practice/reimbursement/medicare/Medicare-Supervision-Requirements-for-Videostroboscopy-and-Nasopharyngoscopy-Procedures/.

(See 92612, 92613, 92616 for endoscopic evaluation of swallowing.)

Vestibular Function Tests, With Observation and Evaluation by Physician, Without Electrical Recording

92531 Spontaneous nystagmus, including gaze

92532 Positional nystagmus

92533 Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes four tests)

92534 Optokinetic nystagmus

Vestibular Function Tests, With Recording (e.g., ENG, PENG), and Medical Diagnostic Evaluation

92537 Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one cool irrigation in each ear for a total of four irrigations) [new code in 2016] (Do not report 92537 in conjunction with 92270, 92538) (For three irrigations, use modifier 52) (For monothermal caloric vestibular testing, use 92538)

92538 monothermal (ie, one irrigation in each ear for a total of two irrigations) (Do not report 92538 in conjunction with 92270, 92537) [new code in 2016] (For one irrigation, use modifier 52) (For bilateral, bithermal caloric vestibular testing, use 92537)

92540 Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording. (Do not report in conjunction with 92270, 92451, 92542, 92544, 92545)

92541 Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording (Do not report 92541 in conjunction with 92270, 92540 or the set of 92542, 92544, 92545)

92542 Positional nystagmus test, minimum of 4 positions, with recording (Do not report 92542 in conjunction with 92270, 92540 or the set of 92541, 92544, 92545)

92543 (92543 has been deleted. To report, see 92537 or 92538)

92544 Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording (Do not report 92544 in conjunction with 92270, 92540 or the set of 92541, 92542, 92545)

92545 Oscillating tracking test, with recording (Do not report 92545 in conjunction with 92270, 92540 or the set of 92541, 92542, and 92544)

92546 Sinusoidal vertical axis rotational testing (Do not report 92546 in conjunction with 92270)

92547 Use of vertical electrodes in any or all of above tests counts as one additional test (Use 92547 in conjunction with 92537, 92538, 92540-92546) (For unlisted vestibular tests, see 92700) (Do not report 92547 in conjunction with 92270)

92548 Computerized dynamic posturography (Do not report 92548 in conjunction with 92270)

Audiologic Function Tests

The audiometric tests listed below require the use of calibrated electronic equipment, recording of results and a report with interpretation. Hearing tests (such as whispered voice, tuning fork) that are otorhinolaryngologic Evaluation & Management services are not reported separately. All services include testing of both ears. Use modifier -52 if a test is applied to one ear instead of two ears. All codes (except 92559), apply to testing of individuals. For testing of groups, use 92559 and specify test(s) used.

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92550 Tympanometry and reflex threshold measurements (Do not report in conjunction with 92567, 92568)

92551 Screening test, pure tone, air only

92552 Pure tone audiometry (threshold); air only

92553 air and bone

92555 Speech audiometry threshold

92556 with speech recognition

92557 Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined)

(For hearing aid evaluation and selection, see 92590-92595)

92559 Audiometric testing of groups

92560 Bekesy audiometry; screening

92561 diagnostic

92562 Loudness balance test, alternate binaural or monaural

92563 Tone decay test

92564 Short increment sensitivity index (SISI)

92565 Stenger test, pure tone

92567 Tympanometry (impedance testing)

92568 Acoustic reflex testing; threshold

92569 has been deleted. For Acoustic reflex decay testing preformed in conjunction with tympanometry, use 92570.

92570 Acoustic immittance testing, includes tympanomtery (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing (Do not report 92570 in conjunction with 92567, 92568)

92571 Filtered speech test

92572 Staggered spondaic word test

92575 Sensorineural acuity level test

92576 Synthetic sentence identification test

92577 Stenger test, speech

92579 Visual reinforcement audiometry (VRA)

92582 Conditioning play audiometry

92583 Select picture audiometry

92584 Electrocochleography

92585 Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive

92586 limited

92558 Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis

92587 Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report

92588 comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report

92590 Hearing aid examination and selection; monaural

92591 binaural

92592 Hearing aid check; monaural

92593 binaural

92594 Electroacoustic evaluation for hearing aid; monaural

92595 binaural

92596 Ear protector attenuation measurements

92620 Evaluation of central auditory function, with report; initial 60 minutes

92621 each additional 15 minutes (List separately in addition to code for primary procedure) (Do not report 92620, 92621 in conjunction with 92521, 92522, 92523, 92524)

92625 Assessment of tinnitus (includes pitch, loudness matching, and masking) (Do not report 92625 in conjunction with 92562) For unilateral assessment, use modifier -52)

92626 Evaluation of auditory rehabilitation status; first hour

92627 each additional 15 minutes

92630 Auditory rehabilitation; pre-lingual hearing loss

92633 Auditory rehabilitation; post-lingual hearing loss

92700 Unlisted otorhinolaryngological service or procedure

Special Diagnostic Procedures

92640 Diagnostic analysis with programming of auditory brainstem implant, per hour

Cochlear Implant Related Codes

Codes 92601 and 92603 describe post-operative analysis and fitting of previously placed external devices, connection to the cochlear implant, and programming of the stimulator. Codes 92602 and 92604 describe subsequent sessions for the measurements and adjustment of the external transmitter and re-programming of the internal stimulator.

92601 Diagnostic analysis of cochlear implant, patient under 7 years of age; with programming

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92602 subsequent reprogramming. (For aural rehab services following cochlear implant, including evaluation of rehabilitation status, use 92626- 92627, 92630-92633.)

92603 Diagnostic analysis of cochlear implant, age 7 years of age or older; with programming

92604 subsequent reprogramming

Augmentative/Alternative Communication Device Services

92605 Evaluation for prescription of non-speech-generating augmentative and alternative communication device, first hour


92606 Therapeutic service(s) for the use of non-speech-generating device, including programming and modification

92607 Evaluation for prescription for speech-generating augmentative and alternative communication device; face-to-face with the patient; evaluation, first hour

92608 each additional 30 minutes (List separately in addition to code for primary procedure); (Use 92608 in conjunction with 92607)

92609 Therapeutic services for the use of speech-generating device, including programming and modification

Swallowing Evaluation

92610 Evaluation of oral and pharyngeal swallowing function

92611 Motion fluoroscopic evaluation of swallowing function by cine or video

92612 Flexible fiberoptic endoscopic evaluation of swallowing by cine or video

92613 interpretation and report only

92614 Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording


92616 Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording


Additional CPT Codes

Surgery: Respiratory System

31599 Unlisted procedure, larynx

Surgery: Auditory System

69210 Removal of impacted cerumen, one or both ears

69930 Cochlear device implantation, with or without mastoidectomy

Diagnostic Radiology

70371 Complex dynamic pharyngeal and speech evaluation by cine or video recording

74230 Swallowing function, with cineradiography and/or video

76536 Ultrasound, soft tissues of head and neck, real time with image documentation

ASHA Note: These are radiology codes included here for information purposes. The codes are not billed by speech-language pathologists.

Nerve Conduction Tests

95907 Nerve conduction studies; 1-2 studies

95908 3-4 studies

95909 5-6 studies

95910 7-8 studies

95911 9-10 studies

95912 11-12 studies

95913 13 or more studies

Intraoperative Neurophysiology

95940 Continuous intraoperative neurophysiology monitoring in the operating room, one-on-one monitoring requiring personal attendance. Each 15 minutes (List separately in addition to code for primary procedure)

(Use 95940 in conjunction with the study performed 92585, 95822, 95860-95870, 95907-95913, 95925, 95926, 95927, 95928, 95929, 95930-95937, 95938, 95939)

95941 Continuous intraoperative neurophysiology monitoring from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (List separately in addition to code for primary procedure)

(Use 95941 in conjunction with the study performed, 92585, 95822, 95860-95870, 95907,-95913, 95925, 95926, 95927, 95928, 95929, 95930-95937, 95938, 95939)

(For time spent waiting on standby before monitoring, use 99360)

(For electrocorticography, use 95829)

(For intraoperative EEG during nonintracranial surgery, use 95955)

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(For intraoperative functional cortical or subcortical mapping, see 95961-95962)

(For intraoperative neurostimulator programming and analysis, see 95970-95975)

G0453 Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure)

[HCPCS code]

Evoked Potentials and Reflex Tests

95925 Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs (Do not report 95925 in conjunction with 95926)

95926 in lower limbs (Do not report 95926 in conjunction with 95925)

95938 in upper and lower limbs (Do not report 95938 in conjunction with 95925, 95926)

95927 in the trunk or head (To report a unilateral study, use modifier -52); (For auditory evoked potentials, use 92585)

95928 Central motor evoked potential study (transcranial motor stimulation); upper limbs (Do not report 95928 in conjunction with 95929)

95929 lower limbs (Do not report 95929 in conjunction with 95929)

95939 in upper and lower limbs (Do not report 95939 in conjunction with 95928, 95929)

95930 Visual evoked potential (VEP) testing central nervous system, checkerboard or flash

95937 Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any 1 method

Other Procedures

95992 Canalith repositioning procedure(s) (e.g., Epley maneuver, Semont maneuver), per day

96105 Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, e.g., by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour

96110 Developmental screening (eg. developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument

G0451 Developmental testing, with interpretation and report, per standardized instrument form ASHA Note: Medicare no longer covers 96110 because its policy is to not cover screens. However, CMS did allow a way for Medicare to pay for developmental screening by also proposing to add a temporary code, a supplemental HCPCS Level II “G” code G0451 Developmental testing with interpretation and report, per standardized instrument, which is valued on the previously-published values of CPT code 96110. Medicare is required to pay G codes. Medicaid and private payers often, but not always, follow suit. There is no guarantee of continued reimbursement, but G0451 may be an alternative to 96110. Because of the potential for confusion with these codes, documentation should be very clear.

96111 Developmental testing, (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments) with interpretation and report

96125 Standardized cognitive performance testing (e.g., Ross Information Processing Assessment) per hour of a qualified health professional’s time, both face-to face time administering tests to the patient and time interpreting these test results and preparing the report

Physical Medicine and Rehabilitation

97532 Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training) direct one-on-one patient contact by the provider, each 15 minutes

97533 Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct one-on-one patient contact by the provider, each 15 minutes

97799 Unlisted physical medicine/rehabilitation service or procedure

Case Management Services(The Center for Medicare & Medicaid Services (CMS) does not cover Case Management Codes.)

Medical Team Conferences

Medical team conferences include face-to face participation by a minimum of three qualified health care professionals from different specialties or disciplines (each of whom provide direct care to the patient) with or without presence for the patient, family member(s), community agencies, surrogate decision maker(s) (e.g., legal guardian), and/or caregiver(s). The participants are actively involved in the development, revision, coordination, and implementation of health services needed by the patient.

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evaluations or treatments of the patient, independent of any team conference, within the previous 60 days.

Physicians may report their time spent in a team conference with the patient and/or family present using evaluation and management (E/M) codes (and times as the key controlling factor for code selection when counseling and/or coordination of care dominates the service). These introductory guidelines do not apply to services reported using E/M codes (see E/M services guideline). However, the physician must be directly involved with the patient, providing face-to-face services outside of the conference visit with other providers or agencies.

Reporting participants shall document their participation in the team conference as well as their contributed information and subsequent treatment recommendations.

No more than one individual from the same specialty may report 99366-99368 at the same encounter.

Individuals should not report 99366-99368 when their participation in the medical team conference is part of a facility or organizational service contractually provided by the organizational or facility provider.

The team conference starts at the beginning of the review of an individual patient and ends at the conclusion of the review. Time related to record keeping and report generation is not reported. The reporting participant shall be present for all time reported. The time reported is not limited to the time that the participant is communicating to the other team members or patient and/or family.

Time reported for medical team conferences may not be used in the determination of time for other services such as care plan oversight (99374-99380), home, domiciliary, or rest home care plan oversight (99339-99340), prolonged services (99354-99359), psychotherapy, or any E/M service. For team conferences where the patient is present for any part of the duration of the conference, non-physician qualified health care professionals (e.g., speech-language pathologists, physical therapists, occupational therapists, social workers, dieticians) report the team conference face-to face code 99366.

Medical Team Conference, Direct (Face-To-Face) Contact with Patient and/or Family

99366 Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more, participation by non-physician qualified health care professional

(Team conference services of less than 30 minutes duration are not reported separately)

(For team conference services by a physician with patient and/or family present, see Evaluation and Management services)

Medical Team Conference, Without Direct (Face-to-Face) Contact with Patient and/or Family

99367 Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more, participation by physician

99368 participation by non-physician qualified health care professional

(Team conference services of less than 30 minutes duration are not reported separately)

Prolonged Service With Direct Patient Contact

These codes are used when a physician or other qualified health care professional provides prolonged service involving direct patient contact that is beyond the usual service.

99354 Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour


Prolonged Service Without Direct Patient Contact

This prolonged service “beyond the usual” may be reported on a different date than the primary service to which it is related. For example, extensive record review may relate to a previous evaluation and management service performed earlier. It must relate to a service or patient where (face-to-face) patient care has occurred or will occur and relate to ongoing patient management.

99358 Prolonged evaluation and management service before and/or after direct patient care; first hour


Codes 99354-99359 are not covered by Medicare. Check with your payer for coverage.

Special Services and Reports

99070 Supplies and materials provided by physician or clinician over and above those usually included with the office visit or other services rendered

99071 Educational supplies, such as books, tapes, and pamphlets, provided by physician or clinician for the patient’s education at cost to physician/clinician


Education and Training for Patient Self-Management

98960 Education and training for patient self-management by qualified, non-physician health care professional using a standardized curriculum, face-to face with the patient (could include the caregiver/family); each 30 minutes; individual patient

98961 2-4 patients

98962 5-8 patients

Telephone Services

Audiologists and speech-language pathologists have three additional codes to report including three procedures for telephone services. They are described as “non-face-to-face assessment and management services provided by a qualified health care professional to a patient using the telephone. These codes are used to report episodes of care by the qualified health care professional initiated by an established patient or guardian of an established patient.” Of course, there are caveats for using these codes, such as not using the codes if the patient is seen within 24 hours of the phone call or are seen during the next available urgent visit appointment. Similarly, the codes cannot be used if the patient was seen within the previous seven days.

The Centers for Medicare & Medicaid Services (CMS) decided not to cover the telephone services codes under Medicare saying “(1) These services are non-face-to-face; and (2) the code descriptor includes language that recognizes the provision of services to parties other than the beneficiary and for whom Medicare does not provide coverage (for example, guardian).” Other health plans are not bound by the CMS decision. At least one private health plan, Blue Cross and Blue Shield of North Carolina, added the codes to its policy under a Telemedicine heading.

The codes are:

98966 Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure with the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

98967 11-20 minutes of medical discussion

98968 21-30 minutes of medical discussion

Online Medical Evaluation

98969 Online assessment and management service provided by a qualified non-physician health care professional to an established patient, guardian, or health care provider not originating from a related assessment and management service provided within the previous 7 days, using the Internet or similar electronic communications network.

Modifiers

Listed services and procedures may be modified under certain circumstances. The modifiers listed below are those typically used by audiologists and speech-language pathologists to describe special circumstances. The two-digit modifier is placed after the usual procedure number and separated by a hyphen.

-22 Unusual Services: When the service(s) provided is greater than that usually required for the listed procedures, it may be identified by adding modifier -22 to the usual procedure. A report may also be appropriate.

-33 When the primary purpose of the service is the delivery of an evidence-based service in accordance with a U.S. Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by appending modifier -33, Preventive Service, to the service. For separately reported services specifically identified as preventive, the modifier should not be used.

-52 Reduced Services: Under certain circumstances a service or procedure is partially reduced or eliminated at the physician’s election. Under these circumstances the service provided can be identified by its usual procedure number and the addition of the modifier -52, signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service.

-59 Distinct Procedural Service: Physician/provider may need to indicate that a procedure/service was distinct and independent from other services performed on same day. Modifier -59 identifies services not normally reported together, but are appropriate under the circumstances.

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Time Components

There are no time components associated with most audiology and speech-language pathology CPT codes. ASHA proposed the inclusion of a “time component” (e.g., adding “each 15 minutes” to 92506) in several treatment and assessment codes. The AMA CPT Editorial Panel, however, rejected the proposal because they believed time components to be highly variable with no conclusive information or data available to substantiate them. The panel also noted that the Centers for Medicare & Medicaid Services (CMS), which administers the Medicare program, includes a time component in their resource-based relative value process. Insurers and health plans may assign time components to codes. Check with health plans that you deal with to determine if they have established time components for CPT codes.

For more information on using timed versus untimed CPT codes, go to www.asha.org/practice/reimbursement/coding/servicebased/.

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http://www.asha.org/practice/reimbursement/coding/servicebased/


Chapter 2: ICD-9-CM Diagnostic CodesICD-9-CM is only valid for services provided on or before September 30, 2015

GeneralThe International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) is based on the World Health Organization’s Ninth Revision, International Classification of Diseases (ICD-9). The intent of ICD-9-CM is to standardize disease and procedure classification throughout the United States and to gather data about basic health statistics. The National Center for Health Statistics (NCHS) and the Centers for Medicare & Medicaid Services (CMS) are the U.S. governmental agencies responsible for overseeing all changes and modifications to the ICD-9-CM.

Use of CodesAudiologists and speech-language pathologists use ICD-9-CM codes to describe and bill for services. The Health Insurance Portability and Accountability Act (HIPAA) requires that the ICD-9-CM be used for health services billing and recordkeeping.

This section contains information from ASHA about coding normal results and coding to the highest degree of specificity.

Note: This is not a comprehensive list of ICD-9-CM codes and a number of codes are included for informational purposes only. Entries with only three or four digits may require coding to a higher degree of specificity than indicated here. However, in general, audiology and speech-language pathology related diagnoses will be listed to the highest level of specificity.

Classification of Diseases and Injuries Related to Speech and Hearing Disorders (from Volume 1)Ch. 1 Infectious and Parasitic Diseases (001-009)

042 AIDS

Ch. 2 Neoplasms (140-239)

Malignant Neoplasm of Lip, Oral Cavity, and Pharynx (140-149)

140 Malignant neoplasm of lip

141 Malignant neoplasm of tongue

143 Malignant neoplasm of gum

144 Malignant neoplasm of floor of mouth

145 Malignant neoplasm of other and unspecified parts of mouth

145.0 Cheek mucosa

145.1 Vestibule of mouth

145.2 Hard palate

145.3 Soft palate

145.4 Uvula

145.5 Palate, unspecified

145.6 Retromolar area

145.8 Other specified parts of mouth

145.9 Mouth, unspecified

146 Malignant neoplasm of oropharynx

147 Malignant neoplasm of nasopharynx

148 Malignant neoplasm of hypopharynx

149 Malignant neoplasm of other and ill-defined sites within lip, oral cavity, and pharynx

150 Malignant neoplasm of esophagus

150.3 Upper third of esophagus

150.4 Middle third of esophagus

150.5 Lower third of esophagus

Malignant Neoplasm of Respiratory and Intrathoracic Organs (160-165)

160 Malignant neoplasm of nasal cavities, middle ear, and accessory sinuses

160.1 Auditory tube, middle ear and mastoid air cells

161 Malignant neoplasm of larynx

Malignant Neoplasm of Bone, Connective Tissue, Skin, and Breast (170-176)

170 Malignant neoplasm of bone and articular cartilage

170.1 Malignant neoplasm of mandible

Malignant Neoplasm of Other and Unspecified Sites (190-199)

191 Malignant neoplasm of brain

191.0 Cerebrum, except lobes and ventricles

191.1 Frontal lobe

191.2 Temporal lobe

191.3 Parietal lobe

191.4 Occipital lobe

191.5 Ventricles

191.6 Cerebellum NOS

191.7 Brain stem

191.8 Other parts of brain

191.9 Brain, unspecified

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195 Malignant neoplasm of other and ill-defined sites

195.0 Head, face, and neck

196 Secondary and unspecified malignant neoplasm of lymph nodes

196.0 Lymph nodes of head, face, and neck

197 Secondary malignant neoplasm of respiratory and digestive systems

198 Secondary malignant neoplasm of other specified sites

198.3 Brain and spinal cord

198.4 Other parts of nervous system

Meninges (cerebral) (spinal)

Benign Neoplasms (210-229)

210 Benign neoplasm of lip, oral cavity, and pharynx

210.0 Lip

210.1 Tongue

210.2 Major salivary glands

210.3 Floor of mouth

210.4 Other and unspecified parts of mouth

Palate (hard) (soft)

Oral mucosa

Gum (upper) (lower)

Oral cavity NOS

210.6 Other parts of oropharynx

210.7 Nasopharynx

210.8 Hypopharynx

210.9 Pharynx, unspecified

212 Benign neoplasm of respiratory and intrathoracic organs

212.0 Nasal cavities, middle ear, and accessory sinuses

212.1 Larynx

212.2 Trachea

213 Benign neoplasm of bone and articular cartilage

213.0 Bones of skull and face

213.1 Lower jaw bone

225 Benign neoplasm of brain and other parts of nervous system

225.0 Brain

225.1 Cranial nerves

225.2 Cerebral meninges

Carcinoma in Situ (230-234)

230 Carcinoma in situ of digestive organs

230.0 Lip, oral cavity, and pharynx

230.1 Esophagus

231 Carcinoma in situ of respiratory system

231.0 Larynx

232.1 Trachea

232 Carcinoma in situ of skin

232.0 Skin of lip

232.2 Ear and external auditory canal

Neoplasms of Uncertain Behavior (235-238)

237 Neoplasm of endocrine glands and nervous system

237.3 Neoplasm of paraganglia

237.5 Brain and spinal cord

237.6 Meninges

237.7 Neurofibromatosis

237.72 Neurofibromatosis, type 2 [acoustic neurofibromatosis]

239 Neoplasms of unspecified nature

239.6 Brain

Ch. 3 Endocrine, Nutritional and Metabolic Diseases, and Immunity Disorders (240-279)

Other Metabolic and Immunity Disorders (270-279)

279 Disorders involving the immune mechanism

279.4 Autoimmune disease, not elsewhere classified

Ch. 4 Diseases of the Blood and Blood-Forming Organs (280-289)

Ch. 5 Mental Disorders (290-319)

Psychoses (290-299)

290 Dementias

290.0 Senile dementia, uncomplicated

Excludes: mild memory disturbances, not amounting to dementia, associated with senile brain disease (310.89)

290.1 Presenile dementia Brain syndrome with

presenile brain disease

290.4 Vascular dementia

Multi-infarct dementia or psychosis

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Use additional code to identify cerebral atherosclerosis (437.0)

290.8 Other specified senile psychotic conditions

Presbyophrenic psychosis

291 Alcohol-induced mental disorders

291.1 Alcohol-induced persisting amnestic disorder

Korsakoff’s psychosis, alcoholic

Wenicke-Korsakoff syndrome (alcoholic)

291.2 Alcohol-induced persisting dementia

293 Transient mental disorders due to conditions classified elsewhere

293.0 Delirium due to conditions classified elsewhere

293.1 Subacute delirium

294 Persistent mental disorders due to conditions classified elsewhere

294.0 Amnestic disorder in conditions classified elsewhere

Korsakoff’s psychosis or syndrome (nonalcoholic)

294.1 Dementia in conditions classified elsewhere

Code first: Any underlying physical condition, as:

For example: Alzheimer’s disease (331.0)

Epilepsy (345.0-345.9)

Multiple Sclerosis (340)

Parkinson’s disease (332.0)

294.10 Dementia in conditions classified elsewhere without behavioral disturbance

294.11 Dementia in conditions classified elsewhere with behavioral disturbance

294.2 Dementia, unspecified

Excludes: mild memory disturbances, not amounting to dementia (310.89)

294.20 Dementia, unspecified, without behavioral disturbance

Dementia NOS

294.21 Dementia, unspecified, behavioral disturbance

Aggressive behavior

Combative behavior

Violent behavior

294.8 Other persistent mental disorders due to conditions classified elsewhere

Excludes: mild memory disturbances, not amounting to dementia (310.89)

294.9 Unspecified persistent mental disorders due to conditions classified elsewhere

295 Schizophrenic disorders

Excludes: childhood type schizophrenia (299.9) infantile autism (299.0)

296 Episodic mood disorders

299 Pervasive developmental disorder

The following fifth-digit subclassification is for use with category 299:

0 current or active state

1 residual state

299.0 Autistic disorder

[0-1] Childhood autism

Infantile psychosis

Kanner’s syndrome

Excludes: disintegrative psychosis (299.1)

Heller’s syndrome (299.1)

Schizophrenic syndrome of childhood (299.9)

299.1 Childhood disintegrative psychosis

[0-1] Heller’s syndrome

Use additional code to identify any associated neurological disorder

Excludes: infantile autism (299.0)

schizophrenic syndrome of childhood (299.9)

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299.8 Other specified pervasive developmental disorders

[0-1] Asperger’s disorder

Atypical childhood psychosis

Borderline psychosis of childhood Excludes: simple stereotypes without psychotic disturbance (307.3)

299.9 Unspecified pervasive developmental disorder

[0-1] Child psychosis NOS

Pervasive developmental disorder NOS

Schizophrenia, childhood type NOS

Schizophrenic syndrome of childhood NOS

Excludes: schizophrenia of adult type occurring in childhood (295.0-295.9)

Neurotic Disorders, Personality Disorders, and Other Nonpsychotic Mental Disorders (300-316)

300 Anxiety, dissociative and somatoform disorders

300.1 Dissociative, conversion and factitious disorders

300.11 Conversion disorder

Hysterical:

blindness

deafness

paralysis

307 Special symptoms or syndromes, not elsewhere classified

Note: This category is intended for use if the psychopathology is manifested by a single specific symptom or groups of symptoms which is not part of an organic illness or other mental disorder classifiable elsewhere.

307.0 Adult onset fluency disorder

Excludes: childhood onset fluency disorder (315.35)

fluency disorder due to late effect of CVA (438.14)

fluency disorder in conditions classified elsewhere (784.52)

307.9 Other and unspecified special symptoms or syndromes, not elsewhere classified

Communication disorder NOS

Hair plucking

Lalling

Lisping

Masturbation

Nail-biting

Thumb-sucking

310 Specific nonpsychotic mental disorders due to brain damage

Excludes: neuroses, personality disorders, or other nonpsychotic conditions occurring in a form similar to that seen with functional disorders but in association with a physical condition (300.0-300.9, 301.0-301.9)

310.0 Frontal lobe syndrome

Lobotomy syndrome

Postleucotomy syndrome [state]

Excludes: postcontusion syndrome (310.2)

310.1 Personality change due to conditions classified elsewhere

Cognitive or personality change of other type, of nonpsychotic severity

Organic psychosyndrome of nonpsychotic severity

Presbyophrenia NOS

Senility with mental changes of nonpsychotic severity

Excludes: mild cognitive impairment (331.83)

postconcussion syndrome (310.2)

signs and symptoms involving emotional state (799.21-799.29)

310.2 Postconcussion syndrome

Postcontusion syndrome or encephalopathy

Posttraumatic brain syndrome, nonpsychotic

Status postcommotio cerebri

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Excludes: any organic psychotic conditions following head injury (293.0-294.0)

frontal lobe syndrome (310.0)

postencephalitic syndrome (310.89)

310.8 Other specified nonpsychotic mental disorders following organic brain damage

310.81 Pseudobulbar affect

Involuntary emotional expression disorder

Code first underlying cause, if known, such as:

amyotrophic lateral sclerosis (335.20)

late effect of cerebrovascular accident (438.89)

late effect of traumatic brain injury (907.0)

multiple sclerosis (340)

310.89 Other specified nonpsychotic mental disorders following organic brain damage

Mild memory disturbance

Other focal (partial) organic psychosyndromes

Postencephalitic syndrome

Excludes: memory loss of unknown cause (780.93)

313 Disturbance of emotions specific to childhood and adolescence

313.2 Sensitivity, shyness, and social withdrawal disorder

313.23 Selective mutism

Excludes: elective mutism as adjustment reaction (309.83)

314 Hyperkinetic syndrome of childhood

314.0 Attention deficit disorder

314.00 Without mention of hyperactivity

314.01 With hyperactivity

314.1 Hyperkinesis with developmental delay

Developmental disorder of hyperkinesis

Use additional code to identify any associated neurological disorder

315 Specific delays in development

Excludes: that due to a neurological disorder (320.0-389.0)

315.0 Specific reading disorder

315.00 Reading disorder, unspecified

315.01 Alexia

315.02 Developmental dyslexia

315.09 Other

specific spelling difficulty

315.1 Mathematics disorder

Dyscalculia

315.2 Other specific learning difficulties

Disorder of written expression

Excludes: specific arithmetical disorder (315.1)

specific reading disorder (315.00-315.09)

315.3 Developmental speech or language disorder

315.31 Expressive language disorder

Developmental aphasia

Word deafness

Excludes: Acquired aphasia (784.3)

Elective mutism (309.83, 313.0, 313.23)

315.32 Mixed receptive-expressive language disorder

Central auditory processing disorder

Excludes: acquired auditory processing disorder (388.45)

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315.34 Speech and language developmental delay due to hearing loss

315.35 Childhood onset fluency disorder

Cluttering NOS

Stuttering NOS

Excludes: adult onset fluency disorder (307.0)


fluency disorder in conditions classified elsewhere (784.52)

315.39 Other

Developmental articulation disorder

Dyslalia

Phonological disorder

Excludes: Lisping and lalling (307.9)

315.4 Developmental coordination disorder

Clumsiness syndrome

Dyspraxia syndrome

Specific motor development disorder

315.5 Mixed developmental disorder

315.8 Other specific delays in development

315.9 Unspecified delay in development

Developmental disorder NOS

Learning disorder NOS

Intellectual Disabilities (317-319)

317 Mild intellectual disabilities

318 Other specific intellectual disabilities

318.0 Moderate intellectual disabilities

318.1 Severe intellectual disabilities

318.2 Profound intellectual disabilities

319 Unspecified intellectual disabilities

Ch. 6 Diseases of the Nervous System and Sense Organs (320-389)

Inflammatory Diseases of the Central Nervous System (320-326)

320 Bacterial meningitis

321 Meningitis due to unspecified bacterium

322 Meningitis of unspecified cause

323 Encephalitis, myelitis, and encephalomyelitis

Hereditary and Degenerative Diseases of the Central Nervous System (330-337)

330 Cerebral degenerations usually manifest in childhood

331 Other cerebral degenerations

331.0 Alzheimer’s disease

331.1 Frontotemporal dementia

331.11 Pick’s Disease

331.2 Senile degeneration of brain

331.8 Other cerebral degeneration

331.83 Mild cognitive impairment, so stated

Excludes: altered mental status (780.97)

cerebral degeneration (331.0-331.9)

change in mental status (780.97)

cognitive deficits following (late effects of) cerebral hemorrhage or infarction (438.0)

cognitive impairment due to intracranial or head injury (850-854, 959.01)

cognitive impairment due to late effect of intracranial injury (907.0)

cognitive impairment due to skull fracture (800-801, 803-804)

dementia (290.0-290.43, 294.8)

mild memory disturbance (310.8)

neurologic neglect syndrome (781.8)

personality change, nonpsychotic (310.1)

332 Parkinson’s disease

332.0 Paralysis agitans

332.1 Secondary parkinsonism

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333 Other extrapyramidal disease and abnormal movement disorders

333.0 Other degenerative diseases of the basal ganglia

333.1 Essential and other specified forms of tremor

333.2 Myoclonus

333.3 Tics of organic origin

333.4 Huntington’s chorea

333.5 Other choreas

333.6 Genetic torsion dystonia

333.7 Acquired torsion dystonia

333.71 Athetoid cerebral palsy

334 Spinocerebellar disease

334.0 Friedreich’s ataxia

334.2 Primary cerebellar degeneration

334.3 Other cerebellar ataxia

334.4 Cerebellar ataxia in diseases classified elsewhere

335 Anterior horn cell disease

335.2 Motor neuron disease

335.20 Amyotrophic lateral sclerosis

Motor neuron disease (bulbar) (mixed type)

335.21 Progressive muscular atrophy

335.22 Progressive bulbar palsy

335.23 Pseudobulbar palsy

335.24 Primary lateral sclerosis

335.29 Other

Other Disorders of the Central Nervous System (340-349)

340 Multiple sclerosis

343 Infantile cerebral palsy

343.0 Diplegic

343.1 Hemiplegic

343.2 Quadriplegic

343.3 Monoplegic

343.4 Infantile hemiplegia

343.8 Other specified infantile cerebral palsy

343.9 Infantile cerebral palsy, unspecified

345 Epilepsy and recurrent seizures

348 Other conditions of brain

348.0 Cerebral cysts

348.1 Anoxic brain damage

348.2 Benign intracranial hypertension

348.3 Encephalopathy, unspecified

348.4 Compression of brain

348.5 Cerebral edema

348.8 Other conditions of brain

348.9 Unspecified condition of brain

349 Other and unspecified disorders of the nervous system

Disorders of the Peripheral Nervous System (350-359)

358 Myoneural disorders

358.0 Myasthenia gravis

359 Muscular dystrophies and other myopathies

359.0 Congenital hereditary muscular dystrophy

359.1 Hereditary progressive muscular dystrophy

Diseases of the Ear and Mastoid Process (380-389)

380 Disorders of external ear

380.0 Perichondritis and chondritis of pinna

Chondritis of auricle

Perichondritis of auricle

380.00 Perichondritis of pinna, unspecified

380.01 Acute perichondritis of pinna

380.02 Chronic perichondritis of pinna

380.03 Chondritis of pinna

380.1 Infective otitis externa

380.10 Infective otitis externa

380.11 Acute infection of pinna

380.12 Acute swimmers’ ear

380.13 Other acute infections of external ear

Code first underlying disease, as:

erysipelas (035)

impetigo (684)

seborrheic dermatitis (690.10-690.18)

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Excludes: herpes simplex (054.73)

herpes zoster (053.71)

380.14 Malignant otitis externa

380.15 Chronic myotic otitis externa


aspergillosis (117.3)

otomycosis NOS (111.9)

Excludes: candida otitis externa (112.82)

380.16 Other chronic infective otitis externa

Chronic infective otitis externa NOS

380.4 Impacted cerumen

Wax in ear

381 Nonsuppurative otitis media and Eustachian tube disorders

381.0 Acute nonsuppurative otitis media

Acute tubotympanic catarrh

Otitis media, acute or subacute

catarrhal

exudative

transudative

with effusion

Excludes: otitic barotrauma (993.0)

381.00 Acute nonsuppurative otitis media, unspecified

381.01 Acute serous otitis media

Acute or subacute secretory otitis media

381.02 Acute mucoid otitis media

Acute or subacute seromucinous otitis media; Blue drum syndrome

381.03 Acute sanguinous otitis media

381.04 Acute allergic serous otitis media

381.05 Acute allergic mucoid otitis media

381.06 Acute allergic sanguinous otitis media

381.1 Chronic serous otitis media

381.10 Chronic serous otitis media, simple or unspecified

381.19 Other

Serosanguinous chronic otitis media

381.2 Chronic mucoid otitis media

Glue ear

381.20 Chronic mucoid otitis media, simple or unspecified

381.29 Other

Mucosanguinous chronic otitis media

381.3 Other and unspecified chronic nonsuppurative otitis media

381.4 Nonsuppurative otitis media, not specified as acute or chronic

382 Suppurative and unspecified otitis media

382.0 Acute suppurative otitis media

Otitis media, acute:

necrotizing NOS

purulent

382.00 Acute suppurative otitis media without spontaneous rupture of ear drum

382.01 Acute suppurative otitis media with spontaneous rupture of ear drum

382.02 Acute suppurative otitis media in diseases classified elsewhere


influenza (487.8)

scarlet fever (034.1)

382.1 Chronic tubotympanic supprative otitis media

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Benign chronic suppurative otitis media (with anterior perforation of ear drum)

Chronic tubotympanic disease (with anterior perforation of ear drum)

382.2 Chronic atticoantral suppurative otitis media

Chronic atticoantral disease (with posterior or superior marginal perforation of ear drum)

Persistent mucosal disease (with posterior or superior marginal perforation of ear drum)

382.3 Unspecified chronic suppurative otitis media

Chronic purulent otitis media

Excludes: tuberculous otitis media (017.4)

382.4 Unspecified suppurative otitis media

Purulent otitis media NOS

382.9 Unspecified otitis media

Otitis media:

NOS

acute NOS

chronic NOS

384 Other disorders of tympanic membrane

384.0 Acute myringitis without mention of otitis media

384.00 Acute myringitis, unspecified

Acute tympanitis NOS

384.01 Bullous myringitis

Myringitis bullosa hemorrhagica

384.09 Other

384.1 Chronic myringitis without mention of otitis media

Chronic tympanitis

384.2 Perforation of tympanic membrane

Perforation of ear drum:

NOS

persistent posttraumatic

postinflammatory

Excludes: otitis media with perforation of tympanic membrane (382.00-382.9)

traumatic perforation (current injury) (872.61)

384.20 Perforation of tympanic membrane, unspecified

384.21 Central perforation of tympanic membrane

384.22 Attic perforation of tympanic membrane

Pars flaccida

384.23 Other marginal perforation of tympanic membrane

384.24 Multiple perforations of tympanic membrane

384.25 Total perforation of tympanic membrane

384.8 Other specified disorders of tympanic membrane

384.81 Atrophic faccid tympanic membrane

Healed perforation of ear drum

384.82 Atrophic nonflaccid tympanic membrane

384.9 Unspecified disorder of tympanic membrane

385 Other disorders of middle ear and mastoid

Excludes: mastoiditis (383.0-383.9)

385.0 Tympanosclerosis

385.00 Tympanosclerosis, unspecified as to involvement

385.01 Tympanosclerosis involving tympanic membrane only

385.02 Tympanosclerosis involving tympanic membrane and ear ossicles

385.03 Tympanosclerosis involving tympanic membrane, ear ossicles, and middle ear

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385.09 Tympanosclerosis involving other combination of structures

385.1 Adhesive middle ear disease

Adhesive otitis

Otitis media: Otitis media: chronic adhesive fibrotic

Excludes: glue ear (381.20-381.29)

385.10 Adhesive middle ear disease, unspecified as to involvement

385.11 Adhesions of drum head to incus

385.12 Adhesions of drum head to stapes

385.13 Adhesions of drum head to promontorium

385.19 Other adhesions and combinations

385.2 Other acquired abnormality of ear ossicles

385.21 Impaired mobility of malleus; Ankylosis of malleus

385.22 Impaired mobility of other ear ossicles; Ankylosis of ear ossicles, except malleus

385.23 Discontinuity or dislocation of ear ossicles

385.24 Partial loss or necrosis of ear ossicles

385.3 Cholesteatoma of middle ear and mastoid

Cholesterosis

Epidermosis

Keratosis

Polyp

Excludes:

cholesteatoma:

external ear canal (380.21)

recurrent of postmastoidectomy cavity (383.32)

385.30 Cholesteatoma, unspecified

385.31 Cholesteatoma of attic

385.32 Cholesteatoma of middle ear


385.35 Diffuse cholesteatosis

385.8 Other disorders of middle ear and mastoid

385.82 Cholesterin granuloma

385.83 Retained foreign body of middle ear

385.89 Other

385.9 Unspecified disorder of middle ear and mastoid

386 Vertiginous syndromes and other disorders of vestibular system

Excludes: vertigo NOS (780.4)

386.0 Ménière’s disease

Endolymphatic hydrops

Lermoyez’s syndrome

Ménière’s syndrome or vertigo

386.00 Ménière’s disease, unspecified Ménière’s disease (active)

386.01 Active Ménière’s disease, cochleovestibular

386.02 Active Ménière’s disease, cochlear

386.03 Active Ménière’s disease, vestibular

386.04 Inactive Ménière’s disease, Ménière’s disease in remission

386.1 Other and unspecified peripheral vertigo

Excludes: epidemic vertigo (078.81)

386.10 Peripheral vertigo, unspecified

386.11 Benign paroxysmal positional vertigo

Benign paroxysmal positional nystagmus

386.12 Vestibular neuronitis

Acute (and recurrent) peripheral vestibulopathy

}of (middle) ear

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386.19 Other

Aural vertigo

Otogenic vertigo

386.2 Vertigo of central origin

Central positional nystagmus

Malignant positional vertigo

386.3 Labyrinthitis

386.30 Labyrinthitis, unspecified

386.31 Serous labyrinthitis

Diffuse labyrinthitis

386.32 Circumscribed labyrinthitis

Focal labyrinthitis

386.33 Suppurative labyrinthitis

386.34 Toxic labyrinthitis

386.35 Viral labyrinthitis

386.4 Labyrinthine fistula

386.40 Labyrinthine fistula, unspecified

386.41 Round window fistula

386.42 Oval window fistula

386.43 Semicircular canal fistula

386.48 Labyrinthine fistula of combined sites

386.5 Labyrinthine dysfunction

386.50 Labyrinthine dysfunction, unspecified

386.51 Hyperactive labyrinth, unilateral

386.52 Hyperactive labyrinth, bilateral

386.53 Hypoactive labyrinth, unilateral

386.54 Hypoactive labyrinth, bilateral

386.55 Loss of labyrinthine reactivity, unilateral

386.56 Loss of labyrinthine reactivity, bilateral

386.58 Other forms and combinations

386.8 Other disorders of labyrinth

386.9 Unspecified vertiginous syndromes and labyrinthine disorders

387 Otosclerosis

388 Other disorders of ear

388.0 Degenerative and vascular disorders of ear

388.00 Degenerative and vascular disorders, unspecified

388.01 Presbyacusis

388.02 Transient ischemic deafness

388.1 Noise effects on inner ear

388.10 Noise effects on inner ear, unspecified

388.11 Acoustic trauma (explosive) to ear

Otitic blast injury

388.12 Noise-induced hearing loss

388.2 Sudden hearing loss, unspecified

388.3 Tinnitus

388.30 Tinnitus, unspecified

388.31 Subjective tinnitus

388.32 Objective tinnitus

388.4 Other abnormal auditory perception

388.40 Abnormal auditory perception, unspecified

388.41 Diplacusis

388.42 Hyperacusis

388.43 Impairment of auditory discrimination

388.44 Recruitment

388.45 Acquired auditory processing disorder

388.5 Disorders of acoustic nerve

Acoustic neuritis

Degeneration of acoustic or eighth nerve

Disorder of acoustic or eighth nerve

Excludes: acoustic neuroma (225.1)

syphilitic acoustic neuritis (094.86)

388.6 Otorrhea

388.60 Otorrhea, unspecified

Discharging ear, NOS

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388.61 Cerebrospinal fluid otorrhea

388.69 Other

Otorrhagia

388.7 Otalgia

388.70 Otalgia, unspecified

Earache NOS

388.71 Otogenic pain

388.72 Referred pain

388.8 Other disorders of ear

388.9 Unspecified disorder of ear 389 Hearing Loss

389.0 Conductive hearing loss

389.00 Conductive hearing loss, unspecified

389.01 Conductive hearing loss, external ear

389.02 Conductive hearing loss, tympanic membrane

389.03 Conductive hearing loss, middle ear

389.04 Conductive hearing loss, inner ear

389.05 Conductive hearing loss, unilateral

389.06 Conductive hearing loss, bilateral

389.08 Conductive hearing loss of combined types

389.1 Sensorineural hearing loss

Perceptive hearing loss or deafness

Excludes: abnormal auditory perception (388.40-388.44)

mixed conductive and sensorineural hearing loss (389.20-389.22)

psychogenic deafness (306.7)

389.10 Sensorineural hearing loss, unspecified

389.11 Sensory hearing loss, bilateral

389.12 Neural hearing loss, bilateral

389.13 Neural hearing loss, unilateral

389.14 Central hearing loss

389.15 Sensorineural hearing loss, unilateral

389.16 Sensorineural hearing loss, asymmetrical

389.17 Sensory hearing loss, unilateral

389.18 Sensorineural hearing loss, bilateral

389.2 Mixed conductive and sensorineural hearing loss

Deafness or hearing loss of type classifiable to 389.00 – 389.08 with type classifiable to 389.10 – 389.18

389.20 Mixed hearing loss, unspecified

389.21 Mixed hearing loss, unilateral

389.22 Mixed hearing loss, bilateral

389.7 Deaf, non-speaking, not elsewhere classifiable

389.8 Other specified forms of hearing loss

389.9 Unspecified hearing loss

Deafness NOS

Ch. 7 Diseases of the Circulatory System (390-459)

Cerebrovascular Disease (430-438)

430 Subarachnoid hemorrhage

431 Intracerebral hemorrhage

432 Other and unspecified intracranial hemorrhage

434 Occlusion of cerebral arteries

435 Transient cerebral ischemia

435.9 Unspecified transient cerebral ischemia

Impending CVA

Intermittent cerebral ischemia

Transient ischemic attack (TIA)

436 Acute, but ill-defined, cerebrovascular disease

437 Other and ill-defined cerebrovascular disease

437.0 Cerebral atherosclerosis

437.1 Other generalized ischemic cerebrovascular disease

437.2 Hypertensive encephalopathy

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437.3 Cerebral aneurysm, nonruptured

437.9 Unspecified

Cerebrovascular disease or lesion NOS

438 Late effects of cerebrovascular disease

Note: This category is to be used to indicate conditions in 430-437 as the cause of late effects. The “late effects” include conditions specified as such, or as sequelae, which may occur at any time after the onset of the causal condition.

438.0 Cognitive deficits

438.1 Speech and language deficits

438.10 Speech and language deficits, unspecified

438.11 Aphasia

438.12 Dysphasia

438.13 Dysarthria

438.14 Fluency disorder

Stuttering due to late effect of CVA

438.19 Other speech and language deficits

438.8 Other late effects of cerebrovascular disease

438.81 Apraxia

438.82 Dysphagia

Use additional code to identify the type of dysphagia, if known (787.20-787.29)

438.83 Facial weakness

Facial droop

438.84 Ataxia

438.85 Vertigo


Use additional code to identify the late effect

438.9 Unspecified late effects of cerebrovascular disease

Ch. 8 Diseases of the Respiratory System (460-519)

Acute Respiratory Infections (460-466)

462 Acute pharyngitis

463 Acute tonsillitis

464 Acute laryngitis and tracheitis

464.0 Acute laryngitis

464.00 Without mention of obstruction

464.01 With obstruction

464.1 Acute tracheitis



464.2 Acute laryngotracheitis



464.3 Acute epiglottitis

Viral epiglottitis



464.4 Croup

Croup syndrome

464.5 Supraglottitis, unspecified



Other Diseases of the Upper Respiratory Tract (470-478)

474 Chronic disease of tonsils and adenoids

474.1 Hypertrophy of tonsils adenoids

474.10 Tonsils with adenoids`

474.11 Tonsils alone

474.12 Adenoids alone

476 Chronic laryngitis and laryngotracheitis

476.0 Chronic laryngitis

476.1 Chronic laryngotracheitis

477 Allergic rhinitis

478 Other diseases of the upper respiratory tract

478.3 Paralysis of vocal cords or larynx

478.30 Paralysis, unspecified

478.31 Unilateral, partial

478.32 Unilateral, complete

478.33 Bilateral, partial

478.34 Bilateral, complete

478.4 Polyp of vocal cord or larynx

478.5 Other diseases of vocal cords

478.6 Edema of larynx

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478.7 Other diseases of larynx, not elsewhere classified

478.70 Unspecified disease of larynx

478.71 Cellulitis and perichondritis of larynx

478.74 Stenosis of larynx

478.75 Laryngeal spasm

478.79 Other

478.8 Upper respiratory tract hypersensitivity reaction, site unspecified

Excludes: hypersensitivity reaction of lower respiratory tract, as:

Extrinsic allergic alveolitis (495.0-495.9)

Pneumoconiosis (500-505)

Pneumoconioses and Other Lung Diseases Due to External Agents (500-508)

507 Pneumonitis due to solids and liquids

507.0 Due to inhalation of food or vomitus

Aspiration pneumonia due to:

NOS milk

food (regurgitated) saliva

gastric secretions vomitus

Ch. 9 Diseases of the Digestive System (520-579)

Diseases of Oral Cavity, Salivary Glands, and Jaws (520-529)

524 Dentofacial anomalies, including malocclusion

524.0 Major anomalies of jaw size

524.00 Unspecified anomaly

524.01 Maxillary hyperplasia

524.02 Mandibular hyperplasia

524.03 Maxillary hypoplasia

524.04 Mandibular hypoplasia

524.05 Macrogenia

524.06 Microgenia

524.07 Excessive tuberosity of jaw

524.09 Other specified anomaly

524.1 Anomalies of relationship of jaw to cranial base

524.10 Unspecified anomaly

Prognathism

Retrognathism

524.11 Maxillary asymmetry

524.12 Other jaw asymmetry

524.19 Other specified anomaly

524.2 Anomalies of dental arch relationship

Anomaly of dental arch

524.20 Unspecified anomaly of dental arch relationship

524.21 Malocclusion, Angle’s class I

Neutro-occlusion

524.22 Malocclusion, Angle’s class II

Disto-occlusion Division I

Disto-occlusion Division II

524.23 Malocclusion, Angle’s class III

Mesio-occlusion

524.24 Open anterior occlusal relationship

Anterior open bit

524.25 Open posterior occlusal relationship

Posterior open bite

524.26 Excessive horizontal overlap

Excessive horizontal overjet

524.27 Reverse articulation

Anterior articulation

Crossbite

Posterior articulation

524.28 Anomalies of interarch distance

Excessive interarch distance

Inadequate interarch distance

524.29 Other anomalies of dental arch relationship

Other anomalies of dental arch

524.4 Malocclusion, unspecified

524.5 Dentofacial functional abnormalities

524.50 Dentofacial function abnormality, unspecified

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524.51 Abnormal jaw closure

524.52 Limited mandibular range of motion

524.53 Deviation in opening and closing of the mandible

524.54 Insufficient anterior guidance

524.55 Centric occlusion maximum intercuspation discrepancy

524.56 Non-working side interference

524.57 Lack of posterior occlusal support

524.59 Other dentofacial functional abnormalities

Abnormal swallowing

Mouth breathing

Sleep postures

Tongue, lip, or finger habits

524.6 Temporomandibular joint disorders

524.64 Temporomandibular joint sounds on opening and/or closing the jaw

524.7 Dental alveolar anomalies

524.75 Vertical displacement of alveolus and teeth

524.76 Occlusal plane deviation

524.8 Other specified dentofacial anomalies

524.81 Anterior soft tissue impingement

524.82 Posterior soft tissue impingement


524.9 Unspecified dentofacial anomalies

528 Diseases of the oral soft tissues, excluding lesions specific for gingiva and tongue

528.9 Other and unspecified diseases of the oral soft tissues

ASHA Note: Such as velopharyngeal incompetence

529 Diseases and other conditions of the tongue

529.8 Other specified conditions of the tongue

Atrophy (of) tongue

Crenated (of) tongue

Enlargement (of) tongue

Hypertrophy (of) tongue

Glossocele

Excludes: erythroplasia of tongue (528.79)

leukoplakia of tongue (528.6)

macroglossia (congenital) (750.15)

microglossia (congenital) (750.16)

oral submucosal fibrosis (528.8)

Diseases of Esophagus, Stomach, and Duodenum (530-538)

530 Diseases of esophagus

530.8 Other specified disorders of esophagus

530.81 Esophageal reflux

Ch. 10 Diseases of the Genitourinary System (580-629)

Ch. 11 Complications of Pregnancy, Childbirth and the Puerperium (630-676)

Ch. 12 Diseases of the Skin and Subcutaneous Tissue (680-709)

Ch. 13 Diseases of the Musculoskeletal System and Connective Tissue (710-739)

Ch. 14 Congenital Anomalies (740-759)

741 Spina bifida

741.0 With hydrocephalus

741.9 Without mention of hydrocephalus

742 Other congenital anomalies of nervous system

742.0 Encephalocele

742.1 Microcephalus

742.2 Reduction deformities of brain

742.3 Congenital hydrocephalus

742.4 Other specified anomalies of brain

742.5 Other specified anomalies of spinal cord

742.8 Other specified anomalies of nervous system

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742.9 Unspecified anomaly of brain, spinal cord, and nervous system

744 Congenital anomalies of ear, face, and neck

744.0 Anomaly of ear causing impairment of hearing

Excludes: congenital deafness without mention of cause (389.0-389.9)

744.00 Unspecified anomaly of ear with impairment of hearing

744.01 Absence of external ear

744.02 Other anomalies of external ear with impairment of hearing

744.03 Anomalies of middle ear, except ossicles

744.04 Anomalies of ear ossicles

744.05 Anomalies of inner ear

744.09 Other

Absence of ear, congenital

744.1 Accessory auricle

Accessory tragus

Polyotia

Preauricular appendage

Supernumerary

ear

lobule

744.2 Other specified anomalies of ear

Excludes: that with impairment of hearing (744.00-744.09)

744.21 Absence of ear lobe, congenital

744.22 Macrotia

744.23 Microtia

744.24 Specified anomalies of Eustachian tube

Absence of Eustachian tube

744.29 Other

Bat ear

Darwin’s tubercle

Pointed ear

Prominence of auricle

Ridge ear

Excludes: preauricular sinus (744.46)

744.3 Unspecified anomaly of ear

Congenital:

anomaly NOS of ear, NEC

deformity NOS of ear, NEC

744.8 Other specified anomalies of face and neck

748 Congenital anomalies of respiratory system

748.2 Web of larynx

748.3 Other anomalies of larynx, trachea and bronchus

749 Cleft palate and cleft lip

749.0 Cleft palate

749.00 Cleft palate, unspecified


749.02 Unilateral, incomplete

Cleft uvula


749.04 Bilateral, incomplete

749.1 Cleft lip

749.10 Cleft lip, unspecified





749.2 Cleft palate with cleft lip

749.20 Cleft palate with cleft lip, unspecified





749.25 Other combinations

750 Other congenital anomalies of upper alimentary tract

Excludes: dentofacial anomalies (524.0-524.9)

750.0 Tongue tie

Ankyloglossia

750.1 Other anomalies of tongue

750.10 Anomalies of tongue, unspecified

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750.11 Aglossia

750.12 Congenital adhesions of tongue

750.13 Fissure of tongue

750.15 Macroglossia

750.16 Microglossia

Hypoplasia of tongue

750.19 Other

750.2 Other specified anomalies of mouth and pharynx

750.29 Other specified anomalies of pharynx

754 Certain congenital musculoskeletal deformities

754.0 Of skull, face, and jaw

758 Chromosomal anomalies

Includes: syndromes associated with anomalies in the number and form of chromosomes

Use additional codes for conditions associated with the chromosomal anomalies

758.0 Down’s syndrome

Mongolism

Translocation Down’s syndrome

Trisomy:

21 or 22

G

758.2 Edward’s syndrome

Trisomy:

18

E3

758.3 Autosomal deletion syndromes

758.31 Cri-du-chat syndrome

758.32 Velo-cardio-facial syndrome

758.33 Other microdeletions

Miller-Dieker syndrome

Smith-Magenis syndrome

758.5 Other conditions due to autosomal anomalies

758.7 Klinefelter’s syndrome (males only)

XXY syndrome

758.8 Other conditions due to chromosome anomalies

758.9 Conditions due to anomaly of unspecified chromosome

Ch. 15 Certain Conditions Originating in the Perinatal Period (760-779)

Other Conditions Originating in the Perinatal Period (764-779)

779 Other and ill-defined conditions originating in the perinatal period

779.3 Disorder of stomach function and feeding problems in newborn

779.31 Feeding problems in newborn

Slow feeding in newborn

Excludes: feeding problem in child over 28 days old (783.3)

779.34 Failure to thrive in newborn

Excludes: failure to thrive in child over 28 days old (783.41)

Ch. 16 Symptoms, Signs, and Ill-defined Conditions (780-799)

Symptoms (780-789)

780 General symptoms

780.4 Dizziness and giddiness

Light-headedness

Vertigo NOS

Excludes: Ménière’s disease and other specified vertiginous syndromes (386.0-386.9)

780.9 Other general symptoms

780.93 Memory loss

Amnesia (retrograde)

Memory loss NOS

Excludes: memory loss due to:

intercranial injuries (850.0-854.19)

skull fractures (800.00-801.99, 803.00-804.99)

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mild memory disturbance due to organic brain damage (310.8)

781 Symptoms involving nervous and musculoskeletal systems

781.3 Lack of coordination

Ataxia NOS

Muscular incoordination

781.8 Neurological neglect syndrome

Asomatognosia Left-sided neglect

Hemi-akinesia Sensory extinction

Hemi-inattention Sensory neglect

Hemispatial Visuospatial neglect neglect

781.9 Other symptoms involving nervous and musculoskeletal systems

781.94 Facial weakness

Facial droop

Excludes: facial weakness due to late effect of CVA (438.83)

783 Symptoms concerning nutrition, metabolism, and development

783.3 Feeding difficulties and mismanagement

Feeding problem (elderly) (infant)

Excludes: feeding disturbance or problems:

in newborn (779.31-779.34)

of nonorganic origin (307.50-307.59)

783.4 Lack of expected normal physiological development in childhood

783.40 Lack of normal physiological development, unspecified

Inadequate development

Lack of development

783.41 Failure to thrive

Failure to gain weight

Excludes: failure to thrive in newborn (779.34)

783.42 Delayed milestones

Late talker

Late walker

784 Symptoms involving head and neck

784.3 Aphasia

Excludes: aphasia due to late effects of cerebrovascular disease developmental aphasia (315.31)

784.4 Voice and resonance disorders

784.40 Voice and resonance disorder, unspecified

784.41 Aphonia

Loss of voice

784.42 Dysphonia

Hoarseness

784.43 Hypernasality

784.44 Hyponasality

784.49 Other voice and resonance disorders

Change in voice

784.5 Other speech disturbance

Excludes: speech disorder due to late effect of CVA (438.10-438.19)

stuttering (315.35)

784.51 Dysarthria

Excludes: Dysarthria due to late effect of CVA (438.13)

784.52 Fluency disorder in conditions classified elsewhere

Stuttering in conditions classified elsewhere

Code first underlying disease or condition, such as Parkinson’s disease (332.0)

Excludes: adult onset fluency disorder (307.0)

(483.11)

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childhood onset fluency disorder (315.35)



Dysphasia

Slurred speech

Speech disturbance NOS

784.6 Other symbolic dysfunction

Excludes: developmental learning delays (315.0-315.9)

784.60 Symbolic dysfunction, unspecified

784.61 Alexia and dyslexia

Alexia (with agraphia)

784.69 Other

Acalculia

Difficulty performing simple mathematical tasks

Agnosia

Loss of ability to recognize objects, persons, sounds, shapes, or smells

Agraphia NOS

Apraxia

Loss of the ability to execute or carry out movements

786 Symptoms involving respiratory system and other chest symptoms

786.0 Dyspnea and respiratory abnormalities

786.09 Other

Respiratory:

distress

insufficiency

Excludes: respiratory distress:

following trauma and surgery (518.52)

newborn (770.89)

respiratory failure (518.81, 518.83- 518.84)

newborn (770.84)

syndrome (newborn) (769)

adult (518.52)

786.2 Cough

Excludes: cough: psychogenic (306.1)

smokers’ (491.0)

with hemorrhage (786.39)

787 Symptoms involving digestive system

787.2 Dysphagia

Code first, if applicable, dysphagia due to late effect of CVA (438.82)

787.20 Dysphagia, unspecified

787.21 Dysphagia, oral phase

787.22 Dysphagia, oropharyngeal phase

787.23 Dysphagia, pharyngeal phase

787.24 Dysphagia, pharyngoesophageal phase

787.29 Other dysphagia

Cervical dysphagia

Neurogenic dysphagia

Nonspecific Abnormal Findings (790-796)

794 Nonspecific abnormal results of function studies

794.0 Brain and central nervous system

794.00 Abnormal function study, unspecified

794.09 Other

Abnormal brain scan

794.1 Peripheral nervous system and special senses

794.13 Abnormal visually evoked potential

794.15 Abnormal auditory function studies

794.16 Abnormal vestibular function studies

Ill-Defined and Unknown Causes of Morbidity and Mortality (797-799)

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797 Senility without mention of psychosis

Frailty

Old age

Senescence

Senile asthenia

Senile:

debility

exhaustion

Excludes: senile psychoses (290.0-290.9)

799 Other ill-defined and unknown causes of morbidity and mortality

799.5 Signs and symptoms involving cognition

Excludes: amnesia (780.93)

amnestic syndrome (294.0)

attention deficit disorder (314.00-314.01)

late effects of cerebrovascular disease (438)

memory loss (780.93)

mild cognitive impairment, so stated (331.83)

specific problems in developmental delay (315.00-315.9)

transient global amnesia (437.7)

visuospatial neglect (781.8)

799.51 Attention or concentration deficit

799.52 Cognitive communication deficit

799.53 Visuospatial deficit

799.54 Psychomotor deficit

799.55 Frontal lobe and executive function deficit

799.59 Other signs and symptoms involving cognition

Ch. 17 Injury and Poisoning (800-999)

Fracture of Skull (800-804)

800 Fracture of vault skull

801 Fracture of base skull

802 Fracture of face bones

803 Other and unqualified skull fractures

804 Multiple fractures involving skull or face with other bones

Fracture of Neck and Trunk (805-809)

805 Fracture of vertebral column without mention of spinal cord injury

807 Fracture of rib(s), sternum, larynx, and trachea

807.5 Larynx and trachea, closed

Hyoid bone

Thyroid cartilage

Trachea

807.6 Larynx and trachea, open

Intracranial Injury, Excluding Those with Skull Fractures (850-854)

850 Concussion

851 Cerebral laceration and contusion

852 Subarachnoid, subdural, and extradural hemorrhage, following injury

853 Other and unspecified intracranial hemorrhage following injury

854 Intracranial injury of other and unspecified nature

Includes injury:

brain NOS

cavernous sinus

intracranial

traumatic brain NOS

Excludes: any condition classifiable to 850-853

head injury NOS (959.01)

Open Wound of Head, Neck, and Trunk (870-879)

872 Open wound of ear

873 Other open wound of head

874 Open wound of neck

Late Effects of Injuries, Poisonings, Toxic Effects, and Other External Causes (905-909)

905 Late effects of musculoskeletal and connective tissue injuries

905.0 Late effect of fracture of skull and face bones

Late effect of injury classifiable to 800-804

907 Late effects of injuries to nervous system

907.0 Late effect of intracranial injury without mention of skull fracture

Late effect of injury classifiable to 850-854

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Effects of Foreign Body Entering Through Orifice (930-939)

931 Foreign body in ear

932 Foreign body in nose

933 Foreign body in pharynx and larynx

934 Foreign body in trachea, bronchus, and lung

935 Foreign body in mouth, esophagus, and stomach

Injury to Nerves and Spinal Cord (950-957)

951 Injury to other cranial nerve(s)

951.0 Injury to oculomotor nerve (3rd cranial nerve)

951.1 Injury to trochlear nerve (4th)

951.2 Injury to trigeminal nerve (5th)

951.3 Injury to abducens nerve (6th)

951.4 Injury to facial nerve (7th)

951.5 Injury to acoustic nerve (8th)

Auditory nerve

Traumatic deafness NOS

951.6 Injury to accessory nerve (11th)

951.7 Injury to hypoglossal nerve (12th)

951.8 Injury to other specified cranial nerves

Glossopharyngeal (9th)

Olfactory (1st)

Pneumogastric (10th)

Traumatic anosmia NOS

Vagus (10th)

951.9 Injury to unspecified cranial nerve

Certain Traumatic Complications and Unspecified Injuries (958-959)

959 Certain early complications of trauma

959.0 Head, face, and neck

959.01 Head injury, unspecified

Excludes: concussion (850.0-850.9)

with head injury NOS (850.0-850.9)

head injury NOS with loss of consciousness (850.1-850.5)

specified head injuries (850.0-854.1)

959.09 Unspecified site

Complications of Surgical and Medical Care, Not Elsewhere Classified (996-999)

997 Complications affecting specified body systems, not elsewhere classifiable

997.3 Respiratory complications

New Code 997.32 Postprocedural aspiration pneumonia

Chemical pneumonitis resulting from a procedure

Mendelson’s syndrome resulting from a procedure

Excludes: aspiration pneumonia during labor and delivery (668.0)

Volume 2: V CodesSupplementary Classification of Factors Influencing Health Status and Contact with Health Services (V01-V82)

The V codes are provided to deal with occasions when circumstances other than a disease or injury classifiable to categories 001-999 (the main part of ICD), or to the E codes (supplementary classification of external causes of injury and poisoning), are recorded as “diagnoses” or “problems.” This can arise mainly in three ways:

a. When a person who is not currently sick encounters the health services for some specific purpose, such as a donor of an organ or tissue, to receive prophylactic vaccination, or to discuss a problem which is in itself not a disease or injury. This will be a fairly rare occurrence among hospital inpatients, but will be relatively more common among hospital outpatients and patients of family practitioners, health clinics, etc.

b. When a person with a known disease or injury, whether it is current or resolving, encounters the health care system for a specific treatment of that disease or injury (e.g., dialysis for renal disease; chemotherapy for malignancy; cast change).

c. When some circumstance or problem is present which influences the person’s health status but is not in itself a current illness or injury. Such factors may be elicited during population surveys, when the person may or may not be currently sick, or be recorded as an additional factor to be borne in mind when the person is receiving care for some current illness or injury classifiable to categories 001-999.

In the latter circumstances, the V code should be used only as a supplementary code and should not be the one selected for use in primary, single cause tabulations.

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Examples of these circumstances are a personal history of certain diseases or a person with an artificial heart valve in situ.

Persons with Potential Health Hazards Related to Personal and Family History (V10-V19)

V13 Personal history of other diseases

V13.6 Congenital (corrected) malformations

V13.64 Personal history of (corrected) congenital malformation of eye, ear, face and neck

Corrected cleft lip and palate

V13.69 Personal history of other (corrected) congenital malformations

V15 Other personal history presenting hazards to health

V15.5 Injury

V15.52 History of traumatic brain injury

Persons with a Condition Influencing Their Health Status (V40-V49)

Note: These categories are intended for use when these conditions are recorded as “diagnoses” or “problems.”

V40 Mental and behavioral problems

V40.0 Problems with learning

V40.1 Problems with communication (including speech)

V40.2 Other mental problems

V40.3 Other behavioral problems

V40.9 Unspecified mental or behavioral problems

V41 Problems with special senses and other special functions

V41.0 Problems with sight

V41.0 Other eye problems

V41.2 Problems with hearing

V41.3 Other ear problems

V41.4 Problems with voice production

V41.6 Problems with swallowing and mastication

V44 Artificial opening status

Excludes artificial openings requiring attention or management (V55.0-V55.9)

V44.0 Tracheostomy

V44.8 Other artificial opening status

V49 Other conditions influencing health status

V49.8 Other specified conditions influencing health status

V49.85 Dual-sensory impairment

Blindness with deafness

Combined visual hearing impairment

Code first: hearing impairment (389.00-389.9)

visual impairment (369.00-369.9)

Persons Encountering Health Services for Specific Procedures and Aftercare (V50-V59)

Note: Categories V51-V58 are intended for use to indicate a reason for care in patients who may have already been treated for some disease or injury not now present or who are receiving care to consolidate the treatment, to deal with residual states, or to prevent recurrence.

V52 Fitting and adjustment of prosthetic device and implant

V52.8 Other specified prosthetic device

V52.9 Unspecified prosthetic device

V53 Fitting and adjustment of other device

Includes: removal of device

replacement of device

Excludes: status only, without need for care (V45.0-V45.8)

V53.2 Hearing aid

V55 Attention to artificial openings

Excludes: complications of external stoma (519.00-519.09, 569.60-569.69, 596.81-596.83, 997.49, 997.5)

V55.0 Tracheostomy

V55.9 Unspecified artificial opening

V57 Care involving use of rehabilitation procedures

V57.0 Breathing exercises

V57.3 Speech-language therapy

V57.8 Other specified rehabilitation procedure

V57.9 Unspecified rehabilitation procedure

V58 Encounter for other and unspecified procedures

V58.1 Chemotherapy

Persons Encountering Health Services in Other Circumstances (V60-V69)

V67 Follow-up examination

Includes: surveillance only following treatment

V68 Encounters for administrative purposes

V68.0 Issue of medical certificates

V68.01 Disability examination

V68.2 Request for expert evidence

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V68.8 Other specified administrative purpose

V68.81 Referral of patient without examination or treatment

V68.89 Other

Persons without Reported Diagnosis Encountered During Examination and Investigation of Individuals and Populations (V70-V82)

V72 Special investigations and examinations

Includes: routine examination of specific system

V72.1 Examination of ears and hearing

V72.11 Encounter for hearing exam following failed hearing screening

V72.12 Encounter for hearing conservation and treatment

V72.19 Other exam of ears and hearing

V72.83 Other specified preoperative examination

ASHANote:

One Medicare Local Coverage Determination (LCD) guides SLPs to use V72.83 to report pre-laryngectomy examinations. Check with payers regarding appropriate use of this code.

V79 Special screening for mental disorders and other developmental handicaps

V79.2 Mental retardation

V79.3 Developmental handicaps in early childhood

V79.8 Other specified mental disorders and developmental handicaps

V79.9 Unspecified mental disorder and developmental handicap

V80 Special screening for neurological, eye, and ear diseases

V80.1 Neurological conditions

V80.01 Traumatic brain injury

V80.09 Other neurological conditions

V80.3 Ear diseases

Excludes: general hearing exam (V72.1)

Volume 3: ProceduresVolume 3 contains tabular lists of 16 categories of operations or procedures that have been adopted for inpatient procedures reported by hospitals.

(4) Operations on the Ear (18-20)

20 Other operations on middle and inner ear

20.3 Diagnostic procedures on middle and inner ear

20.31 Electrocochleography

(6) Operations on the Respiratory System (30-34)

31 Other operations on larynx and trachea

31.4 Diagnostic procedures on larynx and trachea

31.42 Laryngoscopy and other tracheoscopy

31.48 Other diagnostic procedure on larynx

31.9 Other operation on larynx and trachea

31.95 Tracheoesophageal fistulization

(16) Miscellaneous. Diagnostic and Therapeutic Procedures (87-99)

87 Diagnostic Radiology

87.6 Other X-ray of digestive system

87.61 Barium swallow

93 Physical therapy, respiration therapy, rehabilitation, and related procedures

93.7 Speech and reading rehabilitation and rehabilitation of the blind

93.71 Dyslexia training

93.72 Dysphasia training

93.73 Esophageal speech training

93.74 Speech defect training

93.75 Other speech training and therapy

93.78 Other rehabilitation for the blind

93.8 Other rehabilitation therapy

93.89 Rehabilitation, not elsewhere classified

94 Procedures related to the psyche

94.0 Psychologic evaluation and testing

94.01 Administration of intelligence test

94.02 Administration of psychologic test

94.5 Referral for psychologic rehabilitation

95 Ophthalmologic and otologic diagnosis and treatment

95.4 Nonoperative procedures related to hearing

95.41 Audiometry

Bekesy 5-tone audiometry

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Impedance audiometry

Stapedial reflex response

Subjective audiometry

Tympanogram

95.42 Clinical test of hearing

Tuning fork test

Whispered speech test

95.43 Audiological evaluation

Audiological evaluation by:

Barany noise machine

Blindfold test

Delayed feedback

Masking

Weber lateralization

95.44 Clinical vestibular function tests

Thermal test of vestibular function

95.46 Other auditory and vestibular function tests

95.47 Hearing examination, not otherwise specified

95.48 Fitting of hearing aid

Excludes: implantation of electromagnetic hearing aid (20.95)

95.49 Other nonoperative procedures related to hearing

Adjustments (external components) of cochlear prosthetic device

97 Replacement and removal of therapeutic appliances

97.3 Nonoperative removal of therapeutic device from head and neck

97.37 Removal of tracheostomy tube

Code to the Highest Degree of SpecificityClinicians who must select ICD-9-CM diagnosis codes should use codes that provide the highest degree of accuracy and completeness or the greatest specificity. That usually means providing an ICD-9-CM code carried to the 5th digit. The Centers for Medicare & Medicaid Services (CMS) require all Medicare practitioners (as do most private payers) to use ICD-9-CM diagnosis codes with the highest specificity as requested by the Health Insurance Portability and Accountability Act (HIPAA). For example, clinicians using code 784.6 (symbolic dysfunction) to describe language/cognitive impairments of an organic nature may have this code rejected. Because this code category has 5th digit subclassifications, the most appropriate subclassifications should be selected. This might be 784.60 (symbolic dysfunction, unspecified), 784.61 (alexia and dyslexia), or 784.69 (other; acalculia, agnosia, agraphia, apraxia). Code 784.69 is intended to include multiple diagnoses, some of which may differ significantly, according to David Berglund, MD, MPH, at the National Center for Health Statistics/Centers for Disease Control, but it provides the highest level of specificity in that category and, therefore, should be used instead of 784.6. Keep in mind that 784.60, 784.61, and 784.69 are subclassifications of 784.6; so, when you use those codes you are not excluding 784.6.

Following the specificity rule, therefore, assign 3-digit codes when there are no 4-digit codes within the category. (So far, only one 3-digit code relevant for ASHA members has been found, 931—foreign body in ear.) Assign 4-digit codes if there is no 5th digit subclassification for that category. Assign the 5th digit subclassification code for those categories where it exists.

Providers should also be aware that codes marked NOS (not otherwise specified) or “unspecified” indicate that there is insufficient information in the medical record to assign a more specific code. NEC (not elsewhere classifiable) means that ICD-9-CM does not have a code that describes the condition.

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Chapter 3: ICD-10-CM Diagnostic CodesGeneralOn October 1, 2015, a new diagnoses code system, the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), replaced the ICD-9-CM set of diagnostic codes currently in place. ICD-9-CM is a set of codes used by physicians, hospitals, and health care professionals to indicate diagnoses for all patient encounters. ASHA prepared this document of ICD-10-CM codes for speech-language and hearing disorders. The new classification system provides significant changes that all health care providers, including ASHA members, must understand.

The ICD-10-CM codes are very different from the current ICD-9-CM codes; for example, ICD-10-CM codes are based on an alpha-numeric system. There may be up to seven alpha-numeric characters, requiring billing software program changes to accommodate the additional digits, as well as extensive coder training. There will be little change in what the physician documents in the medical record; it is how the information is translated into ICD-10 coding that will change. ICD-10-CM codes will be able to provide more in-depth information about the patient’s condition that can be more easily captured in an electronic medical record. Physician (CMS 1500) and hospital or facility (UB-04) billing forms have been updated to accommodate the changes.

ICD-10-CM is based on the World Health Organization’s Tenth Revision, International Classification of Diseases (ICD-10). The intent of ICD-10-CM is to standardize disease and procedure classification throughout the United States and to gather data about basic health statistics. The National Center for Health Statistics (NCHS) and the Centers for Medicare & Medicaid Services (CMS) are the U.S. governmental agencies responsible for overseeing all changes and modifications to the ICD-10-CM.

Use of CodesAudiologists and speech-language pathologists use ICD-10-CM codes to describe and bill for services. The Health Insurance Portability and Accountability Act (HIPAA) requires that the ICD-10-CM be used for health services billing and recordkeeping.

As was the case with the ICD-9-CM codes, clinicians should use the ICD-10-CM to code to the highest degree of specificity.

Note: This is not a comprehensive list of ICD-10-CM codes. A number of codes, such as those for hearing diseases, are included for informational purposes only and may not represent the entire category of codes. Such categories may actually be more extensive. However, in general, the audiology and speech-language pathology diagnoses codes found in this publication are the most specific available for hearing, speech-language, and swallowing problems.

OverviewThe ICD-10 is owned by the World Health Organization (WHO). The clinical modification (ICD-10-CM) was developed by the Centers for Disease Control and Prevention for use in all U.S. health care treatment settings. The procedure coding system (i.e., ICD-9-PCS and ICD-10-PCS) was developed by the Centers for Medicare & Medicaid Services (CMS) for use in the U.S. for inpatient hospital settings only.

ScopeThe intent of ICD-10-CM is to standardize disease and procedure classification throughout the United States and to gather data about basic health statistics.

PurposeHIPAA legislation requires the ICD-10-CM to be used for health services billing and record keeping. As noted above, the effective implementation date for ICD-10-CM (and ICD-10-PCS) is October 1, 2015. Updates to this version of ICD-10-CM are anticipated prior to its implementation.

Relation to Professional Scope of PracticeThe audiologist and the speech-language pathologist practicing in a health care setting, especially a hospital, may have to code delivery of services according to the ICD-10-CM.

ICD-10-CM GuidelinesThe instructional notations from the published ICD-10-CM Tabular List of Diseases and Injuries can be found at: (www.cdc.gov/nchs/icd/icd10cm.htm).

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Includes

The word ‘Includes’ appears immediately under certain categories to further define, or give examples of, the content of the category.

Excludes Notes

The ICD-10-CM has two types of excludes notes. Each note has a different definition for use but they are both similar in that they indicate that codes excluded from each other are independent of each other.

Excludes1 (Never use the listed codes together)

A type 1 Excludes note is a pure excludes. It means ‘NOT CODED HERE!’ An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.

Excludes2 (Can use the listed codes together)

A type 2 excludes note represents ‘Not included here’. An Excludes2 note indicates that the condition excluded is not part of the condition it is excluded from but a patient may have both conditions at the same time. When an Excludes2 note appears under a code it is acceptable to use both the code and the excluded code together.

Code First/Use Additional Code Notes (etiology/manifestation paired codes)

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists there is a ‘use additional code’ note at the etiology code and a ‘code first’ note at the manifestation code. These instructional notes indicate the proper sequencing order of the code etiology followed by manifestation.

In most cases the manifestation codes will have in the code title, ‘in diseases classified elsewhere’. Codes with this title are a component of the etiology/manifestation convention. The code title indicates that it is a manifestation code. ‘In diseases classified elsewhere’ codes are never permitted to be used as first listed or principal diagnosis codes. They must be used in conjunction with an underlying condition code and they must be listed following the underlying condition.

Code Also

A code also note instructs that 2 codes may be required to fully describe a condition, but the sequencing of the two codes is discretionary, depending on the severity of the conditions and the reason for the encounter.

7th Characters and Placeholder X

For codes less than 6 characters that require a 7th character a placeholder X should be assigned for all characters less than 6. The 7th character must always be the 7th character of a code.

ASHA Note: Certain ICD-10-CM categories have applicable 7th characters. The seventh character of ICD-10 is often a required character in codes involving, for example, injuries and poisonings (Chapter 19, S00-T88). The purpose of the 7th character is to communicate to the payer the “type of encounter” such as initial (A), subsequent (D), or sequela (S).

Official ICD-10-CM Websites• National Center for Health Statistics: www.cdc.gov/nchs/icd/icd10cm.htm

• Centers for Medicare & Medicaid Services: www.cms.gov/ICD10/

• ICD-10-CM Official Guidelines for Coding and Reporting: www.cdc.gov/nchs/data/icd/10cmguidelines_2016_Final.pdf

ASHA Resources• ICD-9 to ICD-10 Mapping Tool for Audiologists and Speech-Language Pathologists:

www.asha.org/icdmapping.aspx

• ICD-10-CM Diagnosis Codes for Audiology and Speech-Language Pathology: www.asha.org/Practice/reimbursement/coding/ICD-10/

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http://www.cdc.gov/nchs/icd/icd10.htm

http://www.cms.gov/ICD10/

http://www.cdc.gov/nchs/data/icd/10cmguidelines_2016_Final.pdf

http://www.asha.org/icdmapping.aspx

http://www.asha.org/Practice/reimbursement/coding/ICD-10/


• ICD-9-CM Diagnosis Codes for Audiology: www.asha.org/practice/reimbursement/coding/icd9Audiology/

• ICD-9-CM Diagnosis Codes for SLP: www.asha.org/practice/reimbursement/coding/icd9SLP/

• Coding Normal Results: www.asha.org/practice/reimbursement/coding/normalresults/

• Coding to the Highest Degree of Specificity: www.asha.org/practice/reimbursement/coding/codespecificity/

ICD-10-CM Diagnostic Codes: AudiologyICD-10-CM Tabular List of Diseases and InjuriesRelated to hearing and vestibular disorders

Note: This is not a comprehensive list and a number of codes are included for information purposes only. Some categories of codes (e.g., specific ear diseases) may be more extensive, contain additional instructional notes, and may also require coding to a higher degree of specificity than indicated here. However, in general, audiology related diagnoses will be listed to their highest level of specificity. For a full list of ICD-10-CM codes, descriptors, and instructions, see the official ICD-10-CM publication at www.cms.gov/Medicare/Coding/ICD10/Latest_News.html.

√ Code typically used by audiologists ◊ Additional digits not listed here

Ch. 6 Diseases of the nervous system (G00-G99)

Other disorders of the nervous system (G89-G99)

G96 Other disorders of central nervous system

G96.0 Cerebrospinal fluid leak

Excludes1: cerebrospinal fluid leak from spinal puncture (G97.0)

Ch. 8 Diseases of the ear and mastoid process (H60-H95)

Note: Use an external cause code following the code for the ear condition, if applicable, to identify the cause of the ear condition

Excludes2: certain conditions originating in the perinatal period (P04-P96)

certain infectious and parasitic diseases (A00-B99)

complications of pregnancy, childbirth and the puerperium (O00-O9A)

congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)

endocrine, nutritional and metabolic diseases (E00-E88)

injury, poisoning and certain other consequences of external causes (S00-T88)

neoplasms (C00-D49)

symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

This chapter contains the following blocks:

H60-H62: Diseases of external ear

H65-H75: Diseases of middle ear and mastoid

H80-H83: Diseases of inner ear

H90-H94: Other disorders of ear

H95: Intraoperative and postprocedural complications and disorders of ear and mastoid process, not elsewhere classified

Diseases of external ear (H60-H62)

H60 Otitis externa

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http://www.asha.org/practice/reimbursement/coding/icd9Audiology/

http://www.asha.org/practice/reimbursement/coding/icd9SLP/

http://www.asha.org/practice/reimbursement/coding/normalresults/

http://www.asha.org/practice/reimbursement/coding/codespecificity/


H60.0 Abscess of external ear

Boil of external ear

Carbuncle of auricle or external auditory canal

Furuncle of external ear

H60.00 Abscess of external ear, unspecified ear

H60.01 Abscess of right external ear

H60.02 Abscess of left external ear

H60.03 Abscess of external ear, bilateral

H60.1 Cellulitis of external ear

Cellulitis of auricle

Cellulitis of external auditory canal

H60.10 Cellulitis of external ear, unspecified ear

H60.11 Cellulitis of right external ear

H60.12 Cellulitis of left external ear

H60.13 Cellulitis of external ear, bilateral

H60.2 Malignant otitis externa

H60.20 Malignant otitis externa, unspecified ear

H60.21 Malignant otitis externa, right ear

H60.22 Malignant otitis externa, left ear

H60.23 Malignant otitis externa, bilateral

H60.3 Other infective otitis externa

H60.31 Diffuse otitis externa

H60.311 Diffuse otitis externa, right ear

H60.312 Diffuse otitis externa, left ear

H60.313 Diffuse otitis externa, bilateral

H60.319 Diffuse otitis externa, unspecified ear

H60.32 Hemorrhagic otitis externa

H60.321 Hemorrhagic otitis externa, right ear

H60.322 Hemorrhagic otitis externa, left ear

H60.323 Hemorrhagic otitis externa, bilateral

H60.329 Hemorrhagic otitis externa, unspecified ear

H60.33 Swimmer’s ear

H60.331 Swimmer’s ear, right ear

H60.332 Swimmer’s ear, left ear

H60.333 Swimmer’s ear, bilateral

H60.339 Swimmer’s ear, unspecified ear

H60.39 Other infective otitis externa

H60.391 Other infective otitis externa, right ear

H60.392 Other infective otitis externa, left ear

H60.393 Other infective otitis externa, bilateral

H60.399 Other infective otitis externa, unspecified ear

H60.4 Cholesteatoma of external ear

Keratosis obturans of external ear (canal)

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Excludes2: cholesteatoma of middle ear (H71.-)

recurrent cholesteatoma of postmastoidectomy cavity (H95.0-)

H60.40 Cholesteatoma of external ear, unspecified ear

H60.41 Cholesteatoma of right external ear

H60.42 Cholesteatoma of left external ear

H60.43 Cholesteatoma of external ear, bilateral

H60.5 Acute noninfective otitis externa

H60.6 Unspecified chronic otitis externa

H60.8 Other otitis externa

H60.9 Unspecified otitis externa

H61 Other disorders of external ear

H61.0 Chondritis and perichondritis of external ear

Chondrodermatitis nodularis chronica helicis

Perichondritis of auricle

Perichondritis of pinna

H61.00 Unspecified perichondritis of external ear

H61.001 Unspecified perichondritis of right external ear

H61.002 Unspecified perichondritis of left external ear

H61.003 Unspecified perichondritis of external ear, bilateral

H61.009 Unspecified perichondritis of external ear, unspecified ear

H61.01 Acute perichondritis of external ear

H61.011 Acute perichondritis of right external ear

H61.012 Acute perichondritis of left external ear

H61.013 Acute perichondritis of external ear, bilateral

H61.019 Acute perichondritis of external ear, unspecified ear

H61.02 Chronic perichondritis of external ear

H61.021 Chronic perichondritis of right external ear

H61.022 Chronic perichondritis of left external ear

H61.023 Chronic perichondritis of external ear, bilateral

H61.029 Chronic perichondritis of external ear, unspecified ear

H61.03 Chondritis of external ear

Chondritis of auricle

Chondritis of pinna

H61.031 Chondritis of right external ear

H61.032 Chondritis of left external ear

H61.033 Chondritis of external ear, bilateral

H61.039 Chondritis of external ear, unspecified ear

H61.1 Noninfective disorders of pinna

Excludes2: cauliflower ear (M95.1-)

gouty tophi of ear ( M1A-, M10.-)

H61.10 Unspecified noninfective disorders of pinna

Disorder of pinna NOS

H61.101 Unspecified noninfective disorders of pinna, right ear

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H61.102 Unspecified noninfective disorders of pinna, left ear

H61.103 Unspecified noninfective disorders of pinna, bilateral

H61.109 Unspecified noninfective disorders of pinna, unspecified ear

H61.11 Acquired deformity of pinna

Acquired deformity of auricle

Excludes2: cauliflower ear (M95.1-)

H61.111 Acquired deformity of pinna, right ear

H61.112 Acquired deformity of pinna, left ear

H61.113 Acquired deformity of pinna, bilateral

H61.119 Acquired deformity of pinna, unspecified ear

H61.12 Hematoma of pinna

Hematoma of auricle

H61.121 Hematoma of pinna, right ear

H61.122 Hematoma of pinna, left ear

H61.123 Hematoma of pinna, bilateral

H61.129 Hematoma of pinna, unspecified ear

H61.19 Other noninfective disorders of pinna

H61.191 Noninfective disorders of pinna, right ear

H61.192 Noninfective disorders of pinna, left ear

H61.193 Noninfective disorders of pinna, bilateral

H61.199 Noninfective disorders of pinna, unspecified ear

H61.2 Impacted cerumen

Wax in ear

H61.20 Impacted cerumen, unspecified ear

H61.21 Impacted cerumen, right ear

H61.22 Impacted cerumen, left ear

H61.23 Impacted cerumen, bilateral

H61.3 Acquired stenosis of external ear canal

Collapse of external ear canal

Excludes1: postprocedural stenosis of external ear canal (H95.81-)

H61.30 Acquired stenosis of external ear canal, unspecified

H61.301 Acquired stenosis of right external ear canal, unspecified

H61.302 Acquired stenosis of left external ear canal, unspecified

H61.303 Acquired stenosis of external ear canal, unspecified, bilateral

H61.309 Acquired stenosis of external ear canal, unspecified, unspecified ear

H61.31 Acquired stenosis of external ear canal secondary to trauma

H61.311 Acquired stenosis of right external ear canal secondary to trauma

H61.312 Acquired stenosis of left external ear canal secondary to trauma

H61.313 Acquired stenosis of external ear canal secondary to trauma, bilateral

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H61.319 Acquired stenosis of external ear canal secondary to trauma, unspecified ear

H61.32 Acquired stenosis of external ear canal secondary to inflammation and infection

H61.321 Acquired stenosis of right external ear canal secondary to inflammation and infection

H61.322 Acquired stenosis of left external ear canal secondary to inflammation and infection

H61.323 Acquired stenosis of external ear canal secondary to inflammation and infection, bilateral

H61.329 Acquired stenosis of external ear canal secondary to inflammation and infection, unspecified ear

H61.39 Other acquired stenosis of external ear canal

H61.391 Other acquired stenosis of right external ear canal

H61.392 Other acquired stenosis of left external ear canal

H61.393 Other acquired stenosis of external ear canal, bilateral

H61.399 Other acquired stenosis of external ear canal, unspecified ear

H61.8 Other specified disorders of external ear

H61.81 Exostosis of external canal

H61.811 Exostosis of right external canal

H61.812 Exostosis of left external canal

H61.813 Exostosis of external canal, bilateral

H61.819 Exostosis of external canal, unspecified ear

H61.89 Other specified disorders of external ear

H61.891 Other specified disorders of right external ear

H61.892 Other specified disorders of left external ear

H61.893 Other specified disorders of external ear, bilateral

H61.899 Other specified disorders of external ear, unspecified ear

H61.9 Disorder of external ear, unspecified

H61.90 Disorder of external ear, unspecified, unspecified ear

H61.91 Disorder of right external ear, unspecified

H61.92 Disorder of left external ear, unspecified

H61.93 Disorder of external ear, unspecified, bilateral

H62 Disorders of external ear in diseases classified elsewhere

Diseases of middle ear and mastoid (H65-H75)

H65 Nonsuppurative otitis media

Includes: nonsuppurative otitis media with myringitis

Use additional code for any associated perforated tympanic membrane (H72.-)

Use additional code to identify:

exposure to environmental tobacco smoke (Z77.22)

exposure to tobacco smoke in the perinatal period (P96.81)

history of tobacco use (Z87.891)

occupational exposure to environmental tobacco smoke (Z57.31)

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tobacco dependence (F17.-)

tobacco use (Z72.0)

H65.0 Acute serous otitis media

Acute and subacute secretory otitis

H65.00 Acute serous otitis media, unspecified ear

H65.01 Acute serous otitis media, right ear

H65.02 Acute serous otitis media, left ear

H65.03 Acute serous otitis media, bilateral

H65.04 Acute serous otitis media, recurrent, right ear

H65.05 Acute serous otitis media, recurrent, left ear

H65.06 Acute serous otitis media, recurrent, bilateral

H65.07 Acute serous otitis media, recurrent, unspecified ear

H65.1 Other acute nonsuppurative otitis media

Excludes1: otitic barotrauma (T70.0)

otitis media (acute) NOS (H66.9)

H65.11 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous)

H65.111 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear

H65.112 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), left ear

H65.113 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), bilateral

H65.114 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, right ear

H65.115 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, left ear

H65.116 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, bilateral

H65.117 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, unspecified ear

H65.119 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), unspecified ear

H65.19 Other acute nonsuppurative otitis media

Acute and subacute mucoid otitis media

Acute and subacute nonsuppurative otitis media NOS

Acute and subacute sanguinous otitis media

Acute and subacute seromucinous otitis media

H65.191 Other acute nonsuppura-tive otitis media, right ear

H65.192 Other acute nonsuppura-tive otitis media, left ear

H65.193 Other acute nonsuppura-tive otitis media, bilateral

H65.194 Other acute nonsuppura-tive otitis media, recurrent, right ear

H65.195 Other acute nonsuppura-tive otitis media, recurrent, left ear

H65.196 Other acute nonsuppura-tive otitis media, recurrent, bilateral

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H65.197 Other acute nonsuppura-tive otitis media recurrent, unspecified ear

H65.199 Other acute nonsuppura-tive otitis media, unspecified ear

H65.2 Chronic serous otitis media

Chronic tubotympanal catarrh

H65.20 Chronic serous otitis media, unspecified ear

H65.21 Chronic serous otitis media, right ear

H65.22 Chronic serous otitis media, left ear

H65.23 Chronic serous otitis media, bilateral

H65.3 Chronic mucoid otitis media

Chronic mucinous otitis media

Chronic secretory otitis media

Chronic transudative otitis media

Glue ear

Excludes1: adhesive middle ear disease (H74.1)

H65.30 Chronic mucoid otitis media, unspecified ear

H65.31 Chronic mucoid otitis media, right ear

H65.32 Chronic mucoid otitis media, left ear

H65.33 Chronic mucoid otitis media, bilateral

H65.4 Other chronic nonsuppurative otitis media

H65.41 Chronic allergic otitis media

H65.411 Chronic allergic otitis media, right ear

H65.412 Chronic allergic otitis media, left ear

H65.413 Chronic allergic otitis media, bilateral

H65.419 Chronic allergic otitis media, unspecified ear

H65.49 Other chronic nonsuppurative otitis media

Chronic exudative otitis media

Chronic nonsuppurative otitis media NOS

Chronic otitis media with effusion (nonpurulent)

Chronic seromucinous otitis media

H65.491 Other chronic nonsuppura-tive otitis media, right ear

H65.492 Other chronic nonsuppura-tive otitis media, left ear

H65.493 Other chronic nonsuppura-tive otitis media, bilateral

H65.499 Other chronic nonsuppura-tive otitis media, unspecified ear

H65.9 Unspecified nonsuppurative otitis media

Allergic otitis media NOS

Catarrhal otitis media NOS

Exudative otitis media NOS

Mucoid otitis media NOS

Otitis media with effusion (nonpurulent) NOS

Secretory otitis media NOS

Seromucinous otitis media NOS

Serous otitis media NOS

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Transudative otitis media NOS

H65.90 Unspecified nonsuppurative otitis media, unspecified ear

H65.91 Unspecified nonsuppurative otitis media, right ear

H65.92 Unspecified nonsuppurative otitis media, left ear

H65.93 Unspecified nonsuppurative otitis media, bilateral

H66 Suppurative and unspecified otitis media

Includes: suppurative and unspecified otitis media with myringitis








tobacco use (Z72.0)

H66.0 Acute suppurative otitis media

H66.00 Acute suppurative otitis media without spontaneous rupture of ear drum

H66.001 Acute suppurative otitis media without spontaneous rupture of ear drum, right ear

H66.002 Acute suppurative otitis media without spontaneous rupture of ear drum, left ear

H66.003 Acute suppurative otitis media without spontaneous rupture of ear drum, bilateral

H66.004 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear

H66.005 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left ear

H66.006 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, bilateral

H66.007 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, unspecified ear

H66.009 Acute suppurative otitis media without spontaneous rupture of ear drum, unspecified ear

H66.01 Acute suppurative otitis media with spontaneous rupture of ear drum

H66.011 Acute suppurative otitis media with spontaneous rupture of ear drum, right ear

H66.012 Acute suppurative otitis media with spontaneous rupture of ear drum, left ear

H66.013 Acute suppurative otitis media with spontaneous rupture of ear drum, bilateral

H66.014 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, right ear

H66.015 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, left ear

H66.016 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, bilateral

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H66.017 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, unspecified ear

H66.019 Acute suppurative otitis media with spontaneous rupture of ear drum, unspecified ear

H66.1 Chronic tubotympanic suppurative otitis media

Benign chronic suppurative otitis media

Chronic tubotympanic disease

H66.10 Chronic tubotympanic suppurative otitis media, unspecified

H66.11 Chronic tubotympanic suppurative otitis media, right ear

H66.12 Chronic tubotympanic suppurative otitis media, left ear

H66.13 Chronic tubotympanic suppurative otitis media, bilateral

H66.2 Chronic atticoantral suppurative otitis media

Chronic atticoantral disease

H66.20 Chronic atticoantral suppurative otitis media, unspecified ear

H66.21 Chronic atticoantral suppurative otitis media, right ear

H66.22 Chronic atticoantral suppurative otitis media, left ear

H66.23 Chronic atticoantral suppurative otitis media, bilateral

H66.3 Other chronic suppurative otitis media

Chronic suppurative otitis media NOS

Excludes1: tuberculous otitis media (A18.6)

H66.3X Other chronic suppurative otitis media

H66.3X1 Other chronic suppurative otitis media, right ear

H66.3X2 Other chronic suppurative otitis media, left ear

H66.3X3 Other chronic suppurative otitis media, bilateral

H66.3X9 Other chronic suppurative otitis media, unspecified ear

H66.4 Suppurative otitis media, unspecified

Purulent otitis media NOS

H66.40 Suppurative otitis media, unspecified, unspecified ear

H66.41 Suppurative otitis media, unspecified, right ear

H66.42 Suppurative otitis media, unspecified, left ear

H66.43 Suppurative otitis media, unspecified, bilateral

H66.9 Otitis media, unspecified

Otitis media NOS

Acute otitis media NOS

Chronic otitis media NOS

H66.90 Otitis media, unspecified, unspecified ear

H66.91 Otitis media, unspecified, right ear

H66.92 Otitis media, unspecified, left ear

H66.93 Otitis media, unspecified, bilateral

H67 Otitis media in diseases classified elsewhere

Code first underlying disease, such as: viral disease NEC (B00-B34)


Excludes1: otitis media in:

influenza (J09.X9, J10.83, J11.83)

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Codes (A

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measles (B05.3)

scarlet fever (A38.0)

tuberculosis (A18.6)

H67.1 Otitis media in diseases classified elsewhere, right ear

H67.2 Otitis media in diseases classified elsewhere, left ear

H67.3 Otitis media in diseases classified elsewhere, bilateral

H67.9 Otitis media in diseases classified elsewhere, unspecified ear

H68 Eustachian salpingitis and obstruction

H68.0 Eustachian salpingitis

H68.00 Unspecified Eustachian salpingitis

H68.001 Unspecified Eustachian salpingitis, right ear

H68.002 Unspecified Eustachian salpingitis, left ear

H68.003 Unspecified Eustachian salpingitis, bilateral

H68.009 Unspecified Eustachian salpingitis, unspecified ear

H68.01 Acute Eustachian salpingitis

H68.011 Acute Eustachian salpingitis, right ear

H68.012 Acute Eustachian salpingitis, left ear

H68.013 Acute Eustachian salpingitis, bilateral

H68.019 Acute Eustachian salpingitis, unspecified ear

H68.02 Chronic Eustachian salpingitis

H68.021 Chronic Eustachian salpingitis, right ear

H68.022 Chronic Eustachian salpingitis, left ear

H68.023 Chronic Eustachian salpingitis, bilateral

H68.029 Chronic Eustachian salpingitis, unspecified ear

H68.1 Obstruction of Eustachian tube

Stenosis of Eustachian tube

Stricture of Eustachian tube

H68.10 Unspecified obstruction of Eustachian tube

H68.101 Unspecified obstruction of Eustachian tube, right ear

H68.102 Unspecified obstruction of Eustachian tube, left ear

H68.103 Unspecified obstruction of Eustachian tube, bilateral

H68.109 Unspecified obstruction of Eustachian tube, unspecified ear

H68.11 Osseous obstruction of Eustachian tube

H68.111 Osseous obstruction of Eustachian tube, right ear

H68.112 Osseous obstruction of Eustachian tube, left ear

H68.113 Osseous obstruction of Eustachian tube, bilateral

H68.119 Osseous obstruction of Eustachian tube, unspecified ear

H68.12 Intrinsic cartilagenous obstruction of Eustachian tube

H68.121 Intrinsic cartilagenous obstruction of Eustachian tube, right ear

H68.122 Intrinsic cartilagenous obstruction of Eustachian tube, left ear

H68.123 Intrinsic cartilagenous obstruction of Eustachian tube, bilateral

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H68.129 Intrinsic cartilagenous obstruction of Eustachian tube, unspecified ear

H68.13 Extrinsic cartilagenous obstruction of Eustachian tube

Compression of Eustachian tube

H68.131 Extrinsic cartilagenous obstruction of Eustachian tube, right ear

H68.132 Extrinsic cartilagenous obstruction of Eustachian tube, left ear

H68.133 Extrinsic cartilagenous obstruction of Eustachian tube, bilateral

H68.139 Extrinsic cartilagenous obstruction of Eustachian tube, unspecified ear

H69 Other and unspecified disorders of Eustachian tube

H69.0 Patulous Eustachian tube

H69.00 Patulous Eustachian tube, unspecified ear

H69.01 Patulous Eustachian tube, right ear

H69.02 Patulous Eustachian tube, left ear

H69.03 Patulous Eustachian tube, bilateral

H69.8 Other specified disorders of Eustachian tube

H69.80 Other specified disorders of Eustachian tube, unspecified ear

H69.81 Other specified disorders of Eustachian tube, right ear

H69.82 Other specified disorders of Eustachian tube, left ear

H69.83 Other specified disorders of Eustachian tube, bilateral

H69.9 Unspecified Eustachian tube disorder

H69.90 Unspecified Eustachian tube disorder, unspecified ear

H69.91 Unspecified Eustachian tube disorder, right ear

H69.92 Unspecified Eustachian tube disorder, left ear

H69.93 Unspecified Eustachian tube disorder, bilateral

H70 Mastoiditis and related conditions

H70.0 Acute mastoiditis

Abscess of mastoid

Empyema of mastoid

H70.00 Acute mastoiditis without complications

H70.001 Acute mastoiditis without complications, right ear

H70.002 Acute mastoiditis without complications, left ear

H70.003 Acute mastoiditis without complications, bilateral

H70.009 Acute mastoiditis without complications, unspecified ear

H70.01 Subperiosteal abscess of mastoid

H70.011 Subperiosteal abscess of mastoid, right ear

H70.012 Subperiosteal abscess of mastoid, left ear

H70.013 Subperiosteal abscess of mastoid, bilateral

H70.019 Subperiosteal abscess of mastoid, unspecified ear

H70.09 Acute mastoiditis with other complications

H70.091 Acute mastoiditis with other complications, right ear

H70.092 Acute mastoiditis with other complications, left ear

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H70.093 Acute mastoiditis with other complications, bilateral

H70.099 Acute mastoiditis with other complications, unspecified ear

H70.1 Chronic mastoiditis

Caries of mastoid

Fistula of mastoid

Excludes1: tuberculous mastoiditis (A18.03)

H70.10 Chronic mastoiditis, unspecified ear

H70.11 Chronic mastoiditis, right ear

H70.12 Chronic mastoiditis, left ear

H70.13 Chronic mastoiditis, bilateral

H70.2 Petrositis

Inflammation of petrous bone

H70.20 Unspecified petrositis

H70.201 Unspecified petrositis, right ear

H70.202 Unspecified petrositis, left ear

H70.203 Unspecified petrositis, bilateral

H70.209 Unspecified petrositis, unspecified ear

H70.21 Acute petrositis

H70.211 Acute petrositis, right ear

H70.212 Acute petrositis, left ear

H70.213 Acute petrositis, bilateral

H70.219 Acute petrositis, unspecified ear

H70.22 Chronic petrositis

H70.221 Chronic petrositis, right ear

H70.222 Chronic petrositis, left ear

H70.223 Chronic petrositis, bilateral

H70.229 Chronic petrositis, unspecified ear

H70.8 Other mastoiditis and related conditions

Excludes1: preauricular sinus and cyst (Q18.1)

sinus, fistula, and cyst of branchial cleft (Q18.0)

H70.81 Postauricular fistula

H70.811 Postauricular fistula, right ear

H70.812 Postauricular fistula, left ear

H70.813 Postauricular fistula, bilateral

H70.819 Postauricular fistula, unspecified ear

H70.89 Other mastoiditis and related conditions

H70.891 Other mastoiditis and related conditions, right ear

H70.892 Other mastoiditis and related conditions, left ear

H70.893 Other mastoiditis and related conditions, bilateral

H70.899 Other mastoiditis and related conditions, unspecified ear

H70.9 Unspecified mastoiditis

H70.90 Unspecified mastoiditis, unspecified ear

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H70.91 Unspecified mastoiditis, right ear

H70.92 Unspecified mastoiditis, left ear

H70.93 Unspecified mastoiditis, bilateral

H71.2 Cholesteatoma of mastoid

H71.20 Cholesteatoma of mastoid, unspecified ear

H71.21 Cholesteatoma of mastoid, right ear

H71.22 Cholesteatoma of mastoid, left ear

H71.23 Cholesteatoma of mastoid, bilateral

H71.3 Diffuse cholesteatosis

H71.30 Diffuse cholesteatosis, unspecified ear

H71.31 Diffuse cholesteatosis, right ear

H71.32 Diffuse cholesteatosis, left ear

H71.33 Diffuse cholesteatosis, bilateral

H71.9 Unspecified cholesteatoma

H71.90 Unspecified cholesteatoma, unspecified ear

H71.91 Unspecified cholesteatoma, right ear

H71.92 Unspecified cholesteatoma, left ear

H71.93 Unspecified cholesteatoma, bilateral

H72 Perforation of tympanic membrane

Includes: persistent post-traumatic perforation of ear drum

postinflammatory perforation of ear drum

Code first any associated otitis media (H65.-, H66.1-, H66.2-, H66.3-, H66.4-, H66.9-, H67.-)

Excludes1: acute suppurative otitis media with rupture of the tympanic membrane (H66.01-)

traumatic rupture of ear drum (S09.2-)

H72.0 Central perforation of tympanic membrane

H72.00 Central perforation of tympanic membrane, unspecified ear

H72.01 Central perforation of tympanic membrane, right ear

H72.02 Central perforation of tympanic membrane, left ear

H72.03 Central perforation of tympanic membrane, bilateral

H72.1 Attic perforation of tympanic membrane

Perforation of pars flaccida

H72.10 Attic perforation of tympanic membrane, unspecified ear

H72.11 Attic perforation of tympanic membrane, right ear

H72.12 Attic perforation of tympanic membrane, left ear

H72.13 Attic perforation of tympanic membrane, bilateral

H72.2 Other marginal perforations of tympanic membrane

H72.2X Other marginal perforations of tympanic membrane

H72.2X1 Other marginal perforations of tympanic membrane, right ear

H72.2X2 Other marginal perforations of tympanic membrane, left ear

H72.2X3 Other marginal perforations of tympanic membrane, bilateral

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H72.2X9 Other marginal perforations of tympanic membrane, unspecified ear

H72.8 Other perforations of tympanic membrane

H72.81 Multiple perforations of tympanic membrane

H72.811 Multiple perforations of tympanic membrane, right ear

H72.812 Multiple perforations of tympanic membrane, left ear

H72.813 Multiple perforations of tympanic membrane, bilateral

H72.819 Multiple perforations of tympanic membrane, unspecified ear

H72.82 Total perforations of tympanic membrane

H72.821 Total perforations of tympanic membrane, right ear

H72.822 Total perforations of tympanic membrane, left ear

H72.823 Total perforations of tympanic membrane, bilateral

H72.829 Total perforations of tympanic membrane, unspecified ear

H72.9 Unspecified perforation of tympanic membrane

H72.90 Unspecified perforation of tympanic membrane, unspecified ear

H72.91 Unspecified perforation of tympanic membrane, right ear

H72.92 Unspecified perforation of tympanic membrane, left ear

H72.93 Unspecified perforation of tympanic membrane, bilateral

H73 Other disorders of tympanic membrane

H73.0 Acute myringitis

Excludes1: acute myringitis with otitis media (H65, H66)

H73.00 Unspecified acute myringitis

Acute tympanitis NOS

H73.001 Acute myringitis, right ear

H73.002 Acute myringitis, left ear

H73.003 Acute myringitis, bilateral

H73.009 Acute myringitis, unspecified ear

H73.01 Bullous myringitis

H73.011 Bullous myringitis, right ear

H73.012 Bullous myringitis, left ear

H73.013 Bullous myringitis, bilateral

H73.019 Bullous myringitis, unspecified ear

H73.09 Other acute myringitis

H73.091 Other acute myringitis, right ear

H73.092 Other acute myringitis, left ear

H73.093 Other acute myringitis, bilateral

H73.099 Other acute myringitis, unspecified ear

H73.1 Chronic myringitis

Chronic tympanitis

Excludes1: chronic myringitis with otitis media (H65, H66)

H73.10 Chronic myringitis, unspecified ear

H73.11 Chronic myringitis, right ear

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H73.12 Chronic myringitis, left ear

H73.13 Chronic myringitis, bilateral

H73.2 Unspecified myringitis

H73.20 Unspecified myringitis, unspecified ear

H73.21 Unspecified myringitis, right ear

H73.22 Unspecified myringitis, left ear

H73.23 Unspecified myringitis, bilateral

H73.8 Other specified disorders of tympanic membrane

H73.81 Atrophic flaccid tympanic membrane

H73.811 Atrophic flaccid tympanic membrane, right ear

H73.812 Atrophic flaccid tympanic membrane, left ear

H73.813 Atrophic flaccid tympanic membrane, bilateral

H73.819 Atrophic flaccid tympanic membrane, unspecified ear

H73.82 Atrophic nonflaccid tympanic membrane

H73.821 Atrophic nonflaccid tympanic membrane, right ear

H73.822 Atrophic nonflaccid tympanic membrane, left ear

H73.823 Atrophic nonflaccid tympanic membrane, bilateral

H73.829 Atrophic nonflaccid tympanic membrane, unspecified ear

H73.89 Other specified disorders of tympanic membrane

H73.891 Other specified disorders of tympanic membrane, right ear

H73.892 Other specified disorders of tympanic membrane, left ear

H73.893 Other specified disorders of tympanic membrane, bilateral

H73.899 Other specified disorders of tympanic membrane, unspecified ear

H73.9 Unspecified disorder of tympanic membrane

H73.90 Unspecified disorder of tympanic membrane, unspecified ear

H73.91 Unspecified disorder of tympanic membrane, right ear

H73.92 Unspecified disorder of tympanic membrane, left ear

H73.93 Unspecified disorder of tympanic membrane, bilateral

H74 Other disorders of middle ear mastoid

Excludes2: mastoiditis (H70.-)

H74.0 Tympanosclerosis

H74.01 Tympanosclerosis, right ear

H74.02 Tympanosclerosis, left ear

H74.03 Tympanosclerosis, bilateral

H74.09 Tympanosclerosis, unspecified ear

H74.1 Adhesive middle ear disease

Adhesive otitis

Excludes1: glue ear (H65.3-)

H74.11 Adhesive right middle ear disease

H74.12 Adhesive left middle ear disease

H74.13 Adhesive middle ear disease, bilateral

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Codes (A

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H74.19 Adhesive middle ear disease, unspecified ear

H74.2 Discontinuity and dislocation of ear ossicles

H74.20 Discontinuity and dislocation of ear ossicles, unspecified ear

H74.21 Discontinuity and dislocation of right ear ossicles

H74.22 Discontinuity and dislocation of left ear ossicles

H74.23 Discontinuity and dislocation of ear ossicles, bilateral

H74.3 Other acquired abnormalities of ear ossicles

H74.31 Ankylosis of ear ossicles

H74.311 Ankylosis of ear ossicles, right ear

H74.312 Ankylosis of ear ossicles, left ear

H74.313 Ankylosis of ear ossicles, bilateral

H74.319 Ankylosis of ear ossicles, unspecified ear

H74.32 Partial loss of ear ossicles

H74.321 Partial loss of ear ossicles, right ear

H74.322 Partial loss of ear ossicles, left ear

H74.323 Partial loss of ear ossicles, bilateral

H74.329 Partial loss of ear ossicles, unspecified ear

H74.39 Other acquired abnormalities of ear ossicles

H74.391 Other acquired abnormalities of right ear ossicles

H74.392 Other acquired abnormalities of left ear ossicles

H74.393 Other acquired abnormalities of ear ossicles, bilateral

H74.399 Other acquired abnormalities of ear ossicles, unspecified ear

H74.4 Polyp of middle ear

H74.40 Polyp of middle ear, unspecified ear

H74.41 Polyp of right middle ear

H74.42 Polyp of left middle ear

H74.43 Polyp of middle ear, bilateral

H74.8 Other specified disorders of middle ear and mastoid

H74.8X Other specified disorders of middle ear and mastoid

H74.8X1 Other specified disorders of right middle ear and mastoid

H74.8X2 Other specified disorders of left middle ear and mastoid

H74.8X3 Other specified disorders of middle ear and mastoid, bilateral

H74.8X9 Other specified disorders of middle ear and mastoid, unspecified ear

H74.9 Unspecified disorder of middle ear and mastoid

H74.90 Unspecified disorder of middle ear and mastoid, unspecified ear

H74.91 Unspecified disorder of right middle ear and mastoid

H74.92 Unspecified disorder of left middle ear and mastoid

H74.93 Unspecified disorder of middle ear and mastoid, bilateral

H75 Other disorders of middle ear and mastoid in diseases classified elsewhere

Diseases of inner ear (H80-H83)

H80 Otosclerosis

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Includes: Otospongiosis

H80.0 Otosclerosis involving oval window, nonobliterative

H80.00 Otosclerosis involving oval window, nonobliterative, unspecified ear

H80.01 Otosclerosis involving oval window, nonobliterative, right ear

H80.02 Otosclerosis involving oval window, nonobliterative, left ear

H80.03 Otosclerosis involving oval window, nonobliterative, bilateral

H80.1 Otosclerosis involving oval window, obliterative

H80.10 Otosclerosis involving oval window, obliterative, unspecified ear

H80.11 Otosclerosis involving oval window, obliterative, right ear

H80.12 Otosclerosis involving oval window, obliterative, left ear

H80.13 Otosclerosis involving oval window, obliterative, bilateral

H80.2 Cochlear otosclerosis

Otosclerosis involving otic capsule

Otosclerosis involving round window

H80.20 Cochlear otosclerosis, unspecified ear

H80.21 Cochlear otosclerosis, right ear

H80.22 Cochlear otosclerosis, left ear

H80.23 Cochlear otosclerosis, bilateral

H80.8 Other otosclerosis

H80.80 Other otosclerosis, unspecified ear

H80.81 Other otosclerosis, right ear

H80.82 Other otosclerosis, left ear

H80.83 Other otosclerosis, bilateral

H80.9 Unspecified otosclerosis

H80.90 Unspecified otosclerosis, unspecified ear

H80.91 Unspecified otosclerosis, right ear

H80.92 Unspecified otosclerosis, left ear

H80.93 Unspecified otosclerosis, bilateral

H81 Disorders of vestibular function

Excludes1: epidemic vertigo (A88.1)

vertigo NOS (R42)

H81.0 Ménière’s disease

Labyrinthine hydrops

Ménière’s syndrome or vertigo

H81.01 Ménière’s disease, right ear

H81.02 Ménière’s disease, left ear

H81.03 Ménière’s disease, bilateral

H81.09 Ménière’s disease, unspecified ear

H81.1 Benign paroxysmal vertigo

H81.10 Benign paroxysmal vertigo, unspecified ear

H81.11 Benign paroxysmal vertigo, right ear

H81.12 Benign paroxysmal vertigo, left ear

H81.13 Benign paroxysmal vertigo, bilateral

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H81.2 Vestibular neuronitis

H81.20 Vestibular neuronitis, unspecified ear

H81.21 Vestibular neuronitis, right ear

H81.22 Vestibular neuronitis, left ear

H81.23 Vestibular neuronitis, bilateral

H81.3 Other peripheral vertigo

H81.31 Aural vertigo

H81.311 Aural vertigo, right ear

H81.312 Aural vertigo, left ear

H81.313 Aural vertigo, bilateral

H81.319 Aural vertigo, unspecified ear

H81.39 Other peripheral vertigo

Lermoyez’ syndrome

Otogenic vertigo

Peripheral vertigo NOS

H81.391 Other peripheral vertigo, right ear

H81.392 Other peripheral vertigo, left ear

H81.393 Other peripheral vertigo, bilateral

H81.399 Other peripheral vertigo, unspecified ear

H81.4 Vertigo of central origin

Central positional nystagmus

H81.41 Vertigo of central origin, right ear

H81.42 Vertigo of central origin, left ear

H81.43 Vertigo of central origin, bilateral

H81.49 Vertigo of central origin, unspecified ear

H81.8 Other disorders of vestibular function

H81.8X Other disorders of vestibular function

H81.8X1 Other disorders of vestibular function, right ear

H81.8X2 Other disorders of vestibular function, left ear

H81.8X3 Other disorders of vestibular function, bilateral

H81.8X9 Other disorders of vestibular function, unspecified ear

H81.9 Unspecified disorder of vestibular function

Vertiginous syndrome NOS

H81.90 Unspecified disorder of vestibular function, unspecified ear

H81.91 Unspecified disorder of vestibular function, right ear

H81.92 Unspecified disorder of vestibular function, left ear

H81.93 Unspecified disorder of vestibular function, bilateral

H82 Vertiginous syndromes in diseases classified elsewhere

Code first underlying disease

Excludes1: epidemic vertigo (A88.1)

H82.1 Vertiginous syndromes in diseases classified elsewhere, right ear

H82.2 Vertiginous syndromes in diseases classified elsewhere, left ear

H82.3 Vertiginous syndromes in diseases classified elsewhere, bilateral

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H82.9 Vertiginous syndromes in diseases classified elsewhere, unspecified ear

H83 Other diseases of inner ear

H83.0 Labyrinthitis

H83.01 Labyrinthitis, right ear

H83.02 Labyrinthitis, left ear

H83.03 Labyrinthitis, bilateral

H83.09 Labyrinthitis, unspecified ear

H83.1 Labyrinthine fistula

H83.11 Labyrinthine fistula, right ear

H83.12 Labyrinthine fistula, left ear

H83.13 Labyrinthine fistula, bilateral

H83.19 Labyrinthine fistula, unspecified ear

H83.2 Labyrinthine dysfunction

Labyrinthine hypersensitivity

Labyrinthine hypofunction

Labyrinthine loss of function

H83.2X Labyrinthine dysfunction

H83.2X1 Labyrinthine dysfunction, right ear

H83.2X2 Labyrinthine dysfunction, left ear

H83.2X3 Labyrinthine dysfunction, bilateral

H83.2X9 Labyrinthine dysfunction, unspecified ear

H83.3 Noise effects on inner ear

Acoustic trauma of inner ear

Noise-induced hearing loss of inner ear

H83.3X Noise effects on inner ear

H83.3X1 Noise effects on right inner ear

H83.3X2 Noise effects on left inner ear

H83.3X3 Noise effects on inner ear, bilateral

H83.3X9 Noise effects on inner ear, unspecified ear

H83.8 Other specified diseases of inner ear

H83.8X Other specified diseases of inner ear

H83.8X1 Other specified diseases of right inner ear

H83.8X2 Other specified diseases of left inner ear

H83.8X3 Other specified diseases of inner ear, bilateral

H83.8X9 Other specified diseases of inner ear, unspecified ear

H83.9 Unspecified disease of inner ear

H83.90 Unspecified disease of inner ear, unspecified ear

H83.91 Unspecified disease of right inner ear

H83.92 Unspecified disease of left inner ear

H83.93 Unspecified disease of inner ear, bilateral

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Other disorders of ear (H90-H94)

H90 Conductive and sensorineural hearing loss

Excludes1: deaf nonspeaking NEC (H91.3)

deafness NOS (H91.9-)

hearing loss NOS (H91.9-)

noise-induced hearing loss (H83.3-)

ototoxic hearing loss (H91.0-)

sudden (idiopathic) hearing loss (H91.2-)

H90.0 Conductive hearing loss, bilateral

H90.1 Conductive hearing loss, unilateral with unrestricted hearing on the contralateral side

H90.11 Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side

H90.12 Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side

H90.2 Conductive hearing loss, unspecified

Conductive deafness NOS

H90.3 Sensorineural hearing loss, bilateral

H90.4 Sensorineural hearing loss, unilateral with unrestricted hearing on the contralateral side

H90.41 Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side

H90.42 Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side

H90.5 Unspecified sensorineural hearing loss

Central hearing loss NOS

Congenital deafness NOS

Neural hearing loss NOS

Perceptive hearing loss NOS

Sensorineural deafness NOS

Sensory hearing loss NOS

Excludes1: abnormal auditory perception (H93.2-)

psychogenic deafness (F44.6)

H90.6 Mixed conductive and sensorineural hearing loss, bilateral

H90.7 Mixed conductive and sensorineural hearing loss, unilateral with unrestricted hearing on the contralateral side

H90.71 Mixed conductive and sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side

H90.72 Mixed conductive and sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side

H90.8 Mixed conductive and sensorineural hearing loss, unspecified

H91 Other and unspecified hearing loss

Excludes1: abnormal auditory perception (H93.2-)

hearing loss as classified in H90.-

impacted cerumen (H61.2-)

noise-induced hearing loss (H83.3-)

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psychogenic deafness (F44.6)

transient ischemic deafness (H93.01-)

H91.0 Ototoxic hearing loss

Code first poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4 or 6)

Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

H91.01 Ototoxic hearing loss, right ear

H91.02 Ototoxic hearing loss, left ear

H91.03 Ototoxic hearing loss, bilateral

H91.09 Ototoxic hearing loss, unspecified ear

H91.1 Presbycusis

Presbyacusia

H91.10 Presbycusis, unspecified ear

H91.11 Presbycusis, right ear

H91.12 Presbycusis, left ear

H91.13 Presbycusis, bilateral

H91.2 Sudden idiopathic hearing loss

Sudden hearing loss NOS

H91.20 Sudden idiopathic hearing loss, unspecified ear

H91.21 Sudden idiopathic hearing loss, right ear

H91.22 Sudden idiopathic hearing loss, left ear

H91.23 Sudden idiopathic hearing loss, bilateral

H91.3 Deaf nonspeaking, not elsewhere classified

H91.8 Other specified hearing loss

H91.8X Other specified hearing loss

H91.8X1 Other specified hearing loss, right ear

H91.8X2 Other specified hearing loss, left ear

H91.8X3 Other specified hearing loss, bilateral

H91.8X9 Other specified hearing loss, unspecified ear

H91.9 Unspecified hearing loss

Deafness NOS

High frequency deafness

Low frequency deafness

H91.90 Unspecified hearing loss, unspecified ear

H91.91 Unspecified hearing loss, right ear

H91.92 Unspecified hearing loss, left ear

H91.93 Unspecified hearing loss, bilateral

H92 Otalgia and effusion of ear

H92.0 Otalgia

H92.01 Otalgia, right ear

H92.02 Otalgia, left ear

H92.03 Otalgia, bilateral

H92.09 Otalgia, unspecified ear

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Unspecified hearing loss codes: It is recommended that audiologists limit the use of these and other “unspecified” hearing loss codes to cases where the type of hearing loss has not yet been determined, such as in newborn diagnostics.


H92.1 Otorrhea

Excludes1: leakage of cerebrospinal fluid through ear (G96.0)

H92.10 Otorrhea, unspecified ear

H92.11 Otorrhea, right ear

H92.12 Otorrhea, left ear

H92.13 Otorrhea, bilateral

H92.2 Otorrhagia

Excludes1: traumatic otorrhagia - code to injury

H92.20 Otorrhagia, unspecified ear

H92.21 Otorrhagia, right ear

H92.22 Otorrhagia, left ear

H92.23 Otorrhagia, bilateral

H93 Other disorders of ear, not elsewhere classified

H93.0 Degenerative and vascular disorders of ear

Excludes1: presbycusis (H91.1)

H93.01 Transient ischemic deafness

H93.011 Transient ischemic deafness, right ear

H93.012 Transient ischemic deafness, left ear

H93.013 Transient ischemic deafness, bilateral

H93.019 Transient ischemic deafness, unspecified ear

H93.09 Unspecified degenerative and vascular disorders of ear

H93.091 Unspecified degenerative and vascular disorders of right ear

H93.092 Unspecified degenerative and vascular disorders of left ear

H93.093 Unspecified degenerative and vascular disorders of ear, bilateral

H93.099 Unspecified degenerative and vascular disorders of unspecified ear

H93.1 Tinnitus

H93.11 Tinnitus, right ear

H93.12 Tinnitus, left ear

H93.13 Tinnitus, bilateral

H93.19 Tinnitus, unspecified ear

H93.2 Other abnormal auditory perceptions

Excludes2: auditory hallucinations (R44.0)

H93.21 Auditory recruitment

H93.211 Auditory recruitment, right ear

H93.212 Auditory recruitment, left ear

H93.213 Auditory recruitment, bilateral

H93.219 Auditory recruitment, unspecified ear

H93.22 Diplacusis

H93.221 Diplacusis, right ear

H93.222 Diplacusis, left ear

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H93.223 Diplacusis, bilateral

H93.229 Diplacusis, unspecified ear

H93.23 Hyperacusis

H93.231 Hyperacusis, right ear

H93.232 Hyperacusis, left ear

H93.233 Hyperacusis, bilateral

H93.239 Hyperacusis, unspecified ear

H93.24 Temporary auditory threshold shift

H93.241 Temporary auditory threshold shift, right ear

H93.242 Temporary auditory threshold shift, left ear

H93.243 Temporary auditory threshold shift, bilateral

H93.249 Temporary auditory threshold shift, unspecified ear

H93.25 Central auditory processing disorder

Congenital auditory imperception

Word deafness

Excludes1: mixed receptive-expressive language disorder (F80.2)

H93.29 Other abnormal auditory perceptions

H93.291 Other abnormal auditory perceptions, right ear

H93.292 Other abnormal auditory perceptions, left ear

H93.293 Other abnormal auditory perceptions, bilateral

H93.299 Other abnormal auditory perceptions, unspecified ear

H93.3 Disorders of acoustic nerve

Disorder of 8th cranial nerve

Excludes1: acoustic neuroma (D33.3)

syphilitic acoustic neuritis (A52.15)

H93.3X Disorders of acoustic nerve

H93.3X1 Disorders of right acoustic nerve

H93.3X2 Disorders of left acoustic nerve

H93.3X3 Disorders of bilateral acoustic nerves

H93.3X9 Disorders of unspecified acoustic nerve

H93.8 Other specified disorders of ear

H93.8X Other specified disorders of ear

H93.8X1 Other specified disorders of right ear

H93.8X2 Other specified disorders of left ear

H93.8X3 Other specified disorders of ear, bilateral

H93.8X9 Other specified disorders of ear, unspecified ear

H93.9 Unspecified disorder of ear

H93.90 Unspecified disorder of ear, unspecified ear

H93.91 Unspecified disorder of right ear

H93.92 Unspecified disorder of left ear

H93.93 Unspecified disorder of ear, bilateral

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Central auditory processing disorder now has its own code, H93.25.


H94 Other disorders of ear in diseases classified elsewhere

H94.0 Acoustic neuritis in infectious and parasitic diseases classified elsewhere

Code first underlying disease, such as: parasitic disease (B65-B89)

Excludes1: acoustic neuritis (in):

herpes zoster (B02.29)

syphilis (A52.15)

H94.00 Acoustic neuritis in infectious and parasitic diseases classified elsewhere, unspecified ear

H94.01 Acoustic neuritis in infectious and parasitic diseases classified elsewhere, right ear

H94.02 Acoustic neuritis in infectious and parasitic diseases classified elsewhere, left ear

H94.03 Acoustic neuritis in infectious and parasitic diseases classified elsewhere, bilateral

H94.8 Other specified disorders of ear in diseases classified elsewhere

Code first underlying disease, such as: congenital syphilis (A50.0)

Excludes1: aural myiasis (B87.4)

syphilitic labyrinthitis (A52.79)

H94.80 Other specified disorders of ear in diseases classified elsewhere, unspecified ear

H94.81 Other specified disorders of right ear in diseases classified elsewhere

H94.82 Other specified disorders of left ear in diseases classified elsewhere

H94.83 Other specified disorders of ear in diseases classified elsewhere, bilateral

Intraoperative and postprocedural complications and disorders of ear and mastoid process, not elsewhere classified (H95)

H95 Intraoperative and postprocedural complications and disorders of ear and mastoid process, not elsewhere classified

H95.0 Recurrent cholesteatoma of postmastoidectomy cavity

H95.1 Other disorders of ear and mastoid process following mastoidectomy

H95.2 Intraoperative hemorrhage and hematoma of ear and mastoid process complicating a procedure

H95.3 Accidental puncture and laceration of ear and mastoid process during a procedure

H95.4 Postprocedural hemorrhage and hematoma of ear and mastoid process following a procedure

H95.8 Other intraoperative and postprocedural complications and disorders of the ear and mastoid process, not elsewhere classified

Ch. 17 Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)

Congenital malformations of eye, ear, face and neck (Q10-Q18)

Q16 Congenital malformations of ear causing impairment of hearing

Excludes1: congenital deafness (H90.-)

Q16.0 Congenital absence of (ear) auricle

Q16.1 Congenital absence, atresia and stricture of auditory canal (external)

Congenital atresia or stricture of osseous meatus

Q16.2 Absence of eustachian tube

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Q16.3 Congenital malformation of ear ossicles

Congenital fusion of ear ossicles

Q16.4 Other congenital malformations of middle ear

Congenital malformation of middle ear NOS

Q16.5 Congenital malformation of inner ear

Congenital anomaly of membranous labyrinth

Congenital anomaly of organ of Corti

Q16.9 Congenital malformation of ear causing impairment of hearing, unspecified

Congenital absence of ear NOS

Q17 Other congenital malformations of ear

Excludes1: congenital malformations of ear with impairment of hearing (Q16.0-Q16.9)

preauricular sinus (Q18.1)

Q17.0 Accessory auricle

Accessory tragus

Polyotia

Preauricular appendage or tag

Supernumerary ear

Supernumerary lobule

Q17.1 Macrotia

Q17.2 Microtia

Q17.3 Other misshapen ear

Pointed ear

Q17.4 Misplaced ear

Low-set ears

Excludes1: cervical auricle (Q18.2)

Q17.5 Prominent ear

Bat ear

Q17.8 Other specified congenital malformations of ear

Congenital absence of lobe of ear

Q17.9 Congenital malformation of ear, unspecified

Congenital anomaly of ear NOS

Ch. 18 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

Symptoms and signs involving cognition, perception, emotional state and behavior (R40-R46)

Excludes1: symptoms and signs constituting part of a pattern of mental disorder (F01-F99)

R42 Dizziness and giddiness

Light-headedness

Vertigo NOS

Excludes1: vertiginous syndromes (H81.-)

vertigo from infrasound (T75.23)

R44 Other symptoms and signs involving general sensations and perceptions

Excludes1: alcoholic hallucinations (F1.5)

hallucinations in drug psychosis (F11-F19 with .5)

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hallucinations in mood disorders with psychotic symptoms (F30.2, F31.5, F32.3, F33.3)

hallucinations in schizophrenia, schizotypal and delusional disorders (F20-F29)

Excludes2: disturbances of skin sensation (R20.-)

R44.0 Auditory hallucinations

Abnormal findings on diagnostic imaging and in function studies, without diagnosis (R90-R94)

R94 Abnormal results of function studies

R94.0 Abnormal results of function studies of central nervous system

R94.01 Abnormal electroencephalogram [EEG]

R94.02 Abnormal brain scan

R94.09 Abnormal results of other function studies of central nervous system

R94.1 Abnormal results of function studies of peripheral nervous system and special senses

R94.12 Abnormal results of function studies of ear and other special senses

R94.120 Abnormal auditory function study

R94.121 Abnormal vestibular function study

R94.128 Abnormal results of other function studies of ear and other special senses

Ch. 19 Injury, poisoning and certain other consequences of external causes (S00-T88)

Note: Use secondary code(s) from Chapter 20, external causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code

Use additional code to identify any retained foreign body, if applicable (Z18.-)

Excludes1: birth trauma (P10-P15)

obstetric trauma (O70-O71)

Note: The chapter uses the S-section for coding different types of injuries related to single body regions and the T-section to cover injuries to unspecified body regions as well as poisoning and certain other consequences of external causes.

Injuries to the head (S00-S09)

Includes: injuries of ear

injuries of eye

injuries of face [any part]

injuries of gum

injuries of jaw

injuries of oral cavity

injuries of palate

injuries of periocular area

injuries of scalp

injuries of temporomandibular joint area

injuries of tongue

injuries of tooth

Excludes2: burns and corrosions (T20-T32)

effects of foreign body in ear (T16)

effects of foreign body in larynx (T17.3)

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effects of foreign body in mouth NOS (T18.0)

effects of foreign body in nose (T17.0-T17.1)

effects of foreign body in pharynx (T17.2)

effects of foreign body on external eye (T15.-)

frostbite (T33-T34)

S00 Superficial injury of head

Excludes1: diffuse cerebral contusion (S06.2-)

focal cerebral contusion (S06.3-)

injury of eye and orbit (S05.-)

open wound of head (S01.-)

The appropriate 7th character is to be added to each code from category S00

A - initial encounter

D - subsequent encounter

S - sequela

S00.4 Superficial injury of ear

S00.41 Abrasion of ear

S00.43 Contusion of ear

Bruise of ear

Hematoma of ear

S00.44 External constriction of ear

S00.45 Superficial foreign body of ear

Splinter in the ear

S01 Open wound of head

Code also

any associated:

injury of cranial nerve (S04.-)

injury of muscle and tendon of head (S09.1-)

intracranial injury (S06.-)

wound infection

Excludes1: open skull fracture (S02.- with 7th character B)

Excludes2: injury of eye and orbit (S05.-)

traumatic amputation of part of head (S08.-)




S - sequela

S01.3 Open wound of ear

S08 Avulsion and traumatic amputation of part of head

An amputation not identified as partial or complete should be coded to complete




S - sequela

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S08.1 Traumatic amputation of ear

S09 Other and unspecified injuries of head




S - sequela

S09.2 Traumatic rupture of ear drum

Excludes1: traumatic rupture of ear drum due to blast injury (S09.31-)

S09.3 Other specified and unspecified injury of middle and inner ear

Excludes1: injury to ear NOS (S09.91-)

Excludes2: injury to external ear (S00.4-, S01.3-, S08.1-)

Injury, poisoning and certain other consequences of external causes (T07-T88)

T16 Foreign body in ear

The appropriate 7th character is to be added to each code from category T17



S - sequela

T16.1 Foreign body in right ear

T16.2 Foreign body in left ear

T16.9 Foreign body in ear, unspecified ear

Ch. 21 Factors Influencing Health Status and Contact with Health Services (Z00-Z99)

Note: Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury, or external cause classifiable to categories A00-Y89 are recorded as ‘diagnoses’ or ‘problems’. This can arise in two main ways:

a. When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.

b. When some circumstance or problem is present which influences the person’s health status but is not in itself a current illness or injury.

Persons encountering health services for examinations (Z00-Z13)

Note: Nonspecific abnormal findings disclosed at the time of these examinations are classified to categories R70-R94.

Excludes1: examinations related to pregnancy and reproduction (Z30-Z36, Z39.-)

Z01 Encounter for other special examination without complaint, suspected or reported diagnosis


Note: Codes from category Z01 represent the reason for the encounter. A separate procedure code is required to identify any examinations or procedures performed

Excludes1: encounter for examination for administrative purposes (Z02.-)

encounter for examination for suspected conditions, proven not to exist (Z03.-)

encounter for laboratory and radiologic examinations as a component of general medical examinations (Z00.0-)

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encounter for laboratory, radiologic and imaging examinations for sign(s) and symptom(s) - code to the sign(s) or symptom(s)

Excludes2: screening examinations (Z11-Z13)

Z01.1 Encounter for examination of ears and hearing

Z01.10 Encounter for examination of ears and hearing without abnormal findings

Encounter for examination of ears and hearing NOS

Z01.11 Encounter for examination of ears and hearing with abnormal findings

Z01.110 Encounter for hearing examination following failed hearing screening

Z01.118 Encounter for examination of ears and hearing with other abnormal findings

Use additional code to identify abnormal findings

Z01.12 Encounter for hearing conservation and treatment

Z02 Encounter for administrative examination

Z02.7 Encounter for issue of medical certificate

Excludes1: encounter for general medical examination (Z00-Z01, Z02.0-Z02.6, Z02.8-Z02.9)

Z02.71 Encounter for disability determination

Encounter for issue of medical certificate of incapacity

Encounter for issue of medical certificate of invalidity

Z02.79 Encounter for issue of other medical certificate

Z13 Encounter for screening for other diseases and disorders

Screening is the testing for disease or disease precursors in asymptomatic individuals so that early detection and treatment can be provided for those who test positive for the disease.

Excludes1: encounter for diagnostic examination-code to sign or symptom

Z13.4 Encounter for screening for certain developmental disorders in childhood

Encounter for screening for developmental handicaps in early childhood

Excludes1: routine development testing of infant or child (Z00.1-)

Z13.5 Encounter for screening for eye and ear disorders

Excludes2: encounter for general hearing examination (Z01.1-)

encounter for general vision examination (Z01.0-)

Z13.8 Encounter for screening for other specified diseases and disorders

Excludes2: screening for malignant neoplasms (Z12.-)

Z13.85 Encounter for screening for nervous system disorders

Z13.850 Encounter for screening for traumatic brain injury

Encounters for other specific health care (Z40-Z53)

Categories Z40-Z53 are intended for use to indicate a reason for care. They may be used for patients who have already been treated for a disease or injury, but who are receiving aftercare or prophylactic care, care to consolidate the treatment, or to deal with a residual state.

Excludes2: follow-up examination for medical surveillance after treatment (Z08-Z09)

Z45 Encounter for adjustment and management of implanted device

Includes: removal or replacement of implanted device

Excludes1: malfunction or other complications of device

presence of prosthetic and other devices (Z95-Z97)

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Excludes2: encounter for fitting and adjustment of non-implanted device (Z46.-)

Z45.3 Encounter for adjustment and management of implanted devices of the special senses

Z45.32 Encounter for adjustment and management of implanted hearing device

Excludes1: Encounter for fitting and adjustment of hearing aid (Z46.1)

Z45.320 Encounter for adjustment and management of bone conduction device

Z45.321 Encounter for adjustment and management of cochlear device

Z45.328 Encounter for adjustment and management of other implanted hearing device

Z46 Encounter for fitting and adjustment of other devices

Includes: removal or replacement of other device

Excludes1: malfunction or other complications of device - see Alphabetical Index

Excludes2: encounter for fitting and management of implanted devices (Z45.-)

issue of repeat prescription only (Z76.0)


Z46.1 Encounter for fitting and adjustment of hearing aid

Excludes1: encounter for adjustment and management of implanted hearing device (Z45.32-)

Z51 Encounter for other aftercare

Z51.8 Encounter for other specified aftercare

Excludes1: holiday relief care (Z75.5)


Persons with potential health hazards related to socioeconomic and psychosocial circumstances (Z55-Z65)

Z57 Occupational exposure to risk factors

Z57.0 Occupational exposure to noise

Persons encountering health services in other circumstances (Z69-Z76)

Z73 Problems related to life management difficulty

Excludes2: problems related to socioeconomic and psychosocial circumstances (Z55-Z65)

Z73.8 Other problems related to life management difficulty

Z73.82 Dual sensory impairment

Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99)

Code also any follow-up examination (Z08-Z09)

Z77 Other contact with and (suspected) exposures hazardous to health

Z77.1 Contact with and (suspected) exposure to environmental pollution and hazards in the physical environment

Z77.12 Contact with and (suspected) exposure to hazards in the physical environment

Z77.122 Contact with and (suspected) exposure to noise

Z81 Family history of mental and behavioral disorders

Z82 Family history of certain disabilities and chronic diseases (leading to disablement)

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Z82.2 Family history of deafness and hearing loss

Conditions classifiable to H90-H91

Z83 Family history of other specific disorders

Excludes2: contact with and (suspected) exposure to communicable disease in the family (Z20.-)

Z83.5 Family history of eye and ear disorders

Conditions classifiable to H00-H53, H55-H83, H92-H95

Excludes2: family history of blindness and visual loss (Z82.1)

family history of deafness and hearing loss (Z82.2)

Z83.52 Family history of ear disorders

Conditions classifiable to H60-H83, H92-H95

Excludes2: family history of deafness and hearing loss (Z82.2)

Z86 Personal history of certain other diseases

Code first any follow-up examination after treatment (Z09)

Z86.5 Personal history of mental and behavioral disorders

Conditions classifiable to F40-F59

Z86.59 Personal history of other mental and behavioral disorders

Z87 Personal history of other diseases and conditions


Z87.7 Personal history of (corrected) congenital malformations

Conditions classifiable to Q00-Q89 that have been repaired or corrected

Z87.72 Personal history of (corrected) congenital malformations of nervous system and sense organs

Z87.721 Personal history of (corrected) congenital malformations of ear

Z87.79 Personal history of other (corrected) congenital malformations

Z87.790 Personal history of (corrected) congenital malformations of face and neck

Z90 Acquired absence of organs, not elsewhere classified

Includes: postprocedural or post-traumatic loss of body part NEC

Excludes1: congenital absence

Z90.0 Acquired absence of part of head and neck

Z90.09 Acquired absence of other part of head and neck

Acquired absence of nose

Excludes2: teeth (K08.1)

Z96 Presence of other functional implants

Excludes2: complications of internal prosthetic devices, implants and grafts (T82-T85)

fitting and adjustment of prosthetic and other devices (Z44-Z46)

Z96.2 Presence of otological and audiological implants

Z96.20 Presence of otological and audiological implant, unspecified

Z96.21 Cochlear implant status

Z96.22 Myringotomy tube(s) status

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Z96.29 Presence of other otological and audiological implants

Presence of bone-conduction hearing device

Presence of eustachian tube stent

Stapes replacement

Z97 Presence of other devices



Z97.4 Presence of external hearing-aid

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ICD-10-CM Tabular List of Diseases and InjuriesRelated to speech, language, and swallowing disorders

Note: This is not a comprehensive list and a number of codes are included for information purposes only. Some categories of codes (e.g., neoplasms) may be more extensive, contain additional instructional notes, and may also require coding to a higher degree of specificity than indicated here. However, in general, speech-language pathology related diagnoses will be listed to their highest level of specificity. For a full list of ICD-10-CM codes, descriptors, and instructions, see the official ICD-10-CM publication at www.cms.gov/Medicare/Coding/ICD10/Latest_News.html.

√ Code typically used by speech-language pathologists ◊ Additional digits not listed here

Ch. 2 Neoplasms (C00-D49)

Malignant neoplasms of lip, oral cavity, and pharynx (C00-C14)

C00 Malignant neoplasm of lip

C00.0 Malignant neoplasm of external upper lip

C00.1 Malignant neoplasm of external lower lip

C00.2 Malignant neoplasm of external lip, unspecified

C00.3 Malignant neoplasm of upper lip, inner aspect

C00.4 Malignant neoplasm of lower lip, inner aspect

C00.5 Malignant neoplasm of lip, unspecified, inner aspect

C00.6 Malignant neoplasm of commissure of lip, unspecified

C00.8 Malignant neoplasm of overlapping sites of lip

C00.9 Malignant neoplasm of lip, unspecified

C01 Malignant neoplasm of base of tongue

C02 Malignant neoplasm of other and unspecified parts of tongue

C02.0 Malignant neoplasm of dorsal surface of tongue

C02.1 Malignant neoplasm of border of tongue

C02.2 Malignant neoplasm of ventral surface of tongue

C02.3 Malignant neoplasm of anterior two-thirds of tongue, part unspecified

C02.4 Malignant neoplasm of lingual tonsil

C02.8 Malignant neoplasm of overlapping sites of tongue

C02.9 Malignant neoplasm of tongue, unspecified

C03 Malignant neoplasm of gum

C04 Malignant neoplasm of floor of mouth

C05 Malignant neoplasm of palate

C05.0 Malignant neoplasm of hard palate

C05.1 Malignant neoplasm of soft palate

C05.2 Malignant neoplasm of uvula

C06 Malignant neoplasm of other and unspecified parts of mouth

C08 Malignant neoplasm of other and unspecified major salivary glands

C09 Malignant neoplasm of tonsil

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C10 Malignant neoplasm of oropharynx

C10.1 Malignant neoplasm of anterior surface of epiglottis

C10.2 Malignant neoplasm of lateral wall of oropharynx

C10.3 Malignant neoplasm of posterior wall of oropharynx

C11 Malignant neoplasm of nasopharynx

C11.0 Malignant neoplasm of superior wall of nasopharynx

C11.1 Malignant neoplasm of posterior wall of nasopharynx

C11.2 Malignant neoplasm of lateral wall of nasopharynx

C11.3 Malignant neoplasm of anterior wall of nasopharynx

C11.8 Malignant neoplasm of overlapping sites of nasopharynx

C14 Malignant neoplasm of other and ill-defined sites in the lip, oral cavity and pharynx

C14.0 Malignant neoplasm of pharynx, unspecified

C15 Malignant neoplasm of esophagus

Malignant neoplasms of digestive organs (C15-C26)

Malignant neoplasms of respiratory and intrathoracic organs (C30-C39)

C30 Malignant neoplasm of nasal cavity and middle ear

C32 Malignant neoplasm of larynx

C32.0 Malignant neoplasm of glottis

C32.1 Malignant neoplasm of supraglottis

C32.2 Malignant neoplasm of subglottis

C32.3 Malignant neoplasm of laryngeal cartilage

C32.8 Malignant neoplasm of overlapping sites of larynx

C32.9 Malignant neoplasm of larynx, unspecified

C33 Malignant neoplasm of trachea

Malignant neoplasms of eye, brain and other parts of central nervous system (C69-C72)

C71 Malignant neoplasm of brain

In situ neoplasms (D00-D09)

D00 Carcinoma in situ of oral cavity, esophagus and stomach

D00.07 Carcinoma in situ of tongue

D02 Carcinoma in situ of middle ear and respiratory system

D02.1 Carcinoma in situ of trachea

Benign neoplasms, except benign neuroendocrine tumors (D10-D36)

D10 Benign neoplasm of mouth and pharynx

D14 Benign neoplasm of middle ear and respiratory system

D14.1 Benign neoplasm of larynx

D14.2 Benign neoplasm of trachea

D33 Benign neoplasm of brain and other parts of central nervous system

D38 Neoplasm of uncertain behavior of middle ear and respiratory and intrathoracic organs

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Ch. 5 Mental, behavioral, and neurodevelopmental disorders (F01-F99)

Mental disorders due to known physiological conditions (F01-F09)

F01 Vascular dementia

F01.5 Vascular dementia

F01.50 Vascular dementia without behavioral disturbance

F01.51 Vascular dementia with behavioral disturbance

F02 Dementia in other diseases classified elsewhere

Code first the underlying physiological condition, such as:

Alzheimer’s (G30.-)

cerebral lipidosis (E75.4)

Creutzfeldt-Jakob disease (A81.0-)

dementia with Lewy bodies (G31.83)

epilepsy and recurrent seizures (G40.-)

frontotemporal dementia (G31.09)

hepatolenticular degeneration (E83.0)

human immunodeficiency virus [HIV] disease (B20)

hypercalcemia (E83.52)

hypothyroidism, acquired (E00-E03.-)

intoxications (T36-T65)

Jakob-Creutzfeldt disease (A81.0-)

multiple sclerosis (G35)

neurosyphilis (A52.17)

niacin deficiency [pellagra] (E52)

Parkinson’s disease (G20)

Pick’s disease (G31.01)

polyarteritis nodosa (M30.0)

systemic lupus erythematosus (M32.-)

trypanosomiasis (B56.-, B57.-)

vitamin B deficiency (E53.8)

F02.8 Dementia in other diseases classified elsewhere

F02.80 Dementia in other diseases classified elsewhere, without behavioral disturbance

F02.81 Dementia in other diseases classified elsewhere, with behavioral disturbance

F03 Unspecified dementia

F03.9 Unspecified dementia

F03.90 Unspecified dementia without behavioral disturbance

Dementia NOS

F03.91 Unspecified dementia with behavioral disturbance

Unspecified dementia with aggressive behavior

Unspecified dementia with combative behavior

Unspecified dementia with violent behavior

Use additional code, if applicable, to identify wandering in unspecified dementia (Z91.83)

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Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (F20-F29)

F20 Schizophrenia

Intellectual Disabilities (F70-F79)

Code first any associated physical or developmental disorders

Excludes1: borderline intellectual functioning, IQ above 70 to 84 (R41.83)

F70 Mild intellectual disabilities

IQ level 50-55 to approximately 70

Mild mental subnormality

F71 Moderate intellectual disabilities

IQ level 35-40 to 50-55

Moderate mental subnormality

F72 Severe intellectual disabilities

IQ 20-25 to 35-40

Severe mental subnormality

F73 Profound intellectual disabilities

IQ level below 20-25

Profound mental subnormality

F78 Other intellectual disabilities

F79 Unspecified intellectual disabilities

Mental deficiency NOS

Mental subnormality NOS

Pervasive and specific developmental disorders (F80-F89)

F80 Specific developmental disorders of speech and language

F80.0 Phonological disorder

Dyslalia

Functional speech articulation disorder

Lalling

Lisping

Phonological developmental disorder

Speech articulation developmental disorder

Excludes1: speech articulation impairment due to aphasia NOS (R47.01)

speech articulation impairment due to apraxia (R48.2)

Excludes2: speech articulation impairment due to hearing loss (F80.4)

speech articulation impairment due to intellectual disabilities (F70-F79)

speech articulation impairment with expressive language developmental disorder (F80.1)

speech articulation impairment with mixed receptive expressive language developmental disorder (F80.2)

F80.1 Expressive language disorder

Developmental dysphasia or aphasia, expressive type

Excludes1: mixed receptive-expressive language disorder (F80.2)

dysphasia and aphasia NOS (R47.-)

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Excludes2: acquired aphasia with epilepsy [Landau-Kleffner] (G40.80-)

selective mutism (F94.0)

intellectual disabilities (F70-F79)

pervasive developmental disorders (F84.-)

F80.2 Mixed receptive-expressive language disorder

Developmental dysphasia or aphasia, receptive type

Developmental Wernicke’s aphasia

Excludes1: central auditory processing disorder (H93.25)

dysphasia or aphasia NOS (R47.-)

expressive language disorder (F80.1)

expressive type dysphasia or aphasia (F80.1)

word deafness (H93.25)

Excludes2: acquired aphasia with epilepsy [Landau-Kleffner] (G40.80-)


selective mutism (F94.0)

intellectual disabilities (F70-F79)

F80.4 Speech and language development delay due to hearing loss

Code also type of hearing loss (H90.-, H91.-)

F80.8 Other developmental disorders of speech and language

F80.81 Childhood onset fluency disorder

Cluttering NOS

Stuttering NOS

Excludes1: adult onset fluency disorder (F98.5)

fluency disorder in conditions classified elsewhere (R47.82)

fluency disorder (stuttering) following cerebrovascular disease (I69. with final characters-23)


F80.9 Developmental disorder of speech and language, unspecified

Communication disorder NOS

Language disorder NOS

F81 Specific developmental disorders of scholastic skills

F81.0 Specific reading disorder

‘Backward reading’

Developmental dyslexia

Specific reading retardation

Excludes1: alexia NOS (R48.0)

dyslexia NOS (R48.0)

F81.2 Mathematics disorder

Developmental acalculia

Developmental arithmetical disorder

Developmental Gerstmann’s syndrome

Excludes1: acalculia NOS (R48.8)

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Excludes2: arithmetical difficulties associated with a reading disorder (F81.0)

arithmetical difficulties associated with a spelling disorder (F81.81)

arithmetical difficulties due to inadequate teaching (Z55.8)

F81.8 Other developmental disorders of scholastic skills

F81.81 Disorder of written expression

Specific spelling disorder


F81.9 Developmental disorder of scholastic skills, unspecified

Knowledge acquisition disability NOS

Learning disability NOS

Learning disorder NOS

F82 Specific developmental disorder of motor function

Clumsy child syndrome

Developmental coordination disorder

Developmental dyspraxia

Excludes1: abnormalities of gait and mobility (R26.-)

lack of coordination (R27.-)

Excludes2: lack of coordination secondary to intellectual disabilities (F70-F79)

F84 Pervasive developmental disorders

Use additional code to identify any associated medical condition and intellectual disabilities.

F84.0 Autistic disorder

Infantile autism

Infantile psychosis

Kanner’s syndrome

Excludes1: Asperger’s syndrome (F84.5)

F84.2 Rett’s syndrome


Autistic disorder (F84.0)

Other childhood disintegrative disorder (F84.3)

F84.3 Other childhood disintegrative disorder

Dementia infantilis

Disintegrative psychosis

Heller’s syndrome

Symbiotic psychosis

Use additional code to identify any associated neurological condition.


Autistic disorder (F84.0)

Rett’s syndrome (F84.2)

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F84.5 Asperger’s syndrome

Asperger’s disorder

Autistic psychopathy

Schizoid disorder of childhood

F84.8 Other pervasive developmental disorders

Overactive disorder associated with intellectual disabilities and stereotyped movements

F84.9 Pervasive developmental disorder, unspecified

Atypical autism

F88 Other disorders of psychological development

Developmental agnosia

F89 Unspecified disorder of psychological development

Behavioral and emotional disorders with onset usually occurring in childhood and adolescence (F90-F98)

F90 Attention-deficit hyperactivity disorders

Includes: attention deficit disorder with hyperactivity

attention deficit syndrome with hyperactivity

Excludes2: anxiety disorders (F40.-, F41.-)

mood [affective] disorders (F30-F39)


schizophrenia (F20.-)

F90.0 Attention-deficit hyperactivity disorder, predominantly inattentive type

F90.1 Attention-deficit hyperactivity disorder, predominantly hyperactive type

F90.2 Attention-deficit hyperactivity disorder, combined type

F90.8 Attention-deficit hyperactivity disorder, other type

F90.9 Attention-deficit hyperactivity disorder, unspecified type

F94 Disorders of social functioning with onset specific to childhood and adolescence

F94.0 Selective mutism

Elective mutism

Excludes2: pervasive developmental disorders (F84.-)

schizophrenia (F20.-)

specific developmental disorders of speech and language (F80.-)

transient mutism as part of separation anxiety in young children (F93.0)

F98 Other behavioral and emotional disorders with onset usually occurring in childhood and adolescence

F98.5 Adult onset fluency disorder

Excludes1: childhood onset fluency disorder (F80.81)

dysphasia (R47.02)

fluency disorder in conditions classified elsewhere (R47.82)

fluency disorder (stuttering) following cerebrovascular disease (I69. with final characters -23)

tic disorders (F95.-)

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Ch. 6 Diseases of the nervous system (G00-G99)

Inflammatory diseases of the central nervous system (G00-G09)

G00 Bacterial meningitis, not elsewhere classified

G00.0 Hemophilus meningitis

G00.1 Pneumococcal meningitis

G00.2 Streptococcal meningitis

Use additional code to further identify organism (B95.0-B95.5)

G00.3 Staphylococcal meningitis

Use additional code to further identify organism (B95.6-B95.8)

G00.8 Other bacterial meningitis

G00.9 Bacterial meningitis, unspecified

G04 Encephalitis, myelitis and encephalomyelitis

Systemic atrophies primarily affecting the central nervous system (G10-G14)

G10 Huntington’s disease

G12 Spinal muscular atrophy and related syndromes

G12.2 Motor neuron disease

G12.21 Amyotrophic lateral sclerosis

Extrapyramidal and movement disorders (G20-G26)

G20 Parkinson’s disease

Hemiparkinsonism

Idiopathic parkinsonism or Parkinson’s disease

Paralysis agitans

Parkinsonism or Parkinson’s disease NOS

Primary parkinsonism or Parkinson’s disease

Excludes1: dementia with parkinsonism (G31.83)

G21 Secondary parkinsonism

Excludes1: dementia with parkinsonism (G31.83)

Huntington’s disease (G10)

Shy-Drager syndrome (G90.3)

syphilitic parkinsonism (A52.19)

G21.0 Malignant neuroleptic syndrome

G21.1 Other drug-induced secondary parkinsonism

G21.11 Neuroleptic induced parkinsonism

Use additional code for adverse effect, if applicable, to identify drug (T43.3X5, T43.4X5, T43.505,T43.595)

Excludes1: malignant neuroleptic syndrome (G21.0)

G21.19 Other drug induced secondary parkinsonism

Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixthcharacter 5)

G21.2 Secondary parkinsonism due to other external agents

Code first (T51-T65) to identify external agent

G21.3 Postencephalitic parkinsonism

G21.4 Vascular parkinsonism

G21.8 Other secondary parkinsonism

G21.9 Secondary parkinsonism, unspecified

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Other degenerative diseases of the nervous system (G30-G32)

G30 Alzheimer’s disease

Includes: Alzheimer’s dementia senile and presenile forms


delirium, if applicable (F05)

dementia with behavioral disturbance (F02.81)

dementia without behavioral disturbance (F02.80)

Excludes1: senile degeneration of brain NEC (G31.1)

senile dementia NOS (F03)

senility NOS (R41.81)

G30.0 Alzheimer’s disease with early onset

G30.1 Alzheimer’s disease with late onset

G30.8 Other Alzheimer’s disease

G30.9 Alzheimer’s disease, unspecified

G31 Other degenerative diseases of nervous system, not elsewhere classified

Use additional code to identify: dementia with behavioral disturbance (F02.81)

dementia without behavioral disturbance (F02.80)

Excludes2: Reye’s syndrome (G93.7)

G31.0 Frontotemporal dementia

G31.01 Pick’s disease

Circumscribed brain atrophy

Progressive isolated aphasia

G31.09 Other frontotemporal dementia

Frontal dementia

G31.1 Senile degeneration of brain, not elsewhere classified

Excludes1: Alzheimer’s disease (G30.-)

senility NOS (R41.81)

G31.8 Other specified degenerative diseases of nervous system

G31.84 Mild cognitive impairment, so stated

Excludes1: age related cognitive decline (R41.81)

altered mental status (R41.82)

cerebral degeneration (G31.9)

change in mental status (R41.82)

cognitive deficits following (sequelae of) cerebral hemorrhage or infarction (I69.01,I69.11, I69.21, I69.31, I69.81, I69.91)

cognitive impairment due to intracranial or head injury (S06.-)

dementia (F01.-, F02.-, F03)

mild memory disturbance (F06.8)

neurologic neglect syndrome (R41.4)

personality change, nonpsychotic (F68.8)

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Demyelinating diseases of the central nervous system (G35-G37)

G35 Multiple sclerosis

Disseminated multiple sclerosis

Generalized multiple sclerosis

Multiple sclerosis NOS

Multiple sclerosis of brain stem

Multiple sclerosis of cord

Episodic and paroxysmal disorders (G40-G47)

G40 Epilepsy and recurrent seizures

G40.8 Other epilepsy and recurrent seizures

Epilepsies and epileptic syndromes undetermined as to whether they are focal or generalized

Landau-Kleffner syndrome

G40.80 Other epilepsy

G40.801 Other epilepsy, not intractable, with status epilepticus

G40.802 Other epilepsy, not intractable, without status epilepticus

Other epilepsy NOS

Other epilepsy without intractability without status epilepticus

G40.803 Other epilepsy, intractable, with status epilepticus

G40.804 Other epilepsy, intractable, without status epilepticus

G45 Transient cerebral ischemic attacks and related syndromes

G46 Vascular syndromes of brain in cerebrovascular diseases

Nerve, nerve root and plexus disorders (G50-G59)

G51 Facial nerve disorders

Includes: disorders of 7th cranial nerve

G51.0 Bell’s palsy

Facial palsy

G51.1 Geniculate ganglionitis

Excludes1: postherpetic geniculate ganglionitis (B02.21)

G51.2 Melkersson’s syndrome

Melkersson-Rosenthal syndrome

G51.3 Clonic hemifacial spasm

G51.4 Facial myokymia

G51.8 Other disorders of facial nerve

G51.9 Disorder of facial nerve, unspecified

G71 Primary disorders of muscles

Excludes2: arthrogryposis multiplex congenita (Q74.3)

metabolic disorders (E70-E88)

myositis (M60.-)

G71.0 Muscular dystrophy

Autosomal recessive, childhood type, muscular dystrophy resembling Duchenne or Becker muscular dystrophy

Benign [Becker] muscular dystrophy

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Benign scapuloperoneal muscular dystrophy with early contractures [Emery-Dreifuss]

Congenital muscular dystrophy NOS

Congenital muscular dystrophy with specific morphological abnormalities of the muscle fiber

Distal muscular dystrophy

Facioscapulohumeral muscular dystrophy

Limb-girdle muscular dystrophy

Ocular muscular dystrophy

Oculopharyngeal muscular dystrophy

Scapuloperoneal muscular dystrophy

Severe [Duchenne] muscular dystrophy

G71.1 Myotonic disorders

G71.11 Myotonic muscular dystrophy

Dystrophia myotonica [Steinert]

Myotonia atrophica

Myotonic muscular dystrophy

Dystrophia myotonica [Steinert]

Myotonia atrophica

G71.12 Myotonia congenital

Acetazolamide responsive myotonia congenita

Dominant myotonia congenita [Thomsen disease]

Myotonia levior

Recessive myotonia congenita [Becker disease]

G71.13 Myotonic chondrodystrophy

Chondrodystrophic myotonia

Congenital myotonic chondrodystrophy

Schwartz-Jampel disease

G71.14 Drug induced myotonia

Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixthcharacter 5)

G71.19 Other specified myotonic disorders

Myotonia fluctuans

Myotonia permanens

Neuromyotonia [Isaacs]

Paramyotonia congenita (of von Eulenburg)

Pseudomyotonia

Symptomatic myotonia

Cerebral palsy and other paralytic syndromes (G80-G83)

G80 Cerebral palsy

Excludes1: hereditary spastic paraplegia (G11.4)

G80.0 Spastic quadriplegic cerebral palsy

Congenital spastic paralysis (cerebral)

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G80.1 Spastic diplegic cerebral palsy

Spastic cerebral palsy NOS

G80.2 Spastic hemiplegic cerebral palsy

G80.3 Athetoid cerebral palsy

Double athetosis (syndrome)

Dyskinetic cerebral palsy

Dystonic cerebral palsy

Vogt disease

G80.4 Ataxic cerebral palsy

G80.8 Other cerebral palsy

Mixed cerebral palsy syndromes

G80.9 Cerebral palsy, unspecified

Cerebral palsy NOS

G81 Hemiplegia and hemiparesis

Note: This category is to be used only when hemiplegia (complete)(incomplete) is reported without further specification, or is stated to be old or longstanding but of unspecified cause. The category is also for use in multiple coding to identify these types of hemiplegia resulting from any cause.

Excludes1: congenital cerebral palsy (G80.-)

hemiplegia and hemiparesis due to sequela of cerebrovascular disease (I69.05-, I69.15-, I69.25-, I69.35-, I69.45-, I69.85-, I69.95-)

Other disorders of the nervous system (G89-G99)

G91 Hydrocephalus

G93 Other disorders of brain

G96 Other disorders of central nervous system

G96.0 Cerebrospinal fluid leak

Excludes1: cerebrospinal fluid leak from spinal puncture (G97.0)

Ch. 9 Diseases of the circulatory system (I00-I99)

Pulmonary heart disease and diseases of pulmonary circulation (I26-I28)

Other forms of heart disease (I30-I52)

I46 Cardiac arrest

Cerebrovascular diseases (I60-I69)

I63 Cerebral infarction

I69 Sequelae of cerebrovascular disease

Note: Category I69 is to be used to indicate conditions in I60-I67 as the cause of sequelae. The ‘sequelae’ include conditions specified as such or as residuals which may occur at any time after the onset of the causal condition.

I69.0 Sequelae of nontraumatic subarachnoid hemorrhage

I69.00 Unspecified sequelae of nontraumatic subarachnoid hemorrhage

I69.01 Cognitive deficits following nontraumatic subarachnoid hemorrhage

I69.02 Speech and language deficits following nontraumatic subarachnoid hemorrhage

I69.020 Aphasia following nontraumatic subarachnoid hemorrhage

I69.021 Dysphasia following nontraumatic subarachnoid hemorrhage

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The original ICD-9 series for cerebrovascular disease (438) is expanded under ICD-10. Check the entire I69.- category before assigning a code.

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I69.022 Dysarthria following nontraumatic subarachnoid hemorrhage

I69.023 Fluency disorder following nontraumatic subarachnoid hemorrhage

Stuttering following nontraumatic subarachnoid hemorrhage

I69.028 Other speech and language deficits following nontraumatic subarachnoid hemorrhage

I69.09 Other sequelae of nontraumatic subarachnoid hemorrhage

I69.090 Apraxia following nontraumatic subarachnoid hemorrhage

I69.091 Dysphagia following nontraumatic subarachnoid hemorrhage

Use additional code to identify the type of dysphagia, if known (R13.1-)

I69.092 Facial weakness following nontraumatic subarachnoid hemorrhage

Facial droop following nontraumatic subarachnoid hemorrhage

I69.093 Ataxia following nontraumatic subarachnoid hemorrhage

I69.098 Other sequelae following nontraumatic subarachnoid hemorrhage

Alterations of sensation following nontraumatic subarachnoid hemorrhage

Disturbance of vision following nontraumatic subarachnoid hemorrhage

Use additional code to identify the sequelae

I69.1 Sequelae of nontraumatic intracerebral hemorrhage

I69.10 Unspecified sequelae of nontraumatic intracerebral hemorrhage

I69.11 Cognitive deficits following nontraumatic intracerebral hemorrhage

I69.12 Speech and language deficits following nontraumatic intracerebral hemorrhage

I69.120 Aphasia following nontraumatic intracerebral hemorrhage

I69.121 Dysphasia following nontraumatic intracerebral hemorrhage

I69.122 Dysarthria following nontraumatic intracerebral hemorrhage

I69.123 Fluency disorder following nontraumatic intracerebral hemorrhage


I69.128 Other speech and language deficits following nontraumatic intracerebral hemorrhage

I69.19 Other sequelae of nontraumatic intracerebral hemorrhage

I69.190 Apraxia following nontraumatic intracerebral hemorrhage

I69.191 Dysphagia following nontraumatic intracerebral hemorrhage


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I69.192 Facial weakness following nontraumatic intracerebral hemorrhage

Facial droop following nontraumatic intracerebral hemorrh age

I69.193 Ataxia following nontraumatic intracerebral hemorrhage

I69.198 Other sequelae of nontraumatic intracerebral hemorrhage

Alteration of sensations following nontraumatic intracerebral hemorrhage

Disturbance of vision following nontraumatic intracerebral hemorrhage


I69.2 Sequelae of other nontraumatic intracranial hemorrhage

I69.20 Unspecified sequelae of other nontraumatic intracranial hemorrhage

I69.21 Cognitive deficits following other nontraumatic intracranial hemorrhage

I69.22 Speech and language deficits following other nontraumatic intracranial hemorrhage

I69.220 Aphasia following other nontraumatic intracranial hemorrhage

I69.221 Dysphasia following other nontraumatic intracranial hemorrhage

I69.222 Dysarthria following other nontraumatic intracranial hemorrhage

I69.223 Fluency disorder following other nontraumatic intracranial hemorrhage


I69.228 Other speech and language deficits following other nontraumatic intracranialhemorrhage

I69.29 Other sequelae of other nontraumatic intracranial hemorrhage

I69.290 Apraxia following other nontraumatic intracranial hemorrhage

I69.291 Dysphagia following other nontraumatic intracranial hemorrhage


I69.292 Facial weakness following other nontraumatic intracranial hemorrhage

Facial droop following other nontraumatic intracranial hemorrhage

I69.293 Ataxia following other nontraumatic intracranial hemorrhage

I69.298 Other sequelae other nontraumatic intracranial hemorrhage

Alteration of sensation following other nontraumatic intracranial hemorrhage

Disturbance of vision following other nontraumatic intracranial hemorrhage


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I69.3 Sequelae of cerebral infarction

Sequelae of stroke NOS

I69.30 Unspecified sequelae of cerebral infarction

I69.31 Cognitive deficits following cerebral infarction

I69.32 Speech and language deficits following cerebral infarction

I69.320 Aphasia following cerebral infarction

I69.321 Dysphasia following cerebral infarction

I69.322 Dysarthria following cerebral infarction

I69.323 Fluency disorder following cerebral infarction


I69.328 Other speech and language deficits following cerebral infarction

I69.39 Other sequelae of cerebral infarction

I69.390 Apraxia following cerebral infarction

I69.391 Dysphagia following cerebral infarction


I69.392 Facial weakness following cerebral infarction

Facial droop following cerebral infarction

I69.393 Ataxia following cerebral infarction

I69.398 Other sequelae of cerebral infarction

Alteration of sensation following cerebral infarction

Disturbance of vision following cerebral infarction


I69.8 Sequelae of other cerebrovascular diseases

Excludes1: sequelae of traumatic intracranial injury (S06.-)

I69.80 Unspecified sequelae of other cerebrovascular disease

I69.81 Cognitive deficits following other cerebrovascular disease

I69.82 Speech and language deficits following other cerebrovascular disease

I69.820 Aphasia following other cerebrovascular disease

I69.821 Dysphasia following other cerebrovascular disease

I69.822 Dysarthria following other cerebrovascular disease

I69.823 Fluency disorder following other cerebrovascular disease


I69.828 Other speech and language deficits following other cerebrovascular disease

I69.89 Other sequelae of other cerebrovascular disease

I69.890 Apraxia following other cerebrovascular disease

I69.891 Dysphagia following other cerebrovascular disease


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I69.892 Facial weakness following other cerebrovascular disease

Facial droop following other cerebrovascular disease

I69.893 Ataxia following other cerebrovascular disease

I69.898 Other sequelae of other cerebrovascular disease

Alteration of sensation following other cerebrovascular disease

Disturbance of vision following other cerebrovascular disease


I69.9 Sequelae of unspecified cerebrovascular diseases

Excludes1: sequelae of stroke (I63.3)

sequelae of traumatic intracranial injury (S06.-)

I69.90 Unspecified sequelae of unspecified cerebrovascular disease

I69.91 Cognitive deficits following unspecified cerebrovascular disease

I69.92 Speech and language deficits following unspecified cerebrovascular disease

I69.920 Aphasia following unspecified cerebrovascular disease

I69.921 Dysphasia following unspecified cerebrovascular disease

I69.922 Dysarthria following unspecified cerebrovascular disease

I69.923 Fluency disorder following unspecified cerebrovascular disease


I69.928 Other speech and language deficits following unspecified cerebrovascular disease

I69.99 Other sequelae of unspecified cerebrovascular disease

I69.990 Apraxia following unspecified cerebrovascular disease

I69.991 Dysphagia following unspecified cerebrovascular disease


I69.992 Facial weakness following unspecified cerebrovascular disease

Facial droop following unspecified cerebrovascular disease

I69.993 Ataxia following unspecified cerebrovascular disease

I69.998 Other sequelae following unspecified cerebrovascular disease

Alteration in sensation following unspecified cerebrovascular disease

Disturbance of vision following unspecified cerebrovascular disease


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Ch. 10 Diseases of the respiratory system (J00-J99)

Acute upper respiratory infections (J00-J06)

J02 Acute pharyngitis

J03 Acute tonsillitis

J04 Acute laryngitis and tracheitis

J05 Acute obstructive laryngitis [croup] and epiglottitis

Other diseases of upper respiratory tract (J30-J39)

J31 Chronic rhinitis, nasopharyngitis and pharyngitis

J35 Chronic diseases of tonsils and adenoids







tobacco use (Z72.0)

J35.1 Hypertrophy of tonsils

Enlargement of tonsils

Excludes1: hypertrophy of tonsils with tonsillitis (J35.0-)

J35.2 Hypertrophy of adenoids

Enlargement of adenoids

Excludes1: hypertrophy of adenoids with adenoiditis (J35.0-)

J35.3 Hypertrophy of tonsils with hypertrophy of adenoids

Excludes1: hypertrophy of tonsils and adenoids with tonsillitis and adenoiditis (J35.03)

J37 Chronic laryngitis and laryngotracheitis

J37.0 Chronic laryngitis

Catarrhal laryngitis

Hypertrophic laryngitis

Sicca laryngitis

Excludes2: acute laryngitis (J04.0)

obstructive (acute) laryngitis (J05.0)

J38 Diseases of vocal cords and larynx, not elsewhere classified

J38.0 Paralysis of vocal cords and larynx

Laryngoplegia

Paralysis of glottis

J38.00 Paralysis of vocal cords and larynx, unspecified

J38.01 Paralysis of vocal cords and larynx, unilateral

J38.02 Paralysis of vocal cords and larynx, bilateral

J38.1 Polyp of vocal cord and larynx

Excludes1: adenomatous polyps (D14.1)

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J38.2 Nodules of vocal cords

Chorditis (fibrinous)(nodosa)(tuberosa)

Singer’s nodes

Teacher’s nodes

J38.3 Other diseases of vocal cords

Abscess of vocal cords

Cellulitis of vocal cords

Granuloma of vocal cords

Leukokeratosis of vocal cords

Leukoplakia of vocal cords

J38.4 Edema of larynx

Edema (of) glottis

Subglottic edema

Supraglottic edema

Excludes1: acute obstructive laryngitis [croup] (J05.0)

edematous laryngitis (J04.0)

J38.5 Laryngeal spasm

Laryngismus (stridulus)

J38.6 Stenosis of larynx

J38.7 Other diseases of larynx

Abscess of larynx

Cellulitis of larynx

Disease of larynx NOS

Necrosis of larynx

Pachyderma of larynx

Perichondritis of larynx

Ulcer of larynx

J39.3 Upper respiratory tract hypersensitivity reaction, site unspecified

Excludes1: hypersensitivity reaction of upper respiratory tract, such as:

extrinsic allergic alveolitis (J67.9)

pneumoconiosis (J60-J67.9)

J39.8 Other specified diseases of upper respiratory tract

J39.9 Disease of upper respiratory tract, unspecified

Lung diseases due to external agents (J60-J70)

J69 Pneumonitis due to solids and liquids

Excludes1: neonatal aspiration syndromes (P24.-)

postprocedural pneumonitis (J95.4)

J69.0 Pneumonitis due to inhalation of food and vomit

Aspiration pneumonia NOS

Aspiration pneumonia (due to) food (regurgitated)

Aspiration pneumonia (due to) gastric secretions

Aspiration pneumonia (due to) milk

Aspiration pneumonia (due to) vomit

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J38.5 is an option for paradoxical vocal fold motion disorder.


Code also any associated foreign body in respiratory tract (T17.-)

Excludes1: chemical pneumonitis due to anesthesia (J95.4)

obstetric aspiration pneumonitis (O74.0)

Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified (J95)

J95 Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified

Excludes2: aspiration pneumonia (J69.-)

emphysema (subcutaneous) resulting from a procedure (T81.82)

hypostatic pneumonia (J18.2)

pulmonary manifestations due to radiation (J70.0- J70.1)

J95.0 Tracheostomy complications

J95.00 Unspecified tracheostomy complication

J95.01 Hemorrhage from tracheostomy stoma

J95.02 Infection of tracheostomy stoma

Use additional code to identify type of infection, such as:

cellulitis of neck (L03.8)

sepsis (A40, A41.-)

J95.03 Malfunction of tracheostomy stoma

Mechanical complication of tracheostomy stoma

Obstruction of tracheostomy airway

Tracheal stenosis due to tracheostomy

J95.04 Tracheo-esophageal fistula following tracheostomy

J95.09 Other tracheostomy complication

Ch. 11 Diseases of the digestive system (K00-K95)

Diseases of oral cavity and salivary glands (K00-K14)

K00 Disorders of tooth development and eruption

K08 Other disorders of teeth and supporting structures

Excludes2: dentofacial anomalies [including malocclusion] (M26.-)

disorders of jaw (M27.-)

K08.2 Atrophy of edentulous alveolar ridge

K13 Other diseases of lip and oral mucosa

K13.7 Other and unspecified lesions of oral mucosa

K13.70 Unspecified lesions of oral mucosa

K13.79 Other lesions of oral mucosa

Focal oral mucinosis

K14 Diseases of tongue

K14.0 Glossitis

Abscess of tongue

Ulceration (traumatic) of tongue

Excludes1: atrophic glossitis (K14.4)

K14.4 Atrophy of tongue papillae

Atrophic glossitis

Chapte

r 3: IC

D-1

0-C

M D

iagnostic

Codes (S

LP

)

◊

◊


K14.5 Plicated tongue

Fissured tongue

Furrowed tongue

Scrotal tongue

Excludes1: fissured tongue, congenital (Q38.3)

K14.8 Other diseases of tongue

Atrophy of tongue

Crenated tongue

Enlargement of tongue

Glossocele

Glossoptosis

Hypertrophy of tongue

K21 Gastro-esophageal reflux disease

Excludes1: newborn esophageal reflux (P78.83)

K21.0 Gastro-esophageal reflux disease with esophagitis

Reflux esophagitis

K21.9 Gastro-esophageal reflux disease without esophagitis

Esophageal reflux NOS

Ch. 13 Diseases of the musculoskeletal system and connective tissue (M00-M99)

Dentofacial anomalies [including malocclusion] and other disorders of jaw (M26-M27)

M26 Dentofacial anomalies [including malocclusion]

M26.0 Major anomalies of jaw size

Excludes1: acromegaly (E22.0)

Robin’s syndrome (Q87.0)

M26.00 Unspecified anomaly of jaw size

M26.01 Maxillary hyperplasia

M26.02 Maxillary hypoplasia

M26.03 Mandibular hyperplasia

M26.04 Mandibular hypoplasia

M26.05 Macrogenia

M26.06 Microgenia

M26.07 Excessive tuberosity of jaw

Entire maxillary tuberosity

M26.09 Other specified anomalies of jaw size

M26.1 Anomalies of jaw-cranial base relationship

M26.10 Unspecified anomaly of jaw-cranial base relationship

M26.11 Maxillary asymmetry

M26.12 Other jaw asymmetry

M26.19 Other specified anomalies of jaw-cranial base relationship

M26.2 Anomalies of dental arch relationship

M26.20 Unspecified anomaly of dental arch relationship

M26.21 Malocclusion, Angle’s class

Chapte

r 3: IC

D-1

0-C

M D

iagnost

ic C

odes

(SLP

)


M26.211 Malocclusion, Angle’s class I

Neutro-occlusion

M26.212 Malocclusion, Angle’s class II

Disto-occlusion Division I

Disto-occlusion Division II

M26.213 Malocclusion, Angle’s class III

Mesio-occlusion

M26.219 Malocclusion, Angle’s class, unspecified

M26.22 Open occlusal relationship

M26.220 Open anterior occlusal relationship

Anterior openbite

M26.221 Open posterior occlusal relationship

Posterior openbite

M26.23 Excessive horizontal overlap

Excessive horizontal overjet

M26.24 Reverse articulation

Crossbite (anterior) (posterior)

M26.25 Anomalies of interarch distance

M26.29 Other anomalies of dental arch relationship

Midline deviation of dental arch

Overbite (excessive) deep

Overbite (excessive) horizontal

Overbite (excessive) vertical

Posterior lingual occlusion of mandibular teeth

M26.3 Anomalies of tooth position of fully erupted tooth or teeth

M26.4 Malocclusion, unspecified

M26.5 Dentofacial functional abnormalities

Excludes1: bruxism (F45.8)

teeth-grinding NOS (F45.8)

M26.50 Dentofacial functional abnormalities, unspecified

M26.51 Abnormal jaw closure

M26.52 Limited mandibular range of motion

M26.53 Deviation in opening and closing of the mandible

M26.54 Insufficient anterior guidance

Insufficient anterior occlusal guidance

M26.55 Centric occlusion maximum intercuspation discrepancy

Excludes1: centric occlusion NOS (M26.59)

M26.56 Non-working side interference

Balancing side interference

M26.57 Lack of posterior occlusal support

Chapte

r 3: IC

D-1

0-C

M D

iagnostic

Codes (S

LP

)

◊


M26.59 Other dentofacial functional abnormalities

Centric occlusion (of teeth) NOS

Malocclusion due to abnormal swallowing

Malocclusion due to mouth breathing

Malocclusion due to tongue, lip or finger habits

M26.6 Temporomandibular joint disorders

Excludes2: current temporomandibular joint dislocation (S03.0)

current temporomandibular joint sprain (S03.4)

M26.60 Temporomandibular joint disorder, unspecified

M26.61 Adhesions and ankylosis of temporomandibular joint

M26.62 Arthralgia of temporomandibular joint

M26.63 Articular disc disorder of temporomandibular joint

M26.69 Other specified disorders of temporomandibular joint

M26.7 Dental alveolar anomalies

M26.70 Unspecified alveolar anomaly

M26.71 Alveolar maxillary hyperplasia

M26.72 Alveolar mandibular hyperplasia

M26.73 Alveolar maxillary hypoplasia

M26.74 Alveolar mandibular hypoplasia

M26.79 Other specified alveolar anomalies

M26.8 Other dentofacial anomalies

M26.81 Anterior soft tissue impingement

Anterior soft tissue impingement on teeth

M26.82 Posterior soft tissue impingement

Posterior soft tissue impingement on teeth


M26.9 Dentofacial anomaly, unspecified

Ch. 16 Certain conditions originating in the perinatal period (P00-P96)

Other disorders originating in the perinatal period (P90-P96)

P92 Feeding problems of newborn

Excludes1: feeding problems in child over 28 days old (R63.3)

P92.1 Regurgitation and rumination of newborn

P92.2 Slow feeding of newborn

P92.6 Failure to thrive in newborn

Excludes1: failure to thrive in child over 28 days old (R62.51)

P92.8 Other feeding problems of newborn

P92.9 Feeding problem of newborn, unspecified

Ch. 17 Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)

Congenital malformations of the nervous system (Q00-Q07)

Q02 Microcephaly

Q03 Congenital hydrocephalus

Q04 Other congenital malformations of brain

Chapte

r 3: IC

D-1

0-C

M D

iagnost

ic C

odes

(SLP

)

◊


Q04.3 Other reduction deformities of brain

Absence of part of brain

Agenesis of part of brain

Agyria

Aplasia of part of brain

Hydranencephaly

Hypoplasia of part of brain

Lissencephaly

Microgyria

Pachygyria

Excludes1: congenital malformations of corpus callosum (Q04.0)

Q05 Spina bifida

Congenital malformations of eye, ear, face and neck (Q10-Q18)

Q16 Congenital malformations of ear causing impairment of hearing

Excludes1: congenital deafness (H90.-)

Q16.0 Congenital absence of (ear) auricle

Q16.1 Congenital absence, atresia and stricture of auditory canal (external)

Congenital atresia or stricture of osseous meatus


Q16.3 Congenital malformation of ear ossicles

Congenital fusion of ear ossicles

Q16.4 Other congenital malformations of middle ear

Congenital malformation of middle ear NOS

Q16.5 Congenital malformation of inner ear

Congenital anomaly of membranous labyrinth

Congenital anomaly of organ of Corti

Q16.9 Congenital malformation of ear causing impairment of hearing, unspecified

Congenital absence of ear NOS

Q17 Other congenital malformations of ear

Excludes1: congenital malformations of ear with impairment of hearing (Q16.0-Q16.9)

preauricular sinus (Q18.1)

Q17.0 Accessory auricle

Accessory tragus

Polyotia

Preauricular appendage or tag

Supernumerary ear

Supernumerary lobule

Q17.1 Macrotia

Q17.2 Microtia

Q17.3 Other misshapen ear

Pointed ear

Chapte

r 3: IC

D-1

0-C

M D

iagnostic

Codes (S

LP

)

◊


Q17.4 Misplaced ear

Low-set ears

Excludes1: cervical auricle (Q18.2)

Q17.5 Prominent ear

Bat ear

Q17.8 Other specified congenital malformations of ear

Congenital absence of lobe of ear

Q17.9 Congenital malformation of ear, unspecified

Congenital anomaly of ear NOS

Congenital malformations of the respiratory system (Q30-Q34)

Q31 Congenital malformations of larynx

Excludes1: congenital laryngeal stridor NOS (P28.89)

Q31.0 Web of larynx

Glottic web of larynx

Subglottic web of larynx

Web of larynx NOS

Q31.1 Congenital subglottic stenosis

Q31.2 Laryngeal hypoplasia

Q31.3 Laryngocele

Q31.5 Congenital laryngomalacia

Q31.8 Other congenital malformations of larynx

Absence of larynx

Agenesis of larynx

Atresia of larynx

Congenital cleft thyroid cartilage

Congenital fissure of epiglottis

Congenital stenosis of larynx NEC

Posterior cleft of cricoid cartilage

Q31.9 Congenital malformation of larynx, unspecified

Cleft lip and cleft palate (Q35-Q37)

Use additional code to identify associated malformation of the nose (Q30.2)

Excludes1: Robin’s syndrome (Q87.0)

Q35 Cleft palate

Includes: fissure of palate

palatoschisis

Excludes1: cleft palate with cleft lip (Q37.-)

Q35.1 Cleft hard palate

Q35.3 Cleft soft palate

Q35.5 Cleft hard palate with cleft soft palate

Q35.7 Cleft uvula

Q35.9 Cleft palate, unspecified

Cleft palate NOS

Chapte

r 3: IC

D-1

0-C

M D

iagnost

ic C

odes

(SLP

)


Q36 Cleft lip

Includes: cheiloschisis

congenital fissure of lip

harelip

labium leporinum

Excludes1: cleft lip with cleft palate (Q37.-)

Q36.0 Cleft lip, bilateral

Q36.1 Cleft lip, median

Q36.9 Cleft lip, unilateral

Cleft lip NOS

Q37 Cleft palate with cleft lip

Includes: cheilopalatoschisis

Q37.0 Cleft hard palate with bilateral cleft lip

Q37.1 Cleft hard palate with unilateral cleft lip

Cleft hard palate with cleft lip NOS

Q37.2 Cleft soft palate with bilateral cleft lip

Q37.3 Cleft soft palate with unilateral cleft lip

Cleft soft palate with cleft lip NOS

Q37.4 Cleft hard and soft palate with bilateral cleft lip

Q37.5 Cleft hard and soft palate with unilateral cleft lip

Cleft hard and soft palate with cleft lip NOS

Q37.8 Unspecified cleft palate with bilateral cleft lip

Q37.9 Unspecified cleft palate with unilateral cleft lip

Cleft palate with cleft lip NOS

Other congenital malformations of the digestive system (Q38-Q45)

Q38 Other congenital malformations of tongue, mouth and pharynx

Excludes1: dentofacial anomalies (M26.-)

macrostomia (Q18.4)

microstomia (Q18.5)

Q38.0 Congenital malformations of lips, not elsewhere classified

Congenital fistula of lip

Congenital malformation of lip NOS

Van der Woude’s syndrome

Excludes1: cleft lip (Q36.-)

cleft lip with cleft palate (Q37.-)

macrocheilia (Q18.6)

microcheilia (Q18.7)

Q38.1 Ankyloglossia

Tongue tie

Q38.2 Macroglossia

Congenital hypertrophy of tongue

Chapte

r 3: IC

D-1

0-C

M D

iagnostic

Codes (S

LP

)


Q38.3 Other congenital malformations of tongue

Aglossia

Bifid tongue

Congenital adhesion of tongue

Congenital fissure of tongue

Congenital malformation of tongue NOS

Double tongue

Hypoglossia

Hypoplasia of tongue

Microglossia

Q38.4 Congenital malformations of salivary glands and ducts

Atresia of salivary glands and ducts

Congenital absence of salivary glands and ducts

Congenital accessory salivary glands and ducts

Congenital fistula of salivary gland

Q38.5 Congenital malformations of palate, not elsewhere classified

Congenital absence of uvula

Congenital malformation of palate NOS

Congenital high arched palate

Excludes1: cleft palate (Q35.-)

cleft palate with cleft lip (Q37.-)

Q38.6 Other congenital malformations of mouth

Congenital malformation of mouth NOS

Q38.7 Congenital pharyngeal pouch

Congenital diverticulum of pharynx

Excludes1: pharyngeal pouch syndrome (D82.1)

Q38.8 Other congenital malformations of pharynx

Congenital malformation of pharynx NOS

Imperforate pharynx

Congenital malformations and deformations of the musculoskeletal system (Q65-Q79)

Q67 Congenital musculoskeletal deformities of head, face, spine and chest

Q67.0 Congenital facial asymmetry

Q67.4 Other congenital deformities of skull, face and jaw

Congenital depressions in skull

Congenital hemifacial atrophy or hypertrophy

Deviation of nasal septum, congenital

Squashed or bent nose, congenital

Excludes1: dentofacial anomalies [including malocclusion] (M26-)

syphilitic saddle nose (A50.5)

Chromosomal abnormalities, not elsewhere classified (Q90-Q99)

Q90 Down syndrome

Use additional code(s) to identify any associated physical conditions and degree of intellectual disabilities (F70-F79)

Chapte

r 3: IC

D-1

0-C

M D

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ic C

odes

(SLP

) √


Q90.0 Trisomy 21, nonmosaicism (meiotic nondisjunction)

Q90.1 Trisomy 21, mosaicism (mitotic nondisjunction)

Q90.2 Trisomy 21, translocation

Q90.9 Down syndrome, unspecified

Trisomy 21 NOS

Q91 Trisomy 18 and Trisomy 13




Q91.3 Trisomy 18, unspecified





Q93 Monosomies and deletions from the autosomes, not elsewhere classified

Q93.3 Deletion of short arm of chromosome 4

Wolff-Hirschorn syndrome

Q93.4 Deletion of short arm of chromosome 5

Cri-du-chat syndrome

Q93.8 Other deletions from the autosomes

Q93.81 Velo-cardio-facial syndrome

Deletion 22q11.2

Q98 Other sex chromosome abnormalities, male phenotype, not elsewhere classified

Q98.0 Klinefelter syndrome karyotype 47, XXY

Q98.1 Klinefelter syndrome, male with more than two X chromosomes

Ch. 18 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

Symptoms and signs involving the digestive system and abdomen (R10-R19)

R12 Heartburn

Excludes1: dyspepsia NOS (R10.13)

functional dyspepsia (K30)

R13 Aphagia and dysphagia

R13.0 Aphagia

Inability to swallow

Excludes1: psychogenic aphagia (F50.9)

R13.1 Dysphagia

Code first, if applicable, dysphagia following cerebrovascular disease (I69. with final characters -91)

Excludes1: psychogenic dysphagia (F45.8)

R13.10 Dysphagia, unspecified

Difficulty in swallowing NOS

R13.11 Dysphagia, oral phase

R13.12 Dysphagia, oropharyngeal phase

R13.13 Dysphagia, pharyngeal phase

Chapte

r 3: IC

D-1

0-C

M D

iagnostic

Codes (S

LP

)

√

√

√

√

√


R13.14 Dysphagia, pharyngoesophageal phase

R13.19 Other dysphagia

Cervical dysphagia

Neurogenic dysphagia

Symptoms and signs involving the nervous and musculoskeletal systems (R25-R29)

R27 Other lack of coordination

Excludes1: ataxic gait (R26.0)

hereditary ataxia (G11.-)

vertigo NOS (R42)

R27.0 Ataxia, unspecified

Excludes1: ataxia following cerebrovascular disease (I69. with final characters -93)

R27.8 Other lack of coordination

R27.9 Unspecified lack of coordination

R29 Other symptoms and signs involving the nervous and musculoskeletal systems

R29.8 Other symptoms and signs involving the nervous and musculoskeletal systems

R29.81 Other symptoms and signs involving the nervous system

R29.810 Facial weakness

Facial droop

Excludes1: Bell’s palsy (G51.0)

facial weakness following cerebrovascular disease (I69. with final characters-92)

R29.818 Other symptoms and signs involving the nervous system

Symptoms and signs involving cognition, perception, emotional state and behavior (R40-R46)

Excludes1: symptoms and signs constituting part of a pattern of mental disorder (F01-F99)

R41 Other symptoms and signs involving cognitive functions and awareness

Excludes1: dissociative [conversion] disorders (F44.-)

mild cognitive impairment, so stated (G31.84)

R41.0 Disorientation, unspecified

Confusion NOS

Delirium NOS

R41.1 Anterograde amnesia

R41.2 Retrograde amnesia

R41.3 Other amnesia

Amnesia NOS

Memory loss NOS

Excludes1: amnestic disorder due to known physiologic condition (F04)

amnestic syndrome due to psychoactive substance use (F10-F19 with 5th character .6)

transient global amnesia (G45.4)

Chapte

r 3: IC

D-1

0-C

M D

iagnost

ic C

odes

(SLP

) √

√


R41.4 Neurologic neglect syndrome

Asomatognosia

Hemi-akinesia

Hemi-inattention

Hemispatial neglect

Left-sided neglect

Sensory neglect

Visuospatial neglect

Excludes1: visuospatial deficit (R41.842)

R41.8 Other symptoms and signs involving cognitive functions and awareness

R41.81 Age-related cognitive decline

Senility NOS

R41.82 Altered mental status, unspecified

Change in mental status NOS

Excludes1: altered level of consciousness (R40.-)

altered mental status due to known condition - code to condition

delirium NOS (R41.0)

R41.83 Borderline intellectual functioning

IQ level 71 to 84

Excludes1: intellectual disabilities (F70-F79)

R41.84 Other specified cognitive deficit

R41.840 Attention and concentration deficit

Excludes1: attention-deficit hyperactivity disorders (F90.-)

R41.841 Cognitive communication deficit

R41.842 Visuospatial deficit

R41.843 Psychomotor deficit

R41.844 Frontal lobe and executive function deficit

R41.89 Other symptoms and signs involving cognitive functions and awareness

Anosognosia

R41.9 Unspecified symptoms and signs involving cognitive functions and awareness

R44 Other symptoms and signs involving general sensations and perceptions

Excludes1: alcoholic hallucinations (F1.5)

hallucinations in drug psychosis (F11-F19 with .5)

hallucinations in mood disorders with psychotic symptoms (F30.2, F31.5, F32.3, F33.3)

hallucinations in schizophrenia, schizotypal and delusional disorders (F20-F29)

Excludes2: disturbances of skin sensation (R20.-)

R44.0 Auditory hallucinations

Chapte

r 3: IC

D-1

0-C

M D

iagnostic

Codes (S

LP

)

√For more information on the use of the “other specified cognitive deficit” codes, see: bit.ly/1SYPx1S

√

√


Symptoms and signs involving speech and voice (R47-R49)

R47 Speech disturbances, not elsewhere classified

Excludes1: autism (F84.0)

cluttering (F80.81)

specific developmental disorders of speech and language (F80.-)

stuttering (F80.81)

R47.0 Dysphasia and aphasia

R47.01 Aphasia

Excludes1: aphasia following cerebrovascular disease (I69. with final characters -20)

progressive isolated aphasia (G31.01)

R47.02 Dysphasia

Excludes1: dysphasia following cerebrovascular disease (I69. with final characters -21)

R47.1 Dysarthria and anarthria

Excludes1: dysarthria following cerebrovascular disease (I69. with final characters -22)

R47.8 Other speech disturbances

Excludes1: dysarthria following cerebrovascular disease (I69. with final characters -28)

R47.81 Slurred speech

R47.82 Fluency disorder in conditions classified elsewhere

Stuttering in conditions classified elsewhere

Code first: underlying disease or condition, such as:

Parkinson’s disease (G20)

Excludes1: adult onset fluency disorder (F98.5)

childhood onset fluency disorder (F80.81)

fluency disorder (stuttering) following cerebrovascular disease (I69. with final characters-23)


R47.9 Unspecified speech disturbances

R48 Dyslexia and other symbolic dysfunctions, not elsewhere classified

Excludes1: specific developmental disorders of scholastic skills (F81.-)

R48.0 Dyslexia and alexia

R48.1 Agnosia

Astereognosia (astereognosis)

Autotopagnosia

Excludes1: visual object agnosia H53.16

R48.2 Apraxia

Excludes1: apraxia following cerebrovascular disease (I69. with final characters -90)

R48.3 Visual agnosia

Prosopagnosia

Simultanagnosia (asimultagnosia)

√

√

√

√

√

√

√

√

√

Chapte

r 3: IC

D-1

0-C

M D

iagnost

ic C

odes

(SLP

)


R48.8 Other symbolic dysfunctions

Acalculia

Agraphia

R48.9 Unspecified symbolic dysfunctions

R49 Voice and resonance disorders

Excludes1: psychogenic voice and resonance disorders (F44.4)

R49.0 Dysphonia

Hoarseness

R49.1 Aphonia

Loss of voice

R49.2 Hypernasality and hyponasality

R49.21 Hypernasality

R49.22 Hyponasality

R49.8 Other voice and resonance disorders

R49.9 Unspecified voice and resonance disorder

Change in voice NOS

Resonance disorder NOS

General symptoms and signs (R50-R69)

R62 Lack of expected normal physiological development in childhood and adults

Excludes1: delayed puberty (E30.0)

gonadal dysgenesis (Q99.1)

hypopituitarism (E23.0)

R62.0 Delayed milestone in childhood

Delayed attainment of expected physiological developmental stage

Late talker

Late walker

R62.5 Other and unspecified lack of expected normal physiological development in childhood

Excludes1: HIV disease resulting in failure to thrive (B20)

physical retardation due to malnutrition (E45)

R62.50 Unspecified lack of expected normal physiological development in childhood

Infantilism NOS

R62.51 Failure to thrive (child)

Failure to gain weight

Excludes1: failure to thrive in child under 28 days old (P92.6)

R63.3 Feeding difficulties

Feeding problem (elderly) (infant) NOS

Excludes1: feeding problems of newborn (P92.-)

infant feeding disorder of nonorganic origin (F98.2-)

R63.4 Abnormal weight loss

Abnormal findings on diagnostic imaging and in function studies, without diagnosis (R90-R94)

R94 Abnormal results of function studies

R94.0 Abnormal results of function studies of central nervous system

Chapte

r 3: IC

D-1

0-C

M D

iagnostic

Codes (S

LP

)

√

R48.8 can be used to capture neurological language impairments when there is documented neurological information to support the diagnosis. Unless caused by stroke (I69.-), cognitive communication problems may also be captured here or with R41.841 (see bit.ly/1SYPx1S for more on the use of R41.841).

√

√

√

√

√

√


R94.01 Abnormal electroencephalogram [EEG]

R94.02 Abnormal brain scan

R94.09 Abnormal results of other function studies of central nervous system

R94.1 Abnormal results of function studies of peripheral nervous system and special senses

R94.12 Abnormal results of function studies of ear and other special senses




Ch. 19 Injury, poisoning and certain other consequences of external causes (S00-T88)

Note: Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T-section that include the external cause do not require an additional external cause code

Use additional code to identify any retained foreign body, if applicable (Z18.-)

Excludes1: birth trauma (P10-P15)

obstetric trauma (O70-O71)

Note: The chapter uses the S-section for coding different types of injuries related to single body regions and the T-section to cover injuries to unspecified body regions as well as poisoning and certain other consequences of external causes.

Injuries to the head (S00-S09)

Includes: injuries of ear

injuries of eye

injuries of face [any part]

injuries of gum

injuries of jaw

injuries of oral cavity

injuries of palate

injuries of periocular area

injuries of scalp

injuries of temporomandibular joint area

injuries of tongue

injuries of tooth

Excludes2: burns and corrosions (T20-T32)

effects of foreign body in ear (T16)

effects of foreign body in larynx (T17.3)

effects of foreign body in mouth NOS (T18.0)

effects of foreign body in nose (T17.0-T17.1)

effects of foreign body in pharynx (T17.2)

effects of foreign body on external eye (T15.-)

frostbite (T33-T34)

S00 Superficial injury of head

Excludes1: diffuse cerebral contusion (S06.2-)

Chapte

r 3: IC

D-1

0-C

M D

iagnost

ic C

odes

(SLP

)


focal cerebral contusion (S06.3-)

injury of eye and orbit (S05.-)

open wound of head (S01.-)




S – sequela

S00.5 Superficial injury of lip and oral cavity

S01 Open wound of head

Code also

any associated:

injury of cranial nerve (S04.-)

injury of muscle and tendon of head (S09.1-)

intracranial injury (S06.-)

wound infection

Excludes1: open skull fracture (S02.- with 7th character B)

Excludes2: injury of eye and orbit (S05.-)

traumatic amputation of part of head (S08.-)




S – sequela

S01.5 Open wound of lip and oral cavity

S02 Fracture of skull and facial bones

Note: A fracture not indicated as open or closed should be coded to closed

Code also

any associated intracranial injury (S06.-)


A - initial encounter for closed fracture

B - initial encounter for open fracture

D - subsequent encounter for fracture with routine healing

G - subsequent encounter for fracture with delayed healing

K - subsequent encounter for fracture with nonunion

S - sequela

S06 Intracranial injury




S - sequela

Includes: traumatic brain injury

Excludes1: head injury NOS (S09.90)

Chapte

r 3: IC

D-1

0-C

M D

iagnostic

Codes (S

LP

)

◊

◊

◊


S06.0 Concussion

S06.2 Diffuse traumatic brain injury

S06.3 Focal traumatic brain injury

S12 Fracture of cervical vertebra and other parts of neck

S12.8 Fracture of other parts of neck

The appropriate 7th character is to be added to code S12.8



S - sequela

Hyoid bone

Larynx

Thyroid cartilage

Trachea

Injury, poisoning and certain other consequences of external causes (T07-T88)

T17 Foreign body in respiratory tract

The appropriate 7th character is to be added to each code from category T17



S - sequela

T17.2 Foreign body in pharynx

Foreign body in nasopharynx

Foreign body in throat NOS

T17.22 Food in pharynx

Bones in pharynx

Seeds in pharynx

T17.220 Food in pharynx causing asphyxiation

T17.3 Foreign body in larynx

T17.32 Food in larynx

Bones in larynx

Seeds in larynx

T17.320 Food in larynx causing asphyxiation

T17.4 Foreign body in trachea

T17.42 Food in trachea

Bones in trachea

Seeds in trachea

T17.420 Food in trachea causing asphyxiation

T18 Foreign body in alimentary tract

Excludes2: foreign body in pharynx (T17.2-)

T18.1 Foreign body in esophagus

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Ch. 21 Factors Influencing Health Status and Contact with Health Services (Z00-Z99)

Note: Z codes (formerly “V codes” in ICD-9-CM) represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury, or external cause classifiable to categories A00-Y89 are recorded as ‘diagnoses’ or ‘problems’. This can arise in two main ways:

a. When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.

b. When some circumstance or problem is present which influences the person’s health status but is not in itself a current illness or injury.

Persons encountering health services for examinations (Z00-Z13)

Note: Nonspecific abnormal findings disclosed at the time of these examinations are classified to categories R70-R94.

Excludes1: examinations related to pregnancy and reproduction (Z30-Z36, Z39.-)

Z01 Encounter for other special examination without complaint, suspected or reported diagnosis


Note: Codes from category Z01 represent the reason for the encounter. A separate procedure code is required to identify any examinations or procedures performed

Excludes1: encounter for examination for administrative purposes (Z02.-)

encounter for examination for suspected conditions, proven not to exist (Z03.-)

encounter for laboratory and radiologic examinations as a component of general medical examinations (Z00.0-)

encounter for laboratory, radiologic and imaging examinations for sign(s) and symptom(s) - code to the sign(s) or symptom(s)

Excludes2: screening examinations (Z11-Z13)

Z01.1 Encounter for examination of ears and hearing

Z01.10 Encounter for examination of ears and hearing without abnormal findings

Encounter for examination of ears and hearing NOS

Z01.11 Encounter for examination of ears and hearing with abnormal findings


Z01.118 Encounter for examination of ears and hearing with other abnormal findings

Use additional code to identify abnormal findings


Z01.818 Encounter for other preprocedural examination

Note: One Medicare Local Coverage Determination (LCD) guides SLPs to use V72.83 to report pre-laryngectomy examinations. Check with payers regarding appropriate use of this code.

Z codes were known as “V codes” in ICD-9-CM

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Z02 Encounter for administrative examination

Z02.7 Encounter for issue of medical certificate

Excludes1: encounter for general medical examination (Z00-Z01, Z02.0-Z02.6, Z02.8-Z02.9)

Z02.71 Encounter for disability determination

Encounter for issue of medical certificate of incapacity

Encounter for issue of medical certificate of invalidity

Z02.79 Encounter for issue of other medical certificate

Z13 Encounter for screening for other diseases and disorders

Screening is the testing for disease or disease precursors in asymptomatic individuals so that early detection and treatment can be provided for those who test positive for the disease.

Excludes1: encounter for diagnostic examination-code to sign or symptom

Z13.4 Encounter for screening for certain developmental disorders in childhood

Encounter for screening for developmental handicaps in early childhood

Excludes1: routine development testing of infant or child (Z00.1-)

Z13.5 Encounter for screening for eye and ear disorders

Excludes2: encounter for general hearing examination (Z01.1-)

encounter for general vision examination (Z01.0-)

Z13.8 Encounter for screening for other specified diseases and disorders

Excludes2: screening for malignant neoplasms (Z12.-)

Z13.85 Encounter for screening for nervous system disorders


Encounters for other specific health care (Z40-Z53)

Categories Z40-Z53 are intended for use to indicate a reason for care. They may be used for patients who have already been treated for a disease or injury, but who are receiving aftercare or prophylactic care, or care to consolidate the treatment, or to deal with a residual state

Excludes2: follow-up examination for medical surveillance after treatment (Z08-Z09)

Z43 Encounter for attention to artificial openings

Includes: closure of artificial openings

passage of sounds or bougies through artificial openings

reforming artificial openings

removal of catheter from artificial openings

toilet or cleansing of artificial openings

Excludes1: artificial opening status only, without need for care (Z93.-)

complications of external stoma (J95.0-, K94.-, N99.5-)

Excludes2: fitting and adjustment of prosthetic and other devices (Z44-Z46)

Z43.0 Encounter for attention to tracheostomy

Z44 Encounter for fitting and adjustment of external prosthetic device

Includes: removal or replacement of external prosthetic device


presence of prosthetic device (Z97.-)

Z44.8 Encounter for fitting and adjustment of other external prosthetic devices

Z44.9 Encounter for fitting and adjustment of unspecified external prosthetic device

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Z45 Encounter for adjustment and management of implanted device

Includes: removal or replacement of implanted device

Excludes1: malfunction or other complications of device presence of prosthetic and other devices (Z95-Z97)

Excludes2: encounter for fitting and adjustment of non-implanted device (Z46.-)

Z45.3 Encounter for adjustment and management of implanted devices of the special senses

Z45.32 Encounter for adjustment and management of implanted hearing device

Excludes1: Encounter for fitting and adjustment of hearing aid (Z46.1)

Z45.320 Encounter for adjustment and management of bone conduction device

Z45.321 Encounter for adjustment and management of cochlear device

Z45.328 Encounter for adjustment and management of other implanted hearing device

Z46 Encounter for fitting and adjustment of other devices

Includes: removal or replacement of other device


Excludes2: encounter for fitting and management of implanted devices (Z45.-)

issue of repeat prescription only (Z76.0)



Excludes1: encounter for adjustment and management of implanted hearing device (Z45.32-)

Z51 Encounter for other aftercare


Excludes1: holiday relief care (Z75.5)


Persons with potential health hazards related to socioeconomic and psychosocial circumstances (Z55-Z65)

Z57 Occupational exposure to risk factors

Z57.0 Occupational exposure to noise

Persons encountering health services in other circumstances (Z69-Z76)

Z73 Problems related to life management difficulty

Excludes2: problems related to socioeconomic and psychosocial circumstances (Z55-Z65)

Z73.8 Other problems related to life management difficulty

Z73.82 Dual sensory impairment

Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99)

Code also any follow-up examination (Z08-Z09)

Z77 Other contact with and (suspected) exposures hazardous to health

Z77.1 Contact with and (suspected) exposure to environmental pollution and hazards in the physical environment

Z77.12 Contact with and (suspected) exposure to hazards in the physical environment

Z77.122 Contact with and (suspected) exposure to noise

ICD-9 code V57.3 Speech-language therapy does not have an exact mapping in ICD-10 and is now captured under Z51.89.

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Z81 Family history of mental and behavioral disorders

Z82 Family history of certain disabilities and chronic diseases (leading to disablement)

Z82.2 Family history of deafness and hearing loss

Conditions classifiable to H90-H91

Z83 Family history of other specific disorders

Excludes2: contact with and (suspected) exposure to communicable disease in the family (Z20.-)

Z83.5 Family history of eye and ear disorders

Conditions classifiable to H00-H53, H55-H83, H92-H95

Excludes2: family history of blindness and visual loss (Z82.1)

family history of deafness and hearing loss (Z82.2)

Z83.52 Family history of ear disorders

Conditions classifiable to H60-H83, H92-H95

Excludes2: family history of deafness and hearing loss (Z82.2)

Z86 Personal history of certain other diseases


Z86.5 Personal history of mental and behavioral disorders

Conditions classifiable to F40-F59


Z87 Personal history of other diseases and conditions


Z87.7 Personal history of (corrected) congenital malformations

Conditions classifiable to Q00-Q89 that have been repaired or corrected

Z87.72 Personal history of (corrected) congenital malformations of nervous system and sense organs


Z87.73 Personal history of (corrected) congenital malformations of digestive system

Z87.730 Personal history of (corrected) cleft lip and palate

Z87.79 Personal history of other (corrected) congenital malformations


Z87.8 Personal history of other specified conditions

Excludes2: personal history of self harm (Z91.5)

Z87.82 Personal history of other (healed) physical injury and trauma

Conditions classifiable to S00-T88, except traumatic fractures

Z87.820 Personal history of traumatic brain injury

Excludes1: personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits (Z86.73)

Z90 Acquired absence of organs, not elsewhere classified

Includes: postprocedural or post-traumatic loss of body part NEC

Excludes1: congenital absence

Z90.0 Acquired absence of part of head and neck

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Z90.02 Acquired absence of larynx

Z90.09 Acquired absence of other part of head and neck

Acquired absence of nose

Excludes2: teeth (K08.1)

Z93 Artificial opening status

Excludes1: artificial openings requiring attention or management (Z43.-)

complications of external stoma (J95.0-, K94.-, N99.5-)

Z93.0 Tracheostomy status

Z96 Presence of other functional implants



Z96.2 Presence of otological and audiological implants

Z96.20 Presence of otological and audiological implant, unspecified

Z96.21 Cochlear implant status

Z96.22 Myringotomy tube(s) status

Z96.29 Presence of other otological and audiological implants

Presence of bone-conduction hearing device

Presence of eustachian tube stent

Stapes replacement

Z96.3 Presence of artificial larynx

Z97 Presence of other devices



Z97.4 Presence of external hearing-aid

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Coding Normal Results Frequently Asked Questions Many third party payers will not reimburse for audiology or speech-language pathology services when the results of an evaluation are reported simply as within normal limits. These FAQs describe how to use International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes when normal results are found and provides examples for complaints that prompt the referral. The answers are based on general coding principles and best practices, as well as guidance from the Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS). Audiologists and speech-language pathologists are responsible for verifying coding and billing policies with their specific payers.

How should an audiologist or speech-language pathologist assign an ICD-10-CM code when an evaluation produces a normal result?

The signs and symptoms, chief complaint, or reason(s) for the encounter should be reported as the first-listed diagnosis. The audiologist or speech-language pathologist should also use additional codes that describe any co-existing or chronic conditions. Do not code conditions that were previously treated and no longer exist, although history codes may be used as secondary codes if the historical condition or family history has an impact on current care or influences treatment.

Are there official instructions on how to code when the results are normal?The ICD-10-CM Official Guidelines for Coding and Reporting [PDF] (http://www.cdc.gov/nchs/data/icd/10cmguidelines_2016_Final.pdf) provides a description of how to report an uncertain diagnosis based on setting.




For outpatient services, ICD-10-CM guidelines state, “Do not code diagnoses documented as ‘probable,’ ‘suspected,’ ‘questionable,’ ‘rule out,’ or ‘working diagnosis’ or other similar terms indicating uncertainty. Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit.”

For inpatient services (including short-term, acute, and long-term care), ICD-10-CM advises “If the diagnosis documented at the time of discharge is qualified as ‘probable,’ ‘suspected,’ ‘likely,’ ‘questionable,’ ‘possible,’ or ‘still to be ruled out’ or other similar terms indicating uncertainty, code the condition as if it existed or was established.’”

Can you provide examples of how a speech-language pathologist should code signs and symptoms when results are normal?The following chart presents examples of patients who present with specific complaints but are found to be within normal limits after an evaluation is completed.

Patient Complaint ICD-10-CM Code

Hoarse vocal quality R49.0 Dysphonia, hoarseness

Problems with swallowing


Unintelligible speech F80.0 Phonological disorder, functional speech articulation disorder

Late talker R62.0 Delayed milestones in childhood

Can you provide examples of how an audiologist should code signs and symptoms when results are normal?The following chart presents examples of patients who present with specific complaints but are found to be within normal limits after an evaluation is completed.

Patient Complaint ICD-10-CM Code

Mild hearing loss H91.90 Unspecified hearing loss, unspecified ear

Dizziness R42 Dizziness and giddiness, light headedness, vertigo NOS

History of noise exposure

H83.3X9 Noise effects on inner ear, unspecified

Where can I obtain a list of the ICD-10-CM codes for audiologists and speech-language pathologists?Audiology and speech-language pathology specific ICD-10-CM lists are available on ASHA’s ICD-10 website. For comprehensive speech and hearing related ICD-10 and CPT (Current Procedural Terminology) coding information, we also recommend ASHA’s Coding and Billing for Audiology and Speech-Language Pathology, which is updated annually and is available for purchase on ASHA’s online store.

Questions about coding can be sent to [email protected].

ICD-10-PCS (Procedure Coding System) for Audiologists and SLPsBeginning October 1, 2015, health care providers will be required to use the new ICD-10 system, which replaces ICD-9. The new ICD-10 will include the ICD-10-CM (clinical modification) and ICD-10-PCS (procedure coding system). The clinical modification was developed by the Centers for Disease Control and Prevention for use in all U.S. health care treatment settings. The procedure coding system (i.e., ICD-9-PCS and ICD-10-PCS) was developed by the Centers for Medicare and Medicaid Services for use in the U.S. for inpatient hospital settings only. ASHA’s resources focus mostly on ICD-10-CM. You may want to check with your facility on use of ICD-10-PCS.

The ICD-10-PCS is a procedure classification published by the United States for classifying procedures performed in hospital inpatient health care settings only.

CMS provides the following link for information about ICD-10-PCS; www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-PCS-and-GEMs.html

The CMS guidelines for ICD-10-PCS, found in the above link, are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-PCS itself. The instructions and conventions of the classification take precedence over guidelines.

The 2015 Code Tables and Index are the actual codes used in ICD-10-PCS. Speech-language pathology and audiology related codes are found in section F - Physical Rehabilitation and Diagnostic Audiology.

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mailto:[email protected]

http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-PCS-and-GEMs.html

http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-PCS-and-GEMs.html


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Chapter 4: HCPCS(Healthcare Common Procedure Coding System, Medicare & Medicaid)

GeneralThe Centers for Medicare & Medicaid Services (CMS) developed a second level of codes, the Healthcare Common Procedure Coding System (HCPCS) or Level II HCPCS National Codes, because the Current Procedural Terminology (CPT) manual does not contain all of the codes needed to report medical services and supplies.

Use of CodesHCPCS codes related to audiology and speech-language pathology are included in this book.

Audiology Related HCPCS CodesHearing services fall under some L-codes and V5008-V5336. Please note that Medicare does not cover routine physical checkups for the purposes of prescribing, fitting, or changing hearing aids or examinations for hearing aids.

G0402 Initial preventive physical examination, face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment

L8614 Cochlear device, includes all internal and external components

L8615 Headset/headpiece for use with cochlear implant device, replacement

L8616 Microphone for use with cochlear implant device, replacement

L8617 Transmitting coil for use with cochlear implant device, replacement

L8618 Transmitter cable for use with cochlear implant device, replacement

L8619 Cochlear implant external speech processor, replacement

L8621 Zinc air battery for use with cochlear implant device, replacement, each

L8622 Alkaline battery for use with cochlear implant device, any size, replacement, each

L8623 Lithium ion battery for use with cochlear implant device speech processor, worn on the body, other than ear level, replacement, each

L8624 Lithium ion battery for use with cochlear implant device speech processor, ear level, replacement, each

L8627 Cochlear implant, external speech processor, component, replacement

L8628 Cochlear implant, external controller component, replacement

L8629 Transmitting coil and cable, integrated for use with cochlear implant device, replacement

L8690 Auditory osseointegrated device, includes all internal and external components

L8691 Auditory osseointegrated device, external sound processor, replacement

L8692 Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment (not covered by Medicare)

L8693 Auditory osseointegrated device abutment, any length, replacement only

L8699 Prosthetic implant, not otherwise specified

L9900 Orthotic and prosthetic supply, accessory, and/or service component of another HCPCS “L” code

S0618 Audiometry for hearing aid evaluation (Medicare and other federal payers do not recognize “S” codes; however, these codes may be useful for claims to private payers)

V5008 Hearing Screening

V5010 Assessment for hearing aid

V5011 Fitting/Orientation/Checking of hearing aid

V5014 Repair/Modification of a hearing aid

V5020 Conformity evaluation

V5030 Hearing aid, monaural, body worn, air conduction

V5040 Hearing aid, monaural, body worn, bone conduction

V5050 Hearing aid, monaural, in the ear

V5060 Hearing aid, monaural, behind the ear

V5070 Glasses, air conduction

V5080 Glasses, bone conduction

V5090 Dispensing fee, unspecified hearing aid

V5095 Semi-implantable middle ear hearing prosthesis (use for Vibrant Soundbridge)

V5100 Hearing aid, bilateral, body worn

V5110 Dispensing fee, bilateral

V5120 Binaural, body

V5130 Binaural, in the ear

V5140 Binaural, behind the ear

V5150 Binaural, glasses

V5160 Dispensing fee, binaural

V5170 Hearing aid, CROS, in the ear

V5180 Hearing aid, CROS, behind the ear

V5190 Hearing aid, CROS, glasses

V5200 Dispensing fee, CROS

V5210 Hearing aid, BICROS, in the ear

V5220 Hearing aid, BICROS, behind the ear


V5230 Hearing aid, BICROS, glasses

V5240 Dispensing fee, BICROS

V5241 Dispensing fee, monaural hearing aid, any type

V5242 Hearing aid, analog, monaural, CIC (completely in the ear canal)

V5243 Hearing aid, analog, monaural, ITC (in the canal)

V5244 Hearing aid, digitally programmable analog, monaural CIC

V5245 Hearing aid, digitally programmable analog, monaural, ITC

V5246 Hearing aid, digitally programmable analog, monaural, ITE (in the ear)

V5247 Hearing aid, digitally programmable analog, monaural, BTE

V5248 Hearing aid, analog, binaural, CIC

V5249 Hearing aid, analog, binaural, ITC

V5250 Hearing aid, digitally programmable analog, binaural, CIC

V5251 Hearing aid, digitally programmable analog, binaural, ITC

V5252 Hearing aid, digitally programmable, binaural, ITE

V5253 Hearing aid, digitally programmable, binaural, BTE

V5254 Hearing aid, digital, monaural, CIC

V5255 Hearing aid, digital, monaural, ITC

V5256 Hearing aid, digital, monaural, ITE

V5257 Hearing aid, digital, monaural, BTE

V5258 Hearing aid, digital, binaural, CIC

V5259 Hearing aid, digital, binaural, ITC

V5260 Hearing aid, digital, binaural, ITE

V5261 Hearing aid, digital, binaural, BTE

V5262 Hearing aid, disposable, any type, monaural

V5263 Hearing aid, disposable, any type, binaural

V5264 Ear mold/insert, not disposable, any type

V5265 Ear mold/insert, disposable, any type

V5266 Battery for use in hearing device

V5267 Hearing aid or assistive listening device/supplies/accessories, not otherwise specified

V5268 Assistive listening device, telephone amplifier, any type

V5269 Assistive listening device, alerting, any type

V5270 Assistive listening device, television amplifier, any type

V5271 Assistive listening device, television caption decoder

V5272 Assistive listening device, TDD

V5273 Assistive listening device, for use with cochlear implant

V5274 Assistive listening device, not otherwise specified

V5275 Ear impression, each

V5281 Personal FM/DM system, monaural, (one receiver, transmitter and microphone)

V5282 Personal FM/DM system, binaural (two receivers, transmitter and microphone)

V5283 Personal FM/DM neck, loop induction receiver

V5284 Personal FM/DM, ear level receiver

V5285 Personal FM/DM, direct audio input receiver

V5286 Personal blue tooth FM/DM receiver

V5287 Personal FM/DM receiver, not otherwise specified

V5288 Personal FM/DM transmitter assistive listening device

V5289 Personal FM/DM adapter/boot coupling device for receiver, any type

V5290 Transmitter microphone, any type

V5298 Hearing aid, not otherwise classified

V5299 Hearing service, miscellaneous

V5336 Repair/Modification of augmentative communicative system or device (excl. adaptive hearing aid)

Modifiers

GT – Via interactive audio and video telecommunication systems

LT – Left side (used to identify procedures performed on the left side of the body)

NU – New equipment

RA – Replacement of a DME, orthotic or prosthetic item

RB – Replacement of a part of a DME, orthotic or prosthetic item furnished as part of a repair

RT – Right side (used to identify procedures performed on the right side of the body)

SZ – Habilitative Services

Speech-Language Pathology Related HCPCS CodesHCPCS Level II includes codes for speech generating devices, voice prosthetics, voice amplifiers, and repair of AAC systems or devices. Please note that Medicare claims for E and L codes and V5336 fall under the jurisdiction of the www.cms.hhs.gov/DMEPOSFeeSched/01_overview.asp (DME MACs).

A7503 Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each

A7504 Filter for use in a tracheostoma heat and moisture exchange system, each

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A7505 Housing, reusable without adhesive, for use in heat and moisture exchange system and/or with a tracheostoma valve, each

A7506 Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, and type, each

A7507 Filter holder and integrated filter without adhesive, for use in a tracheostoma health and moisture exchange system, each

A7508 Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each

A7509 Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each

E1902 Communication board, nonelectronic augmentative or alternative communication device

E2500 Speech generating device, digitized speech, using prerecorded messages, less than or equal to 8 minutes recording time

E2502 Speech generating device, digitized speech, using prerecorded messages, greater than 8 minutes but less than or equal to 20 minutes of recording time

E2504 Speech generating device, digitized speech, using prerecorded messages, greater than 20 minutes but less than or equal to 40 minutes of recording time

E2506 Speech generating device, digitized speech, using prerecorded messages, greater than 40 minutes of recording time

E2508 Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device

E2510 Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access

E2511 Speech generating software program, for personal computer or personal digital assistant

E2512 Accessory for speech generating device, mounting system

E2599 Accessory for speech generating device, not otherwise specified

G0451 Developmental testing with interpretation and report, per standardized instrument

L8499 Unlisted procedure for miscellaneous prosthetic services

L8500 Artificial larynx, any type

L8501 Tracheostomy speaking valve

L8505 Artificial larynx replacement battery/accessory, any type

L8507 Tracheo-esophageal voice prosthesis, patient inserted, any type, each

L8509 Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type

L8510 Voice amplifier

L8511 Insert for indwelling tracheoesophageal prosthesis, with our without valve, replacement only, each

L8512 Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10

L8513 Cleaning device used jwith tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each

L8514 Tracheoesophageal puncture dilator, replacement only, each

L8515 Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each

S9128 Speech therapy, in the home, per diem

S9152 Speech therapy, re-evaluation

V5336 Repair/modification of augmentative communicative system or device (excludes adaptive hearing aid)

V5362 Speech screening

V5363 Language screening

V5364 Dysphagia screening

Modifiers

GT – Via interactive audio and video telecommunication systems

LT – Left side (used to identify procedures performed on the left side of the body)

NU – New equipment

RA – Replacement of a DME, orthotic or prosthetic item

RB – Replacement of a part of a DME, orthotic or prosthetic item furnished as part of a repair

RT – Right side (used to identify procedures performed on the right side of the body)

SZ – Habilitative Services


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Chapter 5: G-codesG-codes and Severity Modifiers for Speech-Language Pathology Claims-Based Outcomes Reporting for Medicare Part B Therapy Services

BackgroundSpeech-language pathologists (SLPs) who treat Medicare Part B beneficiaries must report patient outcomes on claim forms and documenting in the medical record starting January 1, 2013. Claims that do not comply with the data reporting requirements are returned unpaid. The outcomes reporting is for data collection. At this time they are not using the data for tracking individual Medicare beneficiaries’ progress.

Anyone providing therapy, including speech-language evaluation and treatment services, for Medicare Part B beneficiaries must report outcomes on the claim form in this mandatory data collection program. This includes Part B services in:

• hospitals,

• critical access hospitals,

• private practices,

• skilled nursing facilities,

• home health or rehabilitation agencies,

• outpatient rehabilitation facilities (ORFs), and

• comprehensive outpatient rehabilitation facilities (CORFs).

Reporting requirements are not mandated for Medicare Part A, Medicare Advantage/HMO plans, Medicaid or private health plans. However, some plans may elect to require them.

ReportingSLPs are required to report on every Medicare Part B patient they evaluate and treat and can choose from one of seven conditions or one generic measure. Medicare adopted the reportable conditions from ASHA’s National Outcomes Measurement System (NOMS) Functional Communication Measures (FCMs) and created HCPCS G-codes to represent current status, projected goal, and discharge status for each condition. Along with the 7-point severity modifier system, the Medicare reporting requirements correspond to the NOMS data collection system, which offers SLPs a reliable tool for documenting outcomes and complying with the Medicare reporting rules.

SLPs must report one condition for every Medicare Part B beneficiary at every evaluation, admission, discharge, and every 10th treatment day. With every reporting interval, the SLP will report a status G-code (either current status or discharge status) and projected goal G-code, with the appropriate modifier representing the level of severity for status and projected long-term goal. The alphanumeric codes must be documented in the medical record.


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-codes Speech-Language Pathology Related G-codes

G-codes Functional Limitation & Status

SwallowingG8996 Swallowing functional limitation, current status at time of initial therapy treatment/episode outset and

reporting intervals

G8997 Swallowing functional limitation, projected goal status, at initial therapy treatment/outset and at discharge from therapy

G8998 Swallowing functional limitation, discharge status, at discharge from therapy/end of reporting on limitation

Motor Speech (Note: The codes for Motor Speech are not sequentially numbered)

G8999 Motor speech functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals

G9186 Motor speech functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy

G9158 Motor speech functional limitation, discharge status at discharge from therapy/end of reporting on limitation

Spoken Language ComprehensionG9159 Spoken language comprehension functional limitation, current status at time of initial therapy treatment/

episode outset and reporting intervals

G9160 Spoken language comprehension functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy

G9161 Spoken language comprehension functional limitation, discharge status at discharge from therapy/end of reporting on limitation

Spoken Language ExpressionG9162 Spoken language expression functional limitation, current status at time of initial therapy treatment/


G9163 Spoken language expression functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy

G9164 Spoken language expression functional limitation, discharge status at discharge from therapy/end of reporting on limitation

AttentionG9165 Attention functional limitation, current status at time of initial therapy treatment/episode outset and

reporting intervals

G9166 Attention functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy

G9167 Attention functional limitation, discharge status at discharge from therapy/end of reporting on limitation

MemoryG9168 Memory functional limitation, current status at time of initial therapy treatment/episode outset and

reporting intervals

G9169 Memory functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy

G9170 Memory functional limitation, discharge status at discharge from therapy/end of reporting on limitation

VoiceG9171 Voice functional limitation, current status at time of initial therapy treatment/episode outset and reporting

intervals

G9172 Voice functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy

G9173 Voice functional limitation, discharge status at discharge from therapy/end of reporting on limitation


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1See www.asha.org/NOMS/

G-codes Functional Limitation & Status

Other SLP Functional LimitationG9174 Other speech language pathology functional limitation, current status at time of initial therapy treatment/


G9175 Other speech language pathology functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy

G9176 Other speech language pathology functional limitation, discharge status at discharge from therapy/end of reporting on limitation

Severity ModifiersNote: Corresponding National Outcomes Measurement System (NOMS) Functional Communication Measures1 levels are listed here. Use of NOMS can assist with G-code and severity modifier selection, but is not required by CMS.

Modifier Impairment Limitation Restriction FCM LevelCH 0 percent impaired, limited or restricted 7

CI At least 1 percent but less than 20 percent impaired, limited or restricted 6

CJ At least 20 percent but less than 40 percent impaired, limited or restricted 5

CK At least 40 percent but less than 60 percent impaired, limited or restricted 4

CL At least 60 percent but less than 80 percent impaired, limited or restricted 3

CM At least 80 percent but less than 100 percent impaired, limited or restricted 2

CN 100 percent impaired, limited or restricted 1

ASHA Note: GN Modifier

Part B services provided under plans of care for speech-language pathology or dysphagia services require a GN modifier as a suffix to the CPT Code. The requirement applies to physician offices as well as facilities and private practices. Occupational therapy and physical therapy modifiers are GO and GP, respectively.


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Outcomes Reporting for Medicare Part B Therapy ServicesThe American Speech-Language-Hearing Association developed the following scenarios to help speech-language pathologists understand the claims process when reporting outcomes for Medicare Part B therapy services.

For more information on claims-based outcomes reporting, go to www.asha.org/practice/reimbursement/medicare/Claims-Based-Outcomes-Reporting-for-Medicare-Part-B/.

For questions, contact ASHA’s health care economics and advocacy team at [email protected].

Scenarios

Scenario 1: Patient Seen for One Functional Limitation

Scenario 2: Patient Seen for Multiple Functional Limitations

Scenario 3: Patient Seen for Evaluation and Treatment Not Recommended

Scenario 4: Patient Seen for Evaluation and Referred for Treatment

Scenario 5: Patient Seen for Maintenance Therapy


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Scenario 1: Patient Seen for One Functional Limitation• Functional limitation: Motor Speech (G-code: G8999), FCM Level 2 (Modifier: CM)

• Projected Goal: Motor Speech (G-code: G9186), FCM Level 7 (Modifier CH)

Reporting on the Initial Claim (Note: The Motor Speech reporting codes are not sequentially numbered)

• Box 24.D. (Procedures, Services, or Supplies)

o Line 1: CPT/HCPCS: 92522, Modifier: GN

o Line 2: CPT/HCPCS: G8999, Modifier: GN, CM (Current status of motor speech limitation)

o Line 3: CPT/HCPCS: G9186, Modifier: GN, CH (Projected goal for motor speech limitation)

CMS-1500 Claim Form Example

American Speech‐Language‐Hearing Association 2


Functional limitation: Motor Speech (G‐code: G8999), FCM Level 2 (Modifier: CM) Projected Goal: Motor Speech (G‐code : G9186), FCM Level 7 (Modifier CH)


Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92522, Modifier:GN o Line 2: CPT/HCPCS: G8999, Modifier: GN, CM (Current status of motor speech limitation) o Line 3: CPT/HCPCS: G9186, Modifier: GN, CH (Projected goal for motor speech limitation)

CMS‐1500 Claim Form Example

Reporting on the Claim for Visits #2‐#9

Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92507, Modfier: GN o No additional outcome/goal reporting

Reporting on the Claim for Visit #10 (Reporting must occur at least once every 10 treatment days)

Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92507, Modifier: GN o Line 2: CPT/HCPCS: G8999, Modifier: GN, CI (Current status of motor speech limitation) o Line 3: CPT/HCPCS: G9186, Modifier: GN, CH (Projected goal for motor speech limitation)


Scenario continued on the next page

Reporting on the Claim for Visits #2-#9



o No additional outcome/goal reporting




o Line 2: CPT/HCPCS: G8999, Modifier: GN, CI (Current status of motor speech limitation)

o Line 3: CPT/HCPCS: G9186, Modifier: GN, CH (Projected goal for motor speech limitation)


Scenario continued on next page



Functional limitation: Motor Speech (G‐code: G8999), FCM Level 2 (Modifier: CM) Projected Goal: Motor Speech (G‐code : G9186), FCM Level 7 (Modifier CH)


Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92522, Modifier:GN o Line 2: CPT/HCPCS: G8999, Modifier: GN, CM (Current status of motor speech limitation) o Line 3: CPT/HCPCS: G9186, Modifier: GN, CH (Projected goal for motor speech limitation)



Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92507, Modfier: GN o No additional outcome/goal reporting


Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92507, Modifier: GN o Line 2: CPT/HCPCS: G8999, Modifier: GN, CI (Current status of motor speech limitation) o Line 3: CPT/HCPCS: G9186, Modifier: GN, CH (Projected goal for motor speech limitation)




Reporting on the Claim for Final Visit (Patient discharged from plan of care)


o Line 1: CPT/HCPCS: 92507 and/or 92522 (see note below)

o Line 2: CPT/HCPCS: G9158, Modifier: GN, CH (Status of motor speech limitation at discharge)

o Line 3: CPT/HCPCS: G9186, Modifier: GN, CH (Status of projected motor speech goal at discharge=goal met)


ASHA Note: Final visit may include treatment (92507) and/or re-evaluation (92506). The Medicare Benefit Policy Manual (www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf [PDF]) states that “a re-evaluation may be appropriate prior to planned discharge for the purpose of determining whether goals have been met, or for the use of the physician or the treatment setting at which treatment will be continued.”



Box 24.D. (Procedures, Services, or Supplies)

o Line 1: CPT/HCPCS: 92507 and/or 92522 (see note below) o Line 2: CPT/HCPCS: G9158, Modifier: GN, CH (Status of motor speech limitation at discharge) o Line 3: CPT/HCPCS: G9186, Modifier: GN, CH (Status of projected motor speech goal at discharge=goal

met)


ASHA Note: Final visit may include treatment (92507) and/or re‐evaluation (92506). The Medicare Benefit Policy Manual (www.cms.gov/Regulations‐and‐Guidance/Guidance/Manuals/downloads/bp102c15.pdf [PDF]) states that “a re‐evaluation may be appropriate prior to planned discharge for the purpose of determining whether goals have been met, or for the use of the physician or the treatment setting at which treatment will be continued.”

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http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf


Scenario 2: Patient Seen for Multiple Functional LimitationsFunctional limitations:

• Swallowing (G-code: G8996), FCM Level 2 (Modifier: CM)

• Spoken Language Comprehension (G-code: G9159), FCM Level 2 (Modifier: CM)

• Spoken Language Expression (G-code: G9162), FCM Level 1 (Modifier: CN)

CMS allows the reporting of one functional limitation at a time. For this case, it was determined that Swallowing was the most clinically relevent and would be reported initially.

• Projected Goal: Swallowing (G-code G8997), FCM Level 6 (Modifier: CI)

Reporting on the Claim



o Line 2: CPT/HCPCS: G8996, Modifier: GN, CM (Current status of swallowing limitation)

o Line 3: CPT/HCPCS: G8997, Modifier: GN, CI (Projected goal for swallowing)


o Line 5: CPT/HCPCS: G9159, Modifier: GN, CM (Current status of spoken language comprehension)

o Line 6: CPT/HCPCS: G9160, Modifier: GN, CI (Projected goal for spoken language comprehension)

o Line 7: CPT/HCPCS: G9161, Modifier: GN, CM (Discharge for spoken language comprehension)








Scenario 2: Patient Seen for Multiple Functional Limitations

Functional Limitations:

Swallowing (G‐code: G8996), FCM Level 2 (Modifier: CM) Spoken Language Comprehension (G‐code: G9159), FCM Level 2 (Modifier: CM) Spoken Language Expression (G‐code: G9162), FCM Level 1 (Modifier: CN)

CMS allows the reporting of one functional limitation at a time. For this case, it was determined that Swallowing was the most clinically relavent and would be reported initially.

Projected Goal: Swallowing (G‐code G8997), FCM Level 6 (Modifier: CI)

Reporting on the Initial Claim


o Line 1: CPT/HCPCS: 92610, Modifier: GN o Line 2: CPT/HCPCS: G8996, Modifier: GN, CM (Current status of swallowing limitation) o Line 3: CPT/HCPCS: G8997, Modifier: GN, CI (Projected goal for swallowing) o Line 4: CPT/HCPCS: 92523, Modifier: GN o Line 5: CPT/HCPCS: G9159, Modifier: GN, CM (Current status of spoken language comprehension) o Line 6: CPT/HCPCS: G9160, Modifier: GN, CI (Projected goal for spoken language comprehension) o Line 7: CPT/HCPCS: G9161, Modifier: GN, CM (Discharge for spoken language comprehension)




o Line 1: CPT/HCPCS: 92507, Modfier: GN o Line 2: CPT/HCPCS: 92526, Modifier: GN o No additional outcome/goal reporting



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o Line 3: CPT/HCPCX: G8996, Modifier: GN, CK (Current status of swallowing limitation)

o Line 4: CPT/HCPCS: G8997, Modifier: GN, CI (Projected goal for swallowing)


Reporting on the Claim for Visit #18 (Patient discharged from swallowing therapy)

Goals were met for swallowing, but spoken language comprehension and expression have not met therapy goals. The claim will indicate a discharge from the plan of care for swallowing, and the following claim will report the secondary condition of spoken language comprehension.




o Line 3: CPT/HCPCS: G8998, Modifier: GN, CI (Status of swallowing limitation at discharge)

o Line 4: CPT/HCPCS: G8997, Modifier: GN, CI (Status of swallowing projected goal at discharge)





o Line 1: CPT/HCPCS: 92507, Modifier: GN o Line 2: CPT/HCPCS: 92526, Modifier: GN o Line 3: CPT/HCPCX: G8996, Modifier GN, CK (Current status of swallowing limitation) o Line 4: CPT/HCPCS: G8997, Modifier: GN, CI (Projected goal for swallowing)





o Line 1: CPT/HCPCS 92507, Modifier: GN o Line 2: CPT/HCPCS: 92526, Modifier: GN o Line 3: CPT/HCPCS: G8998, Modifier: GN, CI (Status of swallowing limitation at discharge) o Line 4: CPT/HCPCS: G8997, Modifier: GN, CI (Status of swallowing projected goal at discharge)






o Line 1: CPT/HCPCS: 92507, Modifier: GN o Line 2: CPT/HCPCS: 92526, Modifier: GN o Line 3: CPT/HCPCX: G8996, Modifier GN, CK (Current status of swallowing limitation) o Line 4: CPT/HCPCS: G8997, Modifier: GN, CI (Projected goal for swallowing)





o Line 1: CPT/HCPCS 92507, Modifier: GN o Line 2: CPT/HCPCS: 92526, Modifier: GN o Line 3: CPT/HCPCS: G8998, Modifier: GN, CI (Status of swallowing limitation at discharge) o Line 4: CPT/HCPCS: G8997, Modifier: GN, CI (Status of swallowing projected goal at discharge)




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Reporting on the Claim for Visit #19 (Patient continues therapy for spoken language comprehension)



o Line 2: CPT/HCPCS: G9159, Modifier: GN, CK (Current status of spoken language comprehension)

o Line 3: CPT/HCPCS: G9160, Modifier: GN, CI (Projected goal for spoken language comprehension)







Patient has plateaued in therapy progression at FCM Level 5. The patient is discharged from the plan of care.


o Line 1: CPT/HCPCS: 92507

o Line 2: CPT/HCPCS: G8998, Modifier: GN, CJ (Status of spoken language comprehension at discharge)

o Line 3: CPT/HCPCS: G9160, Modifier: GN, CI (Status of spoken language comprehension projected goal at discharge=goal not met))





o Line 1: CPT/HCPCS: 92507, Modifier: GN o Line 2: CPT/HCPCS: G9159, Modifier: GN, CK (Current status of spoken language comprehension) o Line 3: CPT/HCPCS: G9160, Modifier: GN, CI (Projected goal for spoken language comprehension)




o Line 1: CPT/HCPCS: 92507, Modifier: GN o No additional outcome/goal reporting




o Line 1: CPT/HCPCS: 92507 o Line 2: CPT/HCPCS: G9161, Modifier: GN, CJ (Status of spoken language comprehension at discharge) o Line 3: CPT/HCPCS: G9160, Modifier: GN, CI (Status of spoken language comprehension projected goal

at discharge=goal not met)





o Line 1: CPT/HCPCS: 92507, Modifier: GN o Line 2: CPT/HCPCS: G9159, Modifier: GN, CK (Current status of spoken language comprehension) o Line 3: CPT/HCPCS: G9160, Modifier: GN, CI (Projected goal for spoken language comprehension)




o Line 1: CPT/HCPCS: 92507, Modifier: GN o No additional outcome/goal reporting




o Line 1: CPT/HCPCS: 92507 o Line 2: CPT/HCPCS: G9161, Modifier: GN, CJ (Status of spoken language comprehension at discharge) o Line 3: CPT/HCPCS: G9160, Modifier: GN, CI (Status of spoken language comprehension projected goal

at discharge=goal not met)




Scenario 3: Patient Seen for Evaluation and Treatment Not Recommended

Functional limitation: Voice (G‐code: G9171), FCM Level 5 (Modifier: CJ) Projected Goal: FCM Level 5 (Modifier: CJ)

Reporting on the Claim (Required for each time an evaluation procedure is billed)


o Line 1: CPT/HCPCS: 92524, Modifier:GN o Line 2: CPT/HCPCS: G9171, Modifier: GN, CJ (Current status of voice limitation) o Line 3: CPT/HCPCS: G9172, Modifier: GN, CJ (Status of projected goal for voice limitation at discharge) o Line 4: CPT/HCPCS: G9173, Modifier: GN, CJ (Status of voice limitation at discharge)


Scenario 3: Patient Seen for Evaluation and Treatment Not Recommended• Functional limitation: Voice (G-code: G9171), FCM Level 5 (Modifier: CJ)

• Projected Goal: FCM Level 5 (Modifier: CJ)

Reporting on the Claim (Required for each time an evaluation procedure is billed)



o Line 2: CPT/HCPCS: G9171, Modifier: GN, CJ (Current status of voice limitation)

o Line 3: CPT/HCPCS: G9172, Modifier: GN, CJ (Status of projected goal for voice limitation at discharge)

o Line 4: CPT/HCPCS: G9173, Modifier: GN, CJ (Status of voice limitation at discharge)


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Functional limitation: Voice (G‐code: G9171), FCM Level 3 (Modifier: CL) Projected Goal: FCM Level 7 (Modifier: CH)

Reporting on the Initial Claim (Provider #1)

Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92524, Modifier:GN o Line 2: CPT/HCPCS: G9171, Modifier: GN, CL (Current status of voice limitation) o Line 3: CPT/HCPCS: G9172, Modifier: GN, CH (Status of projected goal for voice limitation at

discharge) o Line 4: CPT/HCPCS: G9173, Modifier: GN, CL (Status of voice limitation at discharge)


Reporting on the Claim for Treatment (Provider #2 – Considered first visit)

Patient is seen by treating provider, who determines the projected goal should be FCM Level 5 (Modifier: CJ). Box 24.D. (Procedures, Services, or Supplies)

o Line 1: CPT/HCPCS: 92507, Modifier: GN o Line 2: CPT/HCPCS: G9171, Modifier: GN, CL (Current status of voice limitation) o Line 3: CPT/HCPCS: G9172, Modifier: GN, CJ (Projected goal for voice limitation)



Scenario 4: Patient Seen for Evaluation and Referred for Treatment• Functional limitation: Voice (G-code: G9171), FCM Level 3 (Modifier: CL)

• Projected Goal: FCM Level 7 (Modifier: CH)




o Line 2: CPT/HCPCS: G9171, Modifier: GN, CL (Current status of voice limitation)

o Line 3: CPT/HCPCS: G9172, Modifier: GN, CH (Status of projected goal for voice limitation at discharge)

o Line 4: CPT/HCPCS: G9173, Modifier: GN, CL (Status of voice limitation at discharge)



Patient is seen by treating provider, who determines the projected goal should be FCM Level 5 (Modifier: CJ).



o Line 2: CPT/HCPCS: G9171, Modifier: GN, CL (Current status of voice limitation)

o Line 3: CPT/HCPCS: G9172, Modifier: GN, CJ (Projected goal for voice limitation)


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Functional limitation: Voice (G‐code: G9171), FCM Level 3 (Modifier: CL) Projected Goal: FCM Level 7 (Modifier: CH)


Box 24.D. (Procedures, Services, or Supplies) o Line 1: CPT/HCPCS: 92524, Modifier:GN o Line 2: CPT/HCPCS: G9171, Modifier: GN, CL (Current status of voice limitation) o Line 3: CPT/HCPCS: G9172, Modifier: GN, CH (Status of projected goal for voice limitation at

discharge) o Line 4: CPT/HCPCS: G9173, Modifier: GN, CL (Status of voice limitation at discharge)



Patient is seen by treating provider, who determines the projected goal should be FCM Level 5 (Modifier: CJ). Box 24.D. (Procedures, Services, or Supplies)

o Line 1: CPT/HCPCS: 92507, Modifier: GN o Line 2: CPT/HCPCS: G9171, Modifier: GN, CL (Current status of voice limitation) o Line 3: CPT/HCPCS: G9172, Modifier: GN, CJ (Projected goal for voice limitation)










Patient has completed treatment at treatment visit #10 and is discharged from plan of care.



o Line 2: CPT/HCPCS: G9173, Modifier: GN, CJ (Status of voice limitation at discharge)

o Line 3: CPT/HCPCS: G9172, Modifier: GN, CJ (Status of projected voice goal at discharge=goal met)


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o Line 1: CPT/HCPCS: 92507, Modfier: GN o No additional outcome/goal reporting


Patient has completed treatment at treatment visit #10 and is discharged from plan of care.


o Line 1: CPT/HCPCS: 92507, Modifier: GN o Line 2: CPT/HCPCS: G9173, Modifier: GN, CJ (Status of voice limitation at discharge) o Line 3: CPT/HCPCS: G9172, Modifier: GN, CJ (Status of projected voice goal at discharge=goal met)





Maintenance therapy can be performed by an SLP if skilled services are rendered. CMS requires reporting minimally every 60 days. If the maintenance therapy is so infrequent that the 10th treatment is not within 60 days, reporting will be required. This patient is seen once every other week, requiring reporting at the 60 day interval.

Functional limitation: Motor Speech (G‐code: G8999), FCM Level 4 (Modifier: CK) Projected Goal: FCM Level 4 (Modfier: CK)

Reporting on the Claim at first evaluation (Note: Motor speech codes are not in sequential order)


o Line 1: CPT/HCPCS: 92507, Modifier:GN o Line 2: CPT/HCPCS: G8999, Modifier: GN, CK (Current status of motor speech limitation) o Line 3: CPT/HCPCS: G9186, Modifier: GN, CK (Projected goal of motor speech limitation)


Reporting on the Claim (60 day interval)


o Line 1: CPT/HCPCS: 92507, Modifier:GN o Line 2: CPT/HCPCS: G9158, Modifier: GN, CK (Status of motor speech limitation at discharge) o Line 3: CPT/HCPCS: G9186, Modifier: GN, CK (Status of projected motor speech goal at discharge)


Scenario 5: Patient Seen for Maintenance TherapyMaintenance therapy can be performed by an SLP if skilled services are rendered. CMS requires reporting minimally every 60 days. If the maintenance therapy is so infrequent that the 10th treatment is not within 60 days, reporting will be required. This patient is seen once every other week, requiring reporting at the 60 day interval.

• Functional limitation: Motor Speech (G-code: G8999), FCM Level 4 (Modifier: CK)

• Projected Goal: FCM Level 4 (Modifier: CK)

Reporting on the Claim at First Evaluation (Note: Motor speech codes are not in sequential order)



o Line 2: CPT/HCPCS: G8999, Modifier: GN, CK (Current status of motor speech limitation)

o Line 3: CPT/HCPCS: G9186, Modifier: GN, CK (Projected goal of motor speech limitation)





o Line 2: CPT/HCPCS: G9158, Modifier: GN, CK (Status of motor speech limitation at discharge)

o Line 3: CPT/HCPCS: G9186, Modifier: GN, CK (Status of projected motor speech goal at discharge)


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Maintenance therapy can be performed by an SLP if skilled services are rendered. CMS requires reporting minimally every 60 days. If the maintenance therapy is so infrequent that the 10th treatment is not within 60 days, reporting will be required. This patient is seen once every other week, requiring reporting at the 60 day interval.

Functional limitation: Motor Speech (G‐code: G8999), FCM Level 4 (Modifier: CK) Projected Goal: FCM Level 4 (Modfier: CK)

Reporting on the Claim at first evaluation (Note: Motor speech codes are not in sequential order)


o Line 1: CPT/HCPCS: 92507, Modifier:GN o Line 2: CPT/HCPCS: G8999, Modifier: GN, CK (Current status of motor speech limitation) o Line 3: CPT/HCPCS: G9186, Modifier: GN, CK (Projected goal of motor speech limitation)




o Line 1: CPT/HCPCS: 92507, Modifier:GN o Line 2: CPT/HCPCS: G9158, Modifier: GN, CK (Status of motor speech limitation at discharge) o Line 3: CPT/HCPCS: G9186, Modifier: GN, CK (Status of projected motor speech goal at discharge)



Chapter 6: Physician Quality Reporting System (PQRS) for AudiologyBackgroundThe Physician Quality Reporting System (PQRS) was designed to support improvements in quality of care for Medicare beneficiaries through the tracking of practice patterns. PQRS was initially implemented as a voluntary, incentive-driven program; however, beginning in 2015, it transitioned fully to a penalty for nonparticipation or failure to meet benchmark requirements.

PQRS applies to audiologists who bill fee-for-service outpatient Medicare Part B beneficiaries using the CMS-1500 or electronic equivalent in the following clinical settings:

• Independent private practice

• Group practices (ENT, group audiology)

• University clinics (not university medical centers/hospitals)

PQRS does not apply to facilities because of the billing form that is used.

PQRS participation is measured via the individual’s National Provider Identifier (NPI) for audiologists listed on the claim as the provider rendering the billed services to outpatient Medicare Part B beneficiaries.

2016 Benchmark RequirementsCMS captures the data for PQRS from the claim form via nonpayable codes. The codes typically represent one of the following situations:

• Performance criteria for the measure were met.

• The patient did not qualify due to acceptable exclusions stated in the measure specifications.

• Performance criteria for the measure were not met.

Only positive performances are calculated for the benchmark requirements. Patients who are excluded from the measure for qualifying reasons are not counted in the total visits, and audiologists are not penalized for those patients.

The benchmarks for participation in 2016 are 50% of the qualifying visits. In other words, an audiologist must have performed the measure for a minimum of 50% of either the Medicare patient visits or the number of Medicare patients, depending on the specifications of the codes.

The analysis for the payment adjustment is based on participation 2 years prior to the payment adjustment. In other words, 2014 participation determines the application of the 2016 –2% payment adjustment on all procedures billed under the Medicare Physician Fee Schedule (MPFS). For nonparticipation or failure to meet the benchmark requirements in 2016, a –2% penalty will apply to 2018 claims.

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Measure Action Required Benchmark PQRS Code for Claims

Measure #130: Documentation of Current Medications in the Medical Record

Audiologists need to make their best efforts to document, update, or review a list of the patient’s current medications. This does not involve pharmacological assessment. The medication name, dosage, frequency, and route should be included.

50% of all Medicare patient visits for CPT codes 92541, 92542, 92543, 92544, 92545, 92547, 92548, 92557, 92567, 92568, 92570, 92585, 92588, and 92626.

G8427: Provider has documented in the record that he or she has obtained, updated, or reviewed the patient’s current medications or that the patient is not taking any medications.

G8430: Patient is in an emergency medical situation, and medications were not documented.

G8428: There is no documentation of provider obtaining, updating, or reviewing the patient’s current medications.

Measure #134: Screen for Depression and Follow-up

A standardized screen for depression must be performed as well as a documented follow-up plan for positive findings. Standardized tests include Depression Scale, Geriatric Depression Scale, or Beck Depression Inventory. The follow-up plan must include referral to another provider or a development of a treatment plan.

50% of all Medicare patient visits for CPT code 92625 (tinnitus evaluation).

G8431: Positive screen for depression with follow-up plan is documented.

G8510: Negative screen for depression is documented.

G8433: Patient is excluded and not eligible for screen due to severe mental/physical incapacity or emergency medical situation.

G8940: Screen is positive, but patient is not eligible due to severe mental/physical incapacity or emergency medical situation.

G8511: Screen for depression is positive, but there is no documentation of a follow-up plan.

G8432: There is no documentation of pain assessment.

Measure #154: Falls: Risk Assessment

The audiologist must assess, through balance and counseling, if there is a risk of falling. The assessment MUST include a balance assessment AND one or more of the following screenings: postural blood pressure, vision, home falls hazards, or evidence/documentation of medication effects.

Reporting this measure may require multiple codes and modifiers as well as a follow-up with Measure #155.

Modifiers indicate that the patient did not qualify or that action was not completed or documented.

50% of all Medicare patients seen in a calendar year for CPT codes 92540, 92541, 92542, and 92548.

3288F AND 1100F: Risk assessment for falls was completed. Measure #155 is required (see next measure).

3288F with modifier 1P AND 1100F: Risk assessment was not completed due to medical reasons (patient not ambulatory). Measure #155 is required (see next measure).

1101F: Patient not eligible because there are fewer than two documented falls or no falls without injury.

1101F with modifier 8P: There is no documentation of falls status.

3288F with modifier 8P AND 1100F: Risk assessment is not documented. Measure #155 is required (see next measure).

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In 2016, to avoid the 2018 negative 2% payment adjustment, audiologists need to perform and report the following actions:



Measure #155: Falls: Plan of Care

The audiologist must document a plan of care after a positive falls risk assessment. The plan of care must include a referral to a physician and a recommendation for balance, strength, or gait training.

Reporting this measure may require multiple codes and modifiers as well as follow-up with Measure #155.

Modifiers indicate that the patient did not qualify or that action was not completed or documented.


518F: Falls plan of care is documented.

0518F with modifier 1P: Falls plan of care is not documented for medical reasons (patient is not ambulatory).

0518F with modifier 8P: Falls plan of care is not documented.

Measure #226: Tobacco Use: Screening and Cessation Intervention

The audiologist must ask the patient if he or she smokes. If so, a brief (3-minute or less) consultation on the effects of smoking should be offered.

50% of all Medicare patients seen in a calendar year for CPT codes 92540, 92557, and 92625.

4004F: Patient was screened for tobacco use and received brief counseling.

1036F: Patient is a tobacco nonuser.

4004F, modifier 1P: For medical reasons, patient was not screened for tobacco use.

4004F, modifier 8P: Neither tobacco screening NOR counseling was documented.

Measure #261: Referral for Acute or Chronic Dizziness

The audiologist must (a) ensure that the patient is under the care of a physician for his or her acute or chronic dizziness or (b) refer the patient to an ENT.

Reporting this measure requires the patient to qualify with the diagnosis and the procedure code.

50% of all Medicare patients diagnosed with ICD-10-CM codes H81.10, H81.11, H81.12, H81.13, and R42 AND seen in a calendar year for CPT codes 92540, 92541, 92542, 92543, 92545, 92546, 92547,2548, 92550, 92557, 92567, 92568, 92570, and 92575.

G8856: Referral to physician was documented.

G8857: Patient is already under the care of a physician for dizziness.

G8858: Referral to physician is not documented.

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The audiologist receives positive “credit” for documentation of a follow-up plan for the Falls: Plan of Care (Measure #155). However, because there was no documentation of screenings for postural blood pressure, vision, home falls hazards, or evidence/documentation of medication effects in the falls risk assessment, the audiologist does not receive a performance credit for Falls: Risk Assessment (Measure #154.) The audiologist performed Measure #226 (Tobacco Use: Screening and Cessation Intervention) and Measure #130 (Documentation of Current Medications in the Medical Record) correctly. Because the patient was already under the care of a physician for dizziness (via the referral from the ENT), even though the audiologist referred the patient back to the ENT, it was more appropriate to select exclusion code G8857 for Measure #261 (Referral for Acute or Chronic Dizziness).

Measure Applicability Validation (MAV)—a process that is not available until the beginning of each calendar year—may eliminate some of the requirements for reporting, but it will not increase requirements. For the most current information, additional measure details, flowcharts, and other PQRS reporting rules, see Physician Quality Reporting System for Audiologists at www.asha.org/Advocacy/audiologyPQRI/.

Example

A patient is referred from an ENT for a vestibular evaluation (CPT 92540). Before the appointment, the audiologist had requested that the patient bring his list of medications—including medication name, dosage, frequency, and route. At the appointment, the audiologist collects and reviews the list of medications and asks the patient if he smokes. The patient indicates “yes,” and the audiologist educates him briefly. The audiologist also ascertains that the patient has experienced significant falls, with injury, in his home three times during the past year. However, no additional assessment of the environment, home hazards, vision, medication, or blood pressure is noted. The vestibular evaluation indicates mild Benign Paroxysmal Positional Vertigo (BPPV) for the right ear as well as a general sense of dizziness and unbalance, so the audiologist uses ICD-10 codes H81.11 and R42 on the claim form. After the evaluation, the audiologist discusses treatment options for the BPPV and refers the patient back to the ENT with recommendations of treatment for the BPPV and further gait assessment. All of this is documented in the medical record, and the codes are added to the claim form (see figure below).

http://www.asha.org/Advocacy/audiologyPQRI/


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Chapter 7: Physician Quality Reporting System (PQRS) for Speech-Language PathologyBackgroundThe Physician Quality Reporting System (PQRS) was designed to support improvements in quality of care for Medicare beneficiaries through the tracking of practice patterns. PQRS was initially implemented as a voluntary, incentive-driven program; however, beginning in 2015, it transitioned fully to a penalty for nonparticipation or failure to meet benchmark requirements.

PQRS applies to speech-language pathologists (SLPs) who bill fee-for-service outpatient Medicare Part B beneficiaries using the CMS-1500 or electronic equivalent in the following clinical settings:

• Independent private practice

• Group practices (ENT, therapy practices)

• University clinics (not university medical centers/hospitals)

PQRS does not apply to facilities because of the billing form that is used.

PQRS participation is measured via the individual’s National Provider Identifier (NPI) for SLPs on the claim as the provider rendering the billed services to outpatient Medicare Part B beneficiaries.

2016 Benchmark RequirementsCMS captures the PQRS data from the claim form via nonpayable codes. The codes typically represent one of the following situations:

• Performance criteria for the measure were met.

• The patient did not qualify due to acceptable exclusions stated in the measure specifications.

• Performance criteria for the measure were not met.

Only positive performances are calculated for the benchmark requirements. Patients who are excluded from the measure for qualifying reasons are not counted in the total visits, and SLPs are not penalized for those patients.

The benchmarks for participation in 2016 are 50% of the qualifying visits. In other words, an SLP must have performed the measure for a minimum of 50% of either the Medicare patient visits or the number of Medicare patients, depending on the specifications of the codes.

The analysis for the payment adjustment is based on participation 2 years prior to the payment adjustment. In other words, 2014 participation determines the application of the 2016 –2% payment adjustment on all procedures billed under the Medicare Physician Fee Schedule (MPFS). For nonparticipation or failure to meet benchmark requirements in 2016, a –2% penalty will apply to 2018 claims.


Measure #130: Documentation of Current Medications in the Medical Record

SLPs need to make their best efforts to document, update, or review a list of the patient’s current medications. This does not involve pharmacological assessment. The medication name, dosage, frequency, and route should be included.

50% of all Medicare patient visits for CPT codes 92507, 92508, 92526, 92626, and 97532.

G8427: Provider has documented in the record that he or she has obtained, updated, or reviewed the patient’s current medications or that the patient is not taking any medications.

G8430: Patient is in an emergency medical situation, and medications were not documented.

G8428: There is no documentation of provider obtaining, updating, or reviewing the patient’s current medications.

2016 Reporting Requirements In 2016, to avoid the 2018 negative 2% payment adjustment, SLPs need to perform and report the following actions:


Example

A patient is seen on a date of service for a speech-language evaluation (CPT 92523) followed by a treatment session (CPT 92507). Before the appointment, the SLP had requested that the patient bring her list of medications—including medication name, dosage, frequency, and route. At the appointment, the SLP collects and reviews the list of medications and administers the Faces Pain Scale, which indicates no pain at this time. The SLP also asks the patient if she smokes. The patient indicates “yes,” and the SLP educates her briefly. However, the SLP does not document this brief counseling in the medical record. The PQRS codes are added to the claim form (see figure below).


Measure #131: Pain Assessment and Follow-Up

A standardized pain assessment must be performed as well as a documented follow-up plan for positive findings. Standardized tests include Brief Pain Inventory, Faces Pain Scale, Numeric Rating Scale, and McGill Pain Questionnaire. The follow-up plan must include referral to another provider or development of a treatment plan.

50% of all Medicare patient visits for CPT codes 92507, 92508, 92526, and 97532.

G8730: Positive pain assessment with follow-up plan is documented.

G8731: Negative pain assessment is documented.

G8442: Patient not eligible due to severe mental/physical incapacity or emergency medical situation.

G8939: Pain assessment is positive, but patient is not eligible for follow-up due to severe mental/physical incapacity or emergency medical situation.

G8732: There is no documentation of pain assessment.

G8509: Positive pain assessment is documented, but there is no documentation of a follow-up plan.

Measure #226: Tobacco Use: Screening and Cessation Intervention

The SLP must ask the patient if he or she smokes. If so, a brief (3-minute or less) consultation on the effects of smoking should be offered.


4004F: Patient was screened for tobacco use and received brief counseling.

1036F: Patient is a tobacco nonuser.

4004F, modifier 1P: For medical reasons, patient was not screened for tobacco use.

4004F, modifier 8P: Neither tobacco screening NOR counseling was documented.

The SLP receives positive “credit” for documentation of the medication (G8427 for Measure #130, Documentation of Current Medications in the Medical Record) and the pain assessment (G8731 for Measure #131, Pain Assessment and Follow-Up). However, because counseling for tobacco use (Measure #226) was not documented in the record, this performance criterion was not met. When performance criterion is not met for Measure #226, reporting on the claim for requires the code (4004F) with the 8P modifier. Therefore, the SLP does not receive a performance credit for Measure #226.

For the most current information, additional measure details, flowcharts, and other PQRS reporting rules, see PQRS Measures Available for SLPs to Report on Claims at http://www.asha.org/Practice/reimbursement/medicare/PQRS-Measures-Available-for-SLPs-to-Report-on-Claims/

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http://www.asha.org/Practice/reimbursement/medicare/PQRS-Measures-Available-for-SLPs-to-Report-on-Claims/

http://www.asha.org/Practice/reimbursement/medicare/PQRS-Measures-Available-for-SLPs-to-Report-on-Claims/


Chapter 8: National Correct Coding Initiative (NCCI) EditsThe National Correct Coding Initiative (NCCI, or more commonly, CCI) is an automated edit system to control specific Current Procedural Terminology (CPT) code pairs that can be reported on the same day. It was developed by the Centers for Medicare and Medicaid Services (CMS) for use in all Medicare Part B and, more recently, Medicaid claims. The goal of CCI is to eliminate “mutually exclusive” code pairings and codes considered to be components of more comprehensive services or otherwise inappropriate to be delivered to the same patient on the same day. The CCI is updated quarterly.

A subset of the CCI edits is the Outpatient Code Editor (OCE), which applies only to hospital outpatient services. Typically, the OCE edits for audiology are similar to those in the CCI system. The OCE revisions also occur quarterly, but one quarter after the revised CCI edits are implemented.

The CCI also includes a set of edits called Medically Unlikely Edits (MUEs), also for Medicare Part B and Medicaid claims. An MUE for a CPT or HCPCS Level II code is the maximum number of times that the code can be reported for the same patient on the same day. Not all codes have an MUE and/or CCI edit.

Audiology ProceduresThe following tables for audiology related CCI and OCE edits are derived from the complete lists of edits published on the Centers for Medicare & Medicaid Services (CMS) CCI website www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html. They apply to both Medicare Part B and Medicaid services.

The tables list:

• Code pairs that cannot be billed together for the same patient on the same date of service

• Code pairs that can be billed together for the same patient on the same date of service by attaching a -59 modifier to bypass the code edit. The modifier indicates that the two procedures are separate and distinct (must be supported in the medical record)

• Modifier -59 should be attached to the CPT code listed in Column 2, when applicable

Note: Audiology-related code pairs that are not listed here are not subject to CCI restrictions and can be billed on the same day without a modifier. However, audiologists should also be aware of Medically Unlikely Edit (MUE) restrictions www.asha.org/Practice/reimbursement/coding/Medically-Unlikely-Edits-Audiology/.

Table 1: CCI and OCE Edits[1] for Audiology ServicesNote: CPT 69210, cerumen removal, cannot be paid when billed on the same day as any audiometric or vestibular test. Removal of cerumen is included in the fee for diagnostic tests. See Medicare Coverage Policy on Cerumen Management for additional information www.asha.org/Practice/reimbursement/medicare/cerumen/.

Column 1

CPT Procedure (one)

Column 2

Paired With (one)

Can be performed on same date? Yes/No

If so, use what

modifier?2

Office settingHospital

outpatient setting1

92521, 92522, 92523, 92524 69210 (cerumen removal), 92620 (CAPD evaluation), 92621 (CAPD evaluation add-on)

N N N/A

92540 92541, 92542, 92544, 92545 N N N/A

92541 92542, 92544, 92545 Y Y -59

92542 92544, 92545 Y Y -59

92544 92545 Y Y -59

92550 92567, 92568 N N N/A

92553 92552 or 92556 N N N/A

92556 92555 N N N/A

92557 92552, 92553, 92555, or 92556

N N N/A

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http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

http://www.asha.org/Practice/reimbursement/coding/Medically-Unlikely-Edits-Audiology/

http://www.asha.org/Practice/reimbursement/medicare/cerumen/


1 Hospital outpatient coding edits are determined by the Outpatient Code Editor (OCE) system which usually includes the same therapy edits. New OCE edits are implemented in hospitals one quarter after initiated as CCI edits.2 The -59 modifier denotes that the procedure is distinct or independent from other services performed on the same day. The modifier is attached to the column 2 CPT code, when applicable.

Column 1

CPT Procedure (one)

Column 2

Paired With (one)


If so, use what

modifier?2


outpatient setting1

92563 92552 or 92553 N N N/A

92568 92567 N N N/A

92570 92550, 92567, 92568 N N N/A

92585 92586 (ABR limited) N N N/A

92588 92587 (EOE limited) Y Y -59

92620 92571, 92572, 92576 N N N/A

92620 92626 Y Y -59

92621 92571, 92572, 92576 N N N/A

92625 92562 Y Y -59

92626 92621 Y Y -59

92640 92507, 92508, 92550, 92552, 92553, 92555-92558, 92561-92568, 92570-92572, 92575-92577, 92579, 92582-92588, 92596, 97755

Y Y -59

Table 2: CCI and OCE Edits[1] for Cochlear Implant Programming

Column 1

CPT Procedure (one)

Column 2

Paired With (one)


If so, use what

modifier?2


outpatient setting1

92601 92507, 92508, 92550, 92567, 92568, 92570, 92585, 92586, 92602, 92626

Y Y -59

92601 92552-92565, 92569-92584, 92587-92588, 92596-92597, 92603, 92604, 97755

N N N/A

92602 92507, 92508, 92567, 92568, 92585, 92586, 92626

Y Y -59

92602 92552-92565, 92569-92584, 92587-92597, 92604, 97755

N N N/A

92603 92567, 92568, 92585, 92586, 92604, 92626

Y Y -59

92603 92552-92565, 92569-92584, 92587-92597, 92602, 97755

N N N/A

92604 92507, 92508, 92626, 92567, 92568, 92585, 92586

Y Y -59

92604 92552-92565, 92569-92584, 92587-92597, 97755

N N N/A

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Speech-Language Pathology ProceduresThe following tables for speech-language pathology related CCI and OCE edits are derived from the complete lists of edits published on the Centers for Medicare & Medicaid Services (CMS) CCI website www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html. They apply to both Medicare Part B and Medicaid services.

The tables list:

• Code pairs that cannot be billed together by one provider for the same patient on the same date of service

• Code pairs that can be billed together for the same patient on the same date of service by attaching a -59 modifier to bypass the code edit. The modifier indicates that the two procedures are separate and distinct (must be supported in the medical record)

• Modifier -59 should be attached to the CPT code listed in Column 2, when applicable

Note: SLP-related code pairs that are not listed here are not subject to CCI restrictions and can be billed on the same day without a modifier. However, speech-language pathologists should also be aware of Medically Unlikely Edit (MUE) restrictions www.asha.org/Practice/reimbursement/coding/Medically-Unlikely-Edits-SLP/.

Table 1: CCI Edits and OCE Edits[1] for Speech-Language Pathology Procedures

Column 1

CPT Procedure (one)

Column 2

Paired With (one)


If so, use what

modifier?2


outpatient setting1

31575[3] 31579 N N N/A

31579[3] (videostrobe) 70371, 92520 Y Y -59

74230[4] 70731, 74210, 74220 N/A N N/A

92507, 92508 [5] 97532, 97533 N (when both are provided by SLP)

N (when both are provided by SLP)

N/A

92508 (SLP group) 92507 Y Y -59

92520 (laryngeal function) 70371 (rad. speech eval) Y Y -59

92521 (fluency evaluation) 96105, 96125 Y Y -59

92521 92620, 92621 N N N/A

92522 (speech sound production evaluation)

96105, 96125 Y Y -59

92522 92620, 92621 N N N/A

92523 (speech sound production and language evaluation)

92522, 92620, 92621 N N N/A

92523 96105, 96125 Y Y -59

92524 (qualitative analysis of voice and resonance)

96105, 96125 Y Y -59

92524 92620, 92621 N N N/A

92526 97532 Y Y -59

92526 (dysphag tx) 92520 (laryngeal function), 92511

Y Y -59

92526 (dysphag tx) (G0283=97014), 97032 N N N/A

92607 (SGD eval) 92507, 92508, 92521, 92522, 92523, 92524, 92609

Y Y -59

92607 92597 (voice prosth eval), 97755

N/A N N/A

http://www.asha.org/Practice/reimbursement/coding/Medically-Unlikely-Edits-SLP/


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Column 1

CPT Procedure (one)

Column 2

Paired With (one)


If so, use what

modifier?2


outpatient setting1

92608 97755 N N N/A

92609 92507, 92508, 92521, 92522, 92523, 92524

Y Y -59

92609 97755 N N N/A

92610 92511 Y Y -59

92611 (MBS) 92511, 92610 Y Y -59

92611 76120, 76125 N N N/A

92612 (FEES) 31575, 92511, 92520, 92614 N N N/A

92612 92610, 92611 Y Y -59

92613 92520 N N N/A

92613, 92615, 92617 (physician report)

92610, 92611 Y Y -59

92614 (sensory test) 92610, 92611 Y Y -59

92614 31575, 92511, 92520 N N N/A

92615 92520, 92613 N N N/A

92616 (FEESST) 31575, 92511, 92520, 92612, 92614

N N N/A

92616 92610, 92611 Y Y -59

92617 92520, 92613, 92615 N N N/A

96105 (aphasia assessment) 96110 (dev screen), 96111 (dev testing), 96125 (cognitive testing)

Y Y -59

96110 (dev screen), 96111 (dev testing)

96125 (cognitive testing) Y Y -59

1 Hospital outpatient coding edits are determined by the Outpatient Code Editor (OCE) system which usually includes the same therapy edits as CCI edits. New OCE edits are implemented in hospitals one quarter after initiated as CCI edits. CMS Transmittal 254 (7-30-04) confirms that OCE edits are limited to hospital outpatients. With reference to Transmittal 254, denials should be appealed if based on OCE edits extended to skilled nursing facility, comprehensive outpatient rehabilitation facility, and rehabilitation agency settings.2 The -59 modifier denotes that the procedure is distinct or independent from other services performed on the same day. The modifier is attached to the column 2 CPT code, when applicable.3 There is no level of supervision designated in the Medicare Physician Fee Schedule for laryngoscopy (CPT 31575), videostrobscopy (CPT 31579), and nasopharyngoscopy (CPT 92511). However, state and/or Medicare Administrative Contractor (MAC) supervision requirements may supersede Medicare’s requirement. Some states have endoscopy laws/regulations specific to speech-language pathologists, including California, New Jersey, Illinois, Michigan, and Tennessee. Other states such as Maryland, New York, and Virginia have policy statements and/or guidance documents. In some cases, the licensure laws and regulations may refer only to fiberoptic endoscopic evaluation of swallowing (FEES) or to all forms of endoscopy. For further information, see; www.asha.org/Practice/reimbursement/medicare/Medicare-Supervision-Requirements-for-Videostroboscopy-and-Nasopharyngoscopy-Procedures/.4 The 7000 series are radiology codes. These codes are included here for information purposes and not for billing by speech-language pathologists.5 A single practitioner, such as an SLP, should not bill CPT codes 92507 or 92508 on the same date of service as 97532 or 97533. However, if the two types of services are performed by different types of practitioners on the same date of service (e.g., an SLP bills 92507 and a PT bills 97532), then the codes may be billed together using the -59 modifier.




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Chapter 9: ASHA Model SuperbillsASHA developed superbills for both audiology and speech-language pathology. The superbill is a standard form that health plans use to process claims. For the professional rendering services, it provides a time efficient means to document services, fees, codes, and other information (i.e., certification and licensure) required by insurance companies. The patient uses this form to file for health plan payment.

Model Superbill for AudiologyThe following is a model of a superbill that could be used by an audiology practice when billing private health plans. This sample is not meant to dictate which services should or should not be listed on the bill. Most billable codes are from the American Medical Association (AMA) Current Procedural Terminology (CPT)© 2016. Prosthetic and durable medical equipment codes, such as hearing aid codes, are published by the Centers for Medicare & Medicaid Services (CMS) as the Healthcare Common Procedure Code System (HCPCS).

Note: This is only a model; therefore, some procedures, codes, or other pertinent information may not be included. You can find the copy of the Audiology Superbill at www.asha.org/uploadedFiles/ModelSuperbillAud.pdf


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MODEL AUDIOLOGY SUPERBILL

PATIENT: INSURED: REFERRING PHYSICIAN: ADDRESS: FILE: INSURANCE PLAN: DATE: INSURANCE PLAN #: DATE INITIAL SYMPTOM: DATE FIRST CONSULTATION: PLACE OF SERVICE: HOME OFFICE OTHER:

DIAGNOSIS: PRIMARY (Audiology): ICD-10/9 CODE: SECONDARY (Medical): ICD-10/9 CODE: HEARING AID/EARMOLD DEFECT:

SERVICES:

PROCEDURE CPT CHARGE Audiological Assessment Procedures Tympanometry and reflex threshold

measurements 92550 Screening test, pure tone, air only 92551 Pure tone audiometry (threshold);air only 92552 Pure tone audiometry (threshold); air and

bone 92553 Speech audiometry threshold 92555 Speech audiometry threshold; w/speech

recognition 92556 Comprehensive audiometry threshold

evaluation and speech recognition 92557 Audiometric testing of groups 92559 Bekesy audiometry; screening 92560 Bekesy audiometry; diagnostic 92561 Loudness balance test, alternate binaural or

monaural 92562 Tone decay test 92563 Short increment sensitivity index (SISI) 92564 Stenger test, pure tone 92565 Tympanometry (impedance testing) 92567 Acoustic reflex testing, threshold 92568 Acoustic immittance testing, includes

tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing 92570

Filtered speech test 92571 Staggered spondaic word test 92572 Sensorineural acuity level test 92575 Synthetic sentence identification test 92576 Stenger test, speech 92577 Visual reinforcement audiometry (VRA) 92579 Conditioning play audiometry 92582 Select picture audiometry 92583 Electrocochleography 92584

PROCEDURE CPT CHARGE Auditory evoked potentials, comprehensive 92585 Auditory evoked potentials, limited 92586 Evoked otoacoustic emissions, screening

(qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis 92558

Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report 92587

Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report 92588

Evaluation of central auditory function, with report; initial 60 minutes 92620

each additional 15 minutes 92621 Assessment of tinnitus (includes pitch,

loudness matching, and masking) 92625

Hearing Aid Assessment and Fitting Procedures Hearing aid exam and selection; monaural 92590 Hearing aid exam and selection; binaural 92591

Hearing aid check; monaural 92592 Hearing aid check; binaural 92593 Electroacoustic evaluation for hearing aid;

monoaural 92594 binaural 92595 Ear protector attenuation measurements 92596

Vestibular and Balance System Assessment Procedures Spontaneous nystagmus, including gaze 92531 Positional nystagmus test 92532 Caloric vestibular test, each irrigation

(binaural, bithermal stimulation constitutes 4 tests) 92533

Optokinetic nystagmus test 92534


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PROCEDURE CPT CHARGE Caloric vestibular test with recording,

bilateral; bithermal 92537 monothermal 92538 Basic vestibular evaluation, incl. spontaneous

nystagmus test w/eccentric gaze fixation nystagmus, w/recording, positional nystagmus test, min. of 4 positions, w/recording, optokinetic nystagmus test, bidirectional foveal & peripheral stimulation, w/recording, & oscillating tracking test, w/recording 92540

Spontaneous nystagmus test, incl. gaze and fixation nystagmus, with recording 92541

Positional nystagmus test, minimum of four positions 92542

Optokinetic nystagmus test, bi-directional, foveal or peripheral stimulation, w/ recording 92544

Oscillating tracking test, with recording 92545 Sinusoidal vertical axis rotational testing 92546 Use of vertical electrodes in any or all of the

above tests 92547 Computerized dynamic posturography 92548

Vestibular and Balance Rehabilitation Services Canalith repositioning procedure(s) (eg, Epley

maneuver, Semont maneuver) per day. 95992

Cerumen Management Services Removal of impacted cerumen, one or both

ears 69210

Auditory Implant Services Cochlear implant follow-up exam <7 years of

age 92601

Reprogram cochlear implant <7 years of age 92602 Cochlear implant follow-up exam >7 years of

age 92603 Reprogram cochlear implant > 7 years of age 92604 Diagnostic analysis with programming of

auditory brainstem implant, per hour 92640

Habilitative and Rehabilitative Services Treatment of speech, language, voice,

communication, and/or auditory processing disorder; individual 92507

group, two or more individuals 92508 Evaluation of auditory rehabilitation status,

1st hour 92626 each additional 15 minutes 92627 Auditory rehabilitation; pre-lingual hearing

loss 92630 Auditory rehabilitation; post-lingual hearing

loss 92633

Hearing Aids/FM Systems (HCPCS Level II Codes) Assessment for Hearing Aid V5010 Fitting/Orientation/Checking of Hearing Aid V5011 Repair/Modification of a Hearing Aid V5014 Conformity Evaluation V5020 Hearing aid, Monaural, body worn,

air conduction V5030 bone conduction V5040

PROCEDURE CPT CHARGE Hearing Aid, Monaural, in the ear (ITE) V5050 Hearing Aid, Monaural, behind the ear (BTE) V5060 Glasses, air conduction V5070

Glasses, bone conduction V5080 Dispensing fee, Unspecified Hearing Aid V5090 Hearing Aid, bilateral, body worn V5100

Dispensing fee, bilateral V5110 Binaural, body V5120 Binaural, ITE V5130 Binaural, BTE V5140 Binaural, glasses V5150 Dispensing fee, binaural V5160 Hearing Aid, CROS, ITE V5170 Hearing Aid, CROS, BTE V5180 Hearing Aid, CROS, glasses V5190 Dispensing fee, CROS V5200 Hearing Aid, BICROS, ITE V5210 Hearing Aid, BICROS, BTE V5220 Hearing Aid, BICROS, glasses V5230 Dispensing Fee, BICROS V5240 Dispensing Fee, Monaural Hearing Aid V5241 Hearing Aid, Analog, monaural, completely in

the ear canal (CIC) V5242 Hearing aid, analog, monaural, in the canal

(ITC) V5243 Hearing aid, digitally programmable analog,

monaural, CIC V5244 Hearing aid, digitally programmable analog,

monaural, ITC V5245 Hearing aid, digitally programmable analog,

monaural, ITE V5246 Hearing aid, digitally programmable analog,

monaural, BTE V5247 Hearing aid, analog, binaural, CIC V5248 Hearing aid, analog, binaural, ITC V5249 Hearing aid, digitally programmable analog,

binaural, CIC V5250 Hearing aid, digitally programmable analog,

binaural, ITC V5251 Hearing aid, digitally programmable, binaural,

ITE V5252 Hearing aid, digitally programmable, binaural,

BTE V5253 Hearing aid, digital, monaural, CIC V5254 Hearing aid, digital, monaural, ITC V5255 Hearing aid, digital, monaural, ITE V5256 Hearing aid, digital, monaural, BTE V5257 Hearing aid, digital, binaural, CIC V5258 Hearing aid, digital, binaural, ITC V5259 Hearing aid, digital, binaural, ITE V5260 Hearing aid, digital, binaural, BTE V5261 Hearing aid, disposable, any type, monaural V5262 Hearing aid, disposable, any type, binaural V5263

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PROCEDURE CPT CHARGE Earmold/insert, not disposable, any type V5264 Earmold/insert, disposable, any type V5265 Battery for use in hearing device V5266 Hearing aid or assistive listening

device/supplies/accessories, not otherwise specified V5267

Assistive listening device, telephone amplifier, any type V5268

Assistive listening device, alerting, any type V5269 Assistive listening device, television amplifier,

any type V5270 Assistive listening device, television caption

decoder V5271 Assistive listening device, TDD V5272 Assistive listening device, for use with

cochlear implant V5273 Assistive learning device not otherwise

specified V5274 Ear impression, each V5275 Personal FM/DM system, monaural (one

receiver, transmitter and microphone) V5281 Personal FM/DM system, binaural (two

receivers, transmitter and microphone) V5282 Personal FM/DM neck, loop induction

receiver V5283 Personal FM/DM, ear level receiver V5284 Personal FM/DM, direct audio input receiver V5285 Personal blue tooth FM/DM receiver V5286 Personal FM/DM receiver, not otherwise

specified V5287 Personal FM/DM transmitter assistive

listening device V5288 Personal FM/DM adapter/boot coupling

device for receiver, any type V5289

Transmitter microphone, any type V5290 Hearing Service, Miscellaneous V5299

Electrophysiology Procedures Nerve conduction studies; 1-2 studies 95907 3-4 studies 95908 5-6 studies 95909 7-8 studies 95910 9-10 studies 95911 11-12 studies 95912 13 or more studies 95913 Short-latency somatosensory evoked

potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs 95925

in lower limbs 95926 in upper & lower limbs 95938 in the trunk or head 95927

PROCEDURE CPT CHARGE Visual evoked potential (VEP) testing central

nervous system, checkerboard or flash 95930 Neuromuscular junction testing (repetitive

stimulation, paired stimuli), each nerve, any 1 method 95937

Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure) 95940

Continuous neurophysiology monitoring, from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (List separately in addition to code for primary procedure) 95941

Other Procedures Otorhinolaryngological service or procedure 92700 Telephone assessment and management

service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure with the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion 98966

11-20 minutes of medical discussion 98967

21-30 minutes of medical discussion 98968 Online assessment & management service

provided by a qualified nonphysician health care professional to an established patient, guardian, or health care provider not originating from a related assessment & management service provided within the previous 7 days, using the Internet or similar electronic communications network. 98969

Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more; participation by nonphysician qualified health care professional 99366

Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by nonphysician qualified health care professional 99368

Total Charges: $

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BILLING INFORMATION

PREVIOUS BALANCE: $

TODAY’S CHARGES: $

TOTAL DUE: $

PAID TODAY: $

PAID BY: CASH CREDIT VISA MC OTHER

CHECK

BALANCE: $

AUTHORIZATIONS I hereby authorize direct payment of benefits to Audiology & Hearing Center, Inc.

SIGNATURE:

DATE:

I hereby authorize John Smith, PhD, CCC-A to release any information acquired in the course of treatment.

SIGNATURE:

DATE:

John Smith, PhD, CCC-A Audiology & Hearing Center, Inc.

999 Anywhere Street Rockville, MD 00000 (999) 999-9999 PHONE

(888) 888-8888 FAX

NPI # 1234567890 TAX ID # 22-22222 MARYLAND LICENSE # 3333

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Model Superbill for Speech-Language PathologyThe following is a model of a superbill that could be used by a speech-language pathology practice when billing private health plans. This sample is not meant to dictate which services should or should not be listed on the bill. Most billable codes are from the American Medical Association (AMA) Current Procedural Terminology (CPT)© 2016. Prosthetic and durable medical equipment codes, such as speech-generating device codes, are published by the Centers for Medicare & Medicaid Services (CMS) as the Healthcare Common Procedure Code System (HCPCS).

Note: This is only a model; therefore, some procedures, codes, or other pertinent information may not be included. You can find the copy of the Speech-Language Pathology Superbill at www.asha.org/uploadedFiles/ModelSuperbillSLP.pdf

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P a g e | 1

MODEL SPEECH-LANGUAGE PATHOLOGY SUPERBILL

PATIENT: INSURED: REFERRING PHYSICIAN: ADDRESS: FILE: INSURANCE PLAN: DATE: INSURANCE PLAN #: DATE INITIAL SYMPTOM: DATE FIRST CONSULTATION: PLACE OF SERVICE: HOME OFFICE OTHER:

DIAGNOSIS: PRIMARY (Speech-Language Pathology): ICD-10/9 CODE: SECONDARY (Medical): ICD-10/9 CODE:

SERVICES:

PROCEDURE CPT CHARGE Swallowing Function Treatment of swallowing dysfunction and/or

oral function for feeding 92526 Evaluation of oral & pharyngeal swallowing

function 92610 Motion fluoroscopic evaluation of swallowing

function by cine or video recording 92611 Flexible fiberoptic endoscopic evaluation of

swallowing by cine or video recording 92612 interpretation and report only 92613 Flexible fiberoptic endoscopic evaluation,

laryngeal sensory testing by cine or video recording 92614

interpretation and report only 92615 Flexible fiberoptic endoscopic evaluation of

swallowing and laryngeal sensory testing 92616 interpretation and report only 92617 Speech and Language Treatment of speech, language, voice,

communication, and/or auditory processing disorder, individual 92507

group, two or more individuals 92508 Development of cognitive skills to improve

attention, memory, problem solving, direct one-on-one patient contact by the provider; each 15 minutes 97532

Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands; each 15 minutes 97533

Nasopharyngoscopy w/ endoscope 92511 Laryngeal function studies 92520 Evaluation of speech fluency (eg, stuttering,

cluttering) 92521 Evaluation of speech sound production (eg,

articulation, phonological process, apraxia, dysarthria); 92522

Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria) with evaluation of language comprehension and expression (eg, receptive and expressive language) 92523

PROCEDURE CPT CHARGE Behavioral and qualitative analysis of voice

and resonance 92524 Evaluation of auditory rehabilitation status,

first hour 92626 each additional 15 minutes 92627 Auditory rehabilitation; pre-lingual hearing

loss 92630 Auditory rehabilitation; post-lingual hearing

loss 92633 Assessment of aphasia with interpretation

and report, per hour 96105 Developmental screening, with interpretation

and report, per standardized instrument form 96110 Developmental testing, (includes assessment

of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments) with interpretation and report 96111

Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report 96125

Laryngoscopy; flexible fiberoptic; diagnostic 31575 Laryngoscopy; flexible or rigid fiberoptic, with

stroboscopy 31579

Augmentative and Alternative Communication Evaluation for use/fitting of voice prosthetic

device to supplement oral speech 92597 Evaluation for prescription of non-speech

generating augmentative and alternative communication device, face-to-face with the patient; first hour 92605

each additional 30 minutes 92618 Therapeutic service(s) for the use of non-

speech generating augmentative and alternative communication device, including programming and modification 92606

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PROCEDURE CPT CHARGE Evaluation for prescription for speech-

generating augmentative and alternative communication device; face-to-face with the patient; first hour 92607

each additional 30 minutes 92608 Therapeutic services for the use of speech-

generating device, including programming and modification 92609

Repair/Modification of AAC device (excluding adaptive hearing aid) V5336

Other Procedures Otorhinolaryngological service or procedure 92700 Telephone assessment and management

service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure with the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion 98966



PROCEDURE CPT CHARGE Online assessment & management service

provided by a qualified nonphysician health care professional to an established patient, guardian, or health care provider not originating from a related assessment & management service provided within the previous 7 days, using the Internet or similar electronic communications network. 98969

Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more; participation by nonphysician qualified health care professional 99366

Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by nonphysician qualified health care professional 99368

Total Charges: $

BILLING INFORMATION

PREVIOUS BALANCE: $

TODAY’S CHARGES: $

TOTAL DUE: $

PAID TODAY: $

PAID BY: CASH CREDIT VISA MC OTHER

CHECK

BALANCE: $

AUTHORIZATIONS

I hereby authorize direct payment of benefits to Speech Services, Inc.

SIGNATURE:

DATE:

I hereby authorize Jane Smith, MA, CCC-SLP to release any information acquired in the course of treatment.

SIGNATURE:

DATE:

Jane Smith, MA, CCC-SLP Speech Services, Inc. 999 Anywhere Street Rockville, MD 00000 (999) 999-9999 PHONE

(888) 888-8888 FAX

NPI # 1234567890 TAX ID # 22-22222 MARYLAND LICENSE # 3333


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Chapter 10: 1500 Claim FormThe form CMS-1500 is the standard paper claim form used by health care professionals and suppliers to bill Medicare Part A/B and Durable Medical Equipment Medicare Administrative Contractors. To receive reimbursement from Medicare and most state Medicaid agencies, private practitioners must use the CMS-1500 claim form. Many private health plans may also use this claim form.


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Chapter 11: Fee DataDetermining FeesHealth care providers have some flexibility when setting private fees. Clinicians should choose a pricing philosophy and gather available charge information in order to establish a rational fee schedule and to negotiate health care contracts.

Medicare Fee Schedule• You can compare your fees with the current Medicare Fee Schedule:

For audiology found at www.asha.org/uploadedFiles/2016-Medicare-Physician-Fee-Schedule-Audiology.pdf

For speech-language pathology found at www.asha.org/uploadedFiles/2016-Medicare-Physician-Fee-Schedule-SLP.pdf

• Additional Medicare Fee Schedule information can be found at www.asha.org/Practice/reimbursement/medicare/feeschedule/

Current Milliman DataYou can also use fee data (Milliman, 2015) found in this section to determine the average charge per service by CPT code. Use this information to evaluate how your fees compare nationwide. The Milliman data cannot be shared with entities beyond ASHA members and ASHA certified clinicians, but the data can be used as a reference for negotiating rates. Additionally, the Milliman report published here is a condensed version. Not all Exhibit Charts of the full report are included in this publication.

Remember, in determining fees for your services avoid any method that can be construed as price fixing, such as discussing fees with other local practices. Setting prices in collusion with colleagues is illegal.


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November 9, 2015

Commercial Managed Care Contracting Analysis Arthur L. Baldwin III, FSA, MAAA, Principal & Consulting Actuary

Milliman has evaluated the cost of services typically provided by Audiologists and Speech-Language Pathologists, as you requested. Our analysis presents the utilization and the cost of services provided to a typical commercially insured population (i.e., employer funded coverage, excluding Medicare, Medicaid, and other payers). It is our understanding that you intend to use this research to provide your members with an estimate of the cost to payers for their services.

Milliman prepared this analysis for the internal use of the American Speech-Language Hearing Association (ASHA) and its member organizations. The results may not be distributed beyond these entities without the written permission of Milliman. No benefit is intended for any other party, if such permission is granted. This project was completed under the terms of the Consulting Services Agreement between Milliman and the American Speech-Language-Hearing Association, dated April 11, 2003.

Nationwide and Regional Results

Exhibits A1 thru A4, B1 thru B4, and C1 thru C4 are detailed commercial cost models for services that you identified as being typically provided by Audiologists and/or Speech-Language Pathologists (SLP). The exhibits are separated by geographic region, and each one includes the following information, with regional values listed side-by-side with nationwide values:

□ Procedure Code: CPT Code used to describe the service. □ Modifier: Any modifier selected for the service. □ Description: A short description of that particular service. □ Utilization per 1,000: The annual utilization of the procedure per 1,000 commercial members. □ Average Allowed Per Service: The average allowed charges for the service provided. □ Monthly Per Member Claim Cost: The revenue required to provide the services at the level of

utilization at the average allowed amount per service. Note that this ignores the impact of deductibles, copays, coinsurance or other cost sharing.

Note that each set of Exhibits shows the experience of different sets of codes provided by ASHA for specific Specialties or sets of Specialties. Each exhibit is further reproduced by region, labeled with a lower-case letter (e.g. A1-a displays utilization and allowed costs for the selected audiology code for all specialties at the nationwide level):

□ Exhibits A1-a thru j: Audiology codes for All Specialties □ Exhibits A2-a thru j: Audiology codes for Audiologists □ Exhibits A3-a thru j: Audiology codes for SLPs □ Exhibits A4-a thru j: Audiology codes for All Other Specialties □ Exhibits B1-a thru j: Hearing codes for All Specialties □ Exhibits B2-a thru j: Hearing codes for Audiologists □ Exhibits B3-a thru j: Hearing codes for SLPs □ Exhibits B4-a thru j: Hearing codes for All Other Specialties □ Exhibits C1-a thru j: Speech-Language Pathology codes for All Specialties □ Exhibits C2-a thru j: Speech-Language Pathology codes for Audiologists □ Exhibits C3-a thru j: Speech-Language Pathology codes for SLPs □ Exhibits C4-a thru j: Speech-Language Pathology codes for All Other Specialties


As mentioned above, these exhibits display utilization for different regions. A map of these regions can be found in Appendix 1. Each exhibit is provided a suffix, “a” thru “j”, which are defined by the following associations:

Exhibits ending with “a”: Nationwide Exhibits ending with “b”: East North Central Region (IL, IN, MI, OH, WI) Exhibits ending with “c”: East South Central Region (AL, KY, MS, TN) Exhibits ending with “d”: Middle Atlantic Region (DE, NJ, NY, PA) Exhibits ending with “e”: Mountain Region (AZ, CO, ID, MT, NM, NV, UT, WY) Exhibits ending with “f”: New England Region (CT, MA, ME, NH, RI, VT) Exhibits ending with “g”: Pacific Region (AK, CA, HI, OR, WA) Exhibits ending with “h”: South Atlantic Region (DC, FL, GA, MD, NC, SC, VA, WV) Exhibits ending with “i”: West North Central Region (IA, KS, MN, MO, ND, NE SD) Exhibits ending with “j”: West South Central Region (AR, LA, OK, TX)

The claim cost assumptions on these exhibits are estimates only and do not include insurer administration, profit margin, or other premium loading. Actual experience will vary from expected claims cost due to variations in population characteristics, structure of the delivery system, provider contracts, regional differences in the charge level for services and the utilization of services, health status of the underlying population, random fluctuations, and numerous other factors.

Table 1, below, summarizes the per-member-per-month (PMPM) claim costs from the twelve Nationwide exhibits. Note that some HCPCS appear in more than one Code Type and the sum of all values appearing for the individual Code Types will therefore overstate the total cost for each specialty. The Total (Unique HCPCS) line reflects the total PMPM costs for all unique procedure codes.

Please note that throughout our analysis, and in Table 1, allowed costs have not been trended. Costs are representative of the first nine months of 2014.

Methodology, Assumptions and Considerations

Our analysis is based on Milliman Health Cost Guidelines (HCGs) research and other sources, including the MarketScan database. The 2014Q3 MarketScan database used as the basis of our analysis is a proprietary database of more than 640 million commercial outpatient claims lines incurred and paid in the period January 1, 2014 thru September 30, 2014 and nearly 42 million member months over the same time period.

Table 1Nationwide Allowed PMPMby Specialty and Code Type

Code Type: All

Specialties Audiologists

Speech Language

Pathologist All Other Specialties

Audiology 0.586$ 0.034$ 0.017$ 0.535$ Hearing 0.468$ 0.106$ 0.002$ 0.355$ Speech-Language Pathology 0.736$ 0.018$ 0.255$ 0.463$

Total (Unique HCPCS) 1.447$ 0.125$ 0.272$ 1.044$

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Grouper) performed for the sets of codes requested by ASHA. Our analysis includes only claims lines where HCPCS codes are associated with a blank modifier, unless otherwise requested by ASHA (e.g. HCPCS 92507 modified with SZ). Based on these data considerations, we developed total utilization and allowed dollar amounts from the MarketScan data for all specialties and all regions, including nationwide. The Utilization per 1,000, Average Allowed per Unit and Monthly per Member Allowed values resulting from these totals are included in each table labeled “All Specialties” (e.g. tables labeled A1, B1, or C1).

The data included no professional utilization for some of the codes ASHA requested. We have included them in the relevant tables, but their values are not computed. Rather, the values in the Nationwide Values section of each Exhibit read “No Util.” These codes are listed in Table 2.

Table 2Codes with No Profess ional Utilization

by Code Lis t

Code Lis t HCPCS ModifierHearing V5070Hearing V5080Hearing V5095Hearing V5150Hearing V5190Hearing V5230SLP 92507 SZSLP E2502SLP E2504SLP E2506SLP E2508

Similarly, codes without utilization in a given region are included in that region’s exhibit with the label “No Util”.

We supplemented the All Specialty totals from the MarketScan database with another proprietary database that provided both utilization and allowed dollar allocations by individual provider specialties. We applied these allocations to the composite amounts, in order to estimate utilization and total allowed for Audiologists, Speech Language Pathologists, and All Other specialties. We took this step to adjust for perceived deficiencies in the coding of your specialties in the MarketScan database.

For some codes with All Specialty utilization, the proprietary data was insufficient to estimate specialty allocations. Where possible, specialty allocations for these codes were set equal to the nearest equivalent code with utilization and allowed dollar allocations. Table 3 summarizes these codes and to which code their allocations are now equal.

Even after the allocation of low-utilization codes described above, there remained some codes for which we were unable to allocate utilization or allowed dollar amounts to individual specialties. We have included these codes, but instead of a computed value, they have the label “No Alloc”. These codes appear in Table 3 with the label “no valid code found.” When we update the report for full year data, we can allocate these services, provided you can identify a related CPT for each whose utilization pattern is a reasonable surrogate.

Milliman


Table 3HC P C S Lac k ing A l loc ation

with S our c e A l loc ation HC P C S

Re -a s s ig n e d toH CPCS Ra n g e H CPCS92521-92524 9252095908 9590795910 9590995940 95939V5011 - V5298 V5010E2500-E2510 N o v a lid c o d e fo u n dL8509-L8692 N o v a lid c o d e fo u n d

ASHA also asked that we provide a measure of the variability of the Allowed per Unit by code. Due to the allocation method used, we are unable to calculate the standard deviation of the Allowed per Unit at the Specialty level. However, we were able to calculate the composite standard deviation (i.e., for all specialties combined) at the Regional level. These values are provided by region and code type in Appendix 2. The standard deviation is considered unreliable for regions with low utilization; regions where this is the case have the label “Low Cred” rather than a computed value.

Interpretation of Results

Please also consider the following factors when interpreting our results: 1. We recommend that you consider our results shown to be the mean in a distribution of possible

results; the utilization for infrequently performed services is likely to be quite volatile. Utilization can be expected to vary from our projections because of many factors, including differences in population health status, delivery system differences, variations in practice patterns by providers, benefit plan variations, and random fluctuations.

2. Our analysis relies in part on the lists of CPT codes provided by ASHA. Any omissions or errors in that list would affect our results. Similarly, we have relied on encounter data for the contributors in both the MarketScan database and our proprietary database. Our results could be affected by their practices, including coding or payment practices.

3. Our utilization allocations are based on research deriving from health claim encounter data. We made no estimates for new CPT codes, if any. To the extent that any new codes refine or replace existing CPT codes, emerging health claim experience will show a shift in the utilization mix away from existing codes and toward the new codes. However, if a new code represents a genuinely new service, utilization for that code will increase the overall utilization level for speech-language and audiology services to the extent that it is performed independently of the services codified in the previous system.

4. Note that the specialty exhibits, if summed, may show lower utilization and PMPM allowed cost than the corresponding total exhibit, for all specialties combined. This anomaly is caused by the credibility issues described above. For example, the total PMPM allowed cost for Hearing codes is $0.468, shown in Exhibit B1-a. The sum of the corresponding PMPM allowed cost for Audiologists ($0.106, from Exhibit B2-a), Speech Language Therapists ($0.002, from Exhibit B3-a), and All Other Specialties ($0.355, found in Exhibit B3-a) is $0.463, roughly 1% lower.

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American Speech-Language Hearing AssociationCommercial Cost Model - Professional Services

Nationwide Utilization and Allowed Service Levels - Select Audiology ProceduresSpecialty: All Specialities

Data from January, 2014 thru September, 2014

Nationwide ValuesAverage Monthly Per

Procedure Utilization Allowed per MemberCode Modifier Description Per 1,000 Unit Allowed Cost69210 Removal Impact Cerumen 1/Both Ears 9.0690 $56.74 $0.042992516 Facial Nerve Function Studies 0.0075 57.12 0.0000 92531 Spontaneous nystagmus, including gaze 0.0068 2.44 0.0000 92532 Positional nystagmus test 0.0419 19.89 0.0001 92533 Caloric vestibular test, each irrigation 0.0038 20.85 0.0000 92534 Optokinetic nystagmus test 0.0089 22.73 0.0000 92540 Basic vestibular evaluation 0.7589 124.65 0.0079 92541 Spontaneous Nystagmus Test W/Record 0.1554 59.43 0.0008 92542 Pstn Nystagms Min 4 Pstn W/Record 0.1417 46.84 0.0006 92543 Caloric Vestibular Test, Each Irrigation 2.5809 30.89 0.0066 92544 Optokinetic Nystagms Bidirec/Foveal 0.0346 34.34 0.0001 92545 Oscillat Tracking Test W/Recording 0.0567 28.04 0.0001 92546 Sinusoidal Verticl Axis Rotatal Tst 0.3815 98.69 0.0031 92547 Use Of Vertical Electrodes 1.3896 10.09 0.0012 92548 Computerized Dynamic Posturography 0.0780 122.38 0.0008 92550 Tympanometry and reflex threshold measurements 3.1811 27.36 0.0073 92551 Screening Test Pure Tone Air Only 21.5059 18.94 0.0339 92552 Pure Tone Audiometry; Air Only 9.5591 28.84 0.0230 92553 Pure Tone Audiometry; Air And Bone 0.8481 39.30 0.0028 92555 Speech Audiometry Threshold; 0.9316 25.10 0.0019 92556 Speech Audiom Threshld; W/Recognitn 0.7276 39.76 0.0024 92557 Comp Audiometry Threshold Eval 11.0676 56.61 0.0522 92559 Audiometric testing of groups 0.0008 25.40 0.0000 92560 Bekesy audiometry; screening 0.0168 18.97 0.0000 92561 Bekesy audiometry; diagnostic 0.0135 35.17 0.0000 92562 Loud Balanc Test Altern Bi/Monaural 0.0155 27.32 0.0000 92563 Tone Decay Test 0.2055 24.94 0.0004 92564 Short Increment Sensitivity Index 0.0121 25.67 0.0000 92565 Stenger Test Pure Tone 0.0201 17.54 0.0000 92567 Tympanometry 14.0999 22.28 0.0262 92568 Acoustic Reflex Testing 0.3914 17.74 0.0006 92570 Acoustic immittance testing 0.5637 40.56 0.0019 92571 Filtered Speech Test 0.0221 23.31 0.0000 92572 Staggered Spondaic Word Test 0.0022 26.19 0.0000 92575 Sensorineural Acuity Level Test 0.0026 27.15 0.0000 92576 Synthetic Sentence Id Test 0.0019 63.54 0.0000 92577 Stenger Test Speech 0.0097 22.97 0.0000 92579 Visual Reinforcement Audiometry 1.0129 54.94 0.0046 92582 Conditioning Play Audiometry 0.3501 71.21 0.0021 92583 Select Picture Audiometry 0.3694 47.30 0.0015 92584 Electrocochleography 0.1556 98.04 0.0013

11/12/2015 8:24 AMA1-a.xlsb\ [Exh A1-a Exhibit Audiology]

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Exhibit A1-aAmerican Speech-Language Hearing AssociationCommercial Cost Model - Professional Services




Procedure Utilization Allowed per MemberCode Modifier Description Per 1,000 Unit Allowed Cost92585 Aud Evokd Potnt &/ Test Cns; Comp 0.4919 146.24 0.0060 92586 Aud Evokd Potent &/ Test Cns; Ltd 1.9943 180.71 0.0300 92558 Evoked otoacoustic emissions, screening 0.4714 22.51 0.0009 92587 Distortion product evoked otoacoustic emissions; limited evaluation 6.5138 50.05 0.0272 92588 Distortion product evoked otoacoustic emissions; comprehensive

diagnostic evaluation1.7639 72.75 0.0107

92590 Hearing aid exam and selection; monaural 0.0114 86.69 0.0001 92591 Hearing aid examination and selection; binaural 0.0548 91.18 0.0004 92592 Hearing aid check; monaural 0.0138 31.25 0.0000 92593 Hearing aid check; binaural 0.0351 38.60 0.0001 92594 Electroacoustic evaluation for hearing aid; monaural 0.0041 32.51 0.0000 92595 Electroacoustic evaluation for hearing aid; binaural 0.0130 46.55 0.0001 92596 Ear protector attenuation measurements 0.0003 33.80 0.0000 92601 Dx analysis of cochlear implant, patient younger than 7 years of age;

with programming0.0033 192.71 0.0001

92602 subsequent reprogramming 0.0175 147.46 0.0002 92603 Diagnostic analysis of cochlear implant, age 7 years or older; with

programming0.0115 172.40 0.0002

92604 subsequent reprogramming 0.0937 121.31 0.0009 92620 Evaluation of central auditory function, with report; initial 60 minutes 0.0561 90.02 0.0004 92621 each additional 15 minutes 0.0905 23.09 0.0002 92625 Assessment of tinnitus 0.0763 70.00 0.0004 92626 Evaluation of auditory rehabilitation status; first hour 0.1091 83.20 0.0008 92627 each additional 15 minutes 0.0304 36.69 0.0001 92630 Auditory rehabilitation; prelingual hearing loss 0.1085 120.57 0.0011 92633 Auditory rehabilitation; postlingual hearing loss 0.0286 89.18 0.0002 92640 Diagnostic analysis with programming of auditory brainstem implant,

per hour0.0007 99.03 0.0000

95992 Canalith repositioning procedure 0.4045 55.19 0.0019 95907 Nerve conduction studies; 1–2 studies 0.1001 132.15 0.0011 95908 Nerve conduction studies; 3–4 studies 0.6919 174.60 0.0101 95909 Nerve conduction studies; 5–6 studies 1.3614 201.09 0.0228 95910 Nerve conduction studies; 7–8 studies 1.4459 255.37 0.0308 95911 Nerve conduction studies; 9–10 studies 1.8256 326.43 0.0497 95912 Nerve conduction studies; 11–12 studies 1.0825 343.92 0.0310 95913 Nerve conduction studies; 13 or more studies 1.1255 391.24 0.0367 95925 Short-latency somatosensory evoked potential study, upper limbs 0.1022 163.04 0.0014 95926 Short-latency somatosensory evoked potential study, lower limbs 0.1080 153.55 0.0014 95938 Short-latency somatosensory evoked potential study, upper and lower

limbs0.1211 508.92 0.0051

95927 Short-latency somatosensory evoked potential study, trunk, head 0.0421 153.59 0.0005


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Procedure Utilization Allowed per MemberCode Modifier Description Per 1,000 Unit Allowed Cost95928 Central motor evoked potential study, upper limbs 0.0026 174.10 0.0000 95929 lower limbs 0.0041 245.63 0.0001 95939 in upper and lower limbs 0.0374 834.24 0.0026 95930 Visual evoked potential (VEP) testing 0.7685 135.46 0.0087 95937 Neuromuscular junction testing 0.1820 113.85 0.0017 95940 Continuous intraoperative neurophysiology monitoring in the

operating room0.9103 146.36 0.0111

95941 Continuous neurophysiology monitoring, from outside the operating room

1.7558 428.49 0.0627

Total 103.8675 67.69 $0.5859"No Util" in a field indicates no utilization was found for the specified region."No Alloc" in a field indicates insuffieient data exists to calculate a regions utiliation and/or allowed dollar specialty allocation.


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Nationwide Utilization and Allowed Service Levels - Select Audiology ProceduresSpecialty: Audiology Only



Procedure Utilization Allowed per MemberCode Modifier Description Per 1,000 Unit Allowed Cost69210 Removal Impact Cerumen 1/Both Ears 0.0079 $39.11 $0.000092516 Facial Nerve Function Studies 0.0005 72.95 0.0000 92531 Spontaneous nystagmus, including gaze 0.0011 6.52 0.0000 92532 Positional nystagmus test 0.0039 28.36 0.0000 92533 Caloric vestibular test, each irrigation 0.0002 46.42 0.0000 92534 Optokinetic nystagmus test 0.0002 67.47 0.0000 92540 Basic vestibular evaluation 0.1130 139.87 0.0013 92541 Spontaneous Nystagmus Test W/Record 0.0147 61.23 0.0001 92542 Pstn Nystagms Min 4 Pstn W/Record 0.0166 48.74 0.0001 92543 Caloric Vestibular Test, Each Irrigation 0.4005 33.17 0.0011 92544 Optokinetic Nystagms Bidirec/Foveal 0.0057 41.78 0.0000 92545 Oscillat Tracking Test W/Recording 0.0051 37.37 0.0000 92546 Sinusoidal Verticl Axis Rotatal Tst 0.0292 105.75 0.0003 92547 Use Of Vertical Electrodes 0.1644 8.65 0.0001 92548 Computerized Dynamic Posturography 0.0074 199.91 0.0001 92550 Tympanometry and reflex threshold measurements 0.1963 93.03 0.0015 92551 Screening Test Pure Tone Air Only 0.0063 28.98 0.0000 92552 Pure Tone Audiometry; Air Only 0.2459 53.34 0.0011 92553 Pure Tone Audiometry; Air And Bone 0.0985 43.97 0.0004 92555 Speech Audiometry Threshold; 0.1396 30.87 0.0004 92556 Speech Audiom Threshld; W/Recognitn 0.1456 47.01 0.0006 92557 Comp Audiometry Threshold Eval 2.1453 60.06 0.0107 92559 Audiometric testing of groups 0.0001 44.99 0.0000 92560 Bekesy audiometry; screening 0.0000 45.95 0.0000 92561 Bekesy audiometry; diagnostic 0.0000 83.54 0.0000 92562 Loud Balanc Test Altern Bi/Monaural 0.0004 390.92 0.0000 92563 Tone Decay Test 0.0231 53.06 0.0001 92564 Short Increment Sensitivity Index 0.0030 49.50 0.0000 92565 Stenger Test Pure Tone 0.0021 53.04 0.0000 92567 Tympanometry 0.5263 72.39 0.0032 92568 Acoustic Reflex Testing 0.0021 248.66 0.0000 92570 Acoustic immittance testing 0.0774 82.50 0.0005 92571 Filtered Speech Test 0.0136 15.77 0.0000 92572 Staggered Spondaic Word Test 0.0010 30.51 0.0000 92575 Sensorineural Acuity Level Test 0.0012 30.38 0.0000 92576 Synthetic Sentence Id Test 0.0007 62.01 0.0000 92577 Stenger Test Speech 0.0018 27.75 0.0000 92579 Visual Reinforcement Audiometry 0.1862 62.03 0.0010 92582 Conditioning Play Audiometry 0.0896 84.06 0.0006 92583 Select Picture Audiometry 0.0073 102.84 0.0001 92584 Electrocochleography 0.0240 78.01 0.0002


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Procedure Utilization Allowed per MemberCode Modifier Description Per 1,000 Unit Allowed Cost92585 Aud Evokd Potnt &/ Test Cns; Comp 0.0601 169.13 0.0008 92586 Aud Evokd Potent &/ Test Cns; Ltd 0.0888 146.05 0.0011 92558 Evoked otoacoustic emissions, screening 0.0566 96.57 0.0005 92587 Distortion product evoked otoacoustic emissions; limited

evaluation0.3180 65.66 0.0017

92588 Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation

0.2269 81.12 0.0015

92590 Hearing aid exam and selection; monaural 0.0071 87.90 0.0001 92591 Hearing aid examination and selection; binaural 0.0368 77.15 0.0002 92592 Hearing aid check; monaural 0.0097 39.71 0.0000 92593 Hearing aid check; binaural 0.0257 37.88 0.0001 92594 Electroacoustic evaluation for hearing aid; monaural 0.0023 40.71 0.0000 92595 Electroacoustic evaluation for hearing aid; binaural 0.0061 57.42 0.0000 92596 Ear protector attenuation measurements 0.0002 40.30 0.0000 92601 Dx analysis of cochlear implant, patient younger than 7 years

of age; with programming0.0015 170.63 0.0000

92602 subsequent reprogramming 0.0084 130.55 0.0001 92603 Diagnostic analysis of cochlear implant, age 7 years or older;

with programming0.0032 161.14 0.0000

92604 subsequent reprogramming 0.0326 115.40 0.0003 92620 Evaluation of central auditory function, with report; initial 60

minutes0.0308 87.15 0.0002

92621 each additional 15 minutes 0.0650 23.07 0.0001 92625 Assessment of tinnitus 0.0300 69.87 0.0002 92626 Evaluation of auditory rehabilitation status; first hour 0.0396 77.88 0.0003 92627 each additional 15 minutes 0.0123 25.94 0.0000 92630 Auditory rehabilitation; prelingual hearing loss 0.0310 130.54 0.0003 92633 Auditory rehabilitation; postlingual hearing loss 0.0028 88.27 0.0000 92640 Diagnostic analysis with programming of auditory brainstem

implant, per hour0.0002 50.58 0.0000

95992 Canalith repositioning procedure 0.0208 63.50 0.0001 95907 Nerve conduction studies; 1–2 studies 0.0000 181.73 0.0000 95908 Nerve conduction studies; 3–4 studies 0.0001 240.10 0.0000 95909 Nerve conduction studies; 5–6 studies - No Util No Util95910 Nerve conduction studies; 7–8 studies - No Util No Util95911 Nerve conduction studies; 9–10 studies - No Util No Util95912 Nerve conduction studies; 11–12 studies - No Util No Util95913 Nerve conduction studies; 13 or more studies - No Util No Util95925 Short-latency somatosensory evoked potential study, upper 0.0015 360.05 0.000095926 Short-latency somatosensory evoked potential study, lower 0.0014 370.09 0.0000


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Procedure Utilization Allowed per MemberCode Modifier Description Per 1,000 Unit Allowed Cost95938 Short-latency somatosensory evoked potential study, upper

and lower limbs0.0013 877.05 0.0001

95927 Short-latency somatosensory evoked potential study, trunk, 0.0001 113.02 0.000095928 Central motor evoked potential study, upper limbs 0.0000 332.61 0.0000 95929 lower limbs 0.0001 473.44 0.0000 95939 in upper and lower limbs 0.0006 1,635.09 0.0001 95930 Visual evoked potential (VEP) testing 0.0003 166.22 0.0000 95937 Neuromuscular junction testing 0.0008 148.17 0.0000 95940 Continuous intraoperative neurophysiology monitoring in the

operating room0.0135 286.86 0.0003

95941 Continuous neurophysiology monitoring, from outside the operating room

0.0269 856.53 0.0019

Total 5.8712 69.27 $0.0339

"No Util" in a field indicates no utilization was found for the specified region."No Alloc" in a field indicates insuffieient data exists to calculate a regions utiliation and/or allowed dollar specialty allocation.


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Nationwide Utilization and Allowed Service Levels - Select Hearing ProceduresSpecialty: All Specialities



Procedure Utilization Allowed per MemberCode Modifier Description Per 1,000 Unit Allowed Cost69210 Removal Impact Cerumen 1/Both Ears 9.0690 $56.74 $0.042992531 Spontaneous nystagmus, including gaze 0.0068 2.44 0.0000 92532 Positional nystagmus test 0.0419 19.89 0.0001 92533 Caloric vestibular test, each irrigation 0.0038 20.85 0.0000 92534 Optokinetic nystagmus test 0.0089 22.73 0.0000 92540 Basic vestibular evaluation 0.7589 124.65 0.0079 92541 Spontaneous Nystagmus Test W/Record 0.1554 59.43 0.0008 92542 Pstn Nystagms Min 4 Pstn W/Record 0.1417 46.84 0.0006 92543 Caloric Vestibular Test, Each Irrigation 2.5809 30.89 0.0066 92544 Optokinetic Nystagms Bidirec/Foveal 0.0346 34.34 0.0001 92545 Oscillat Tracking Test W/Recording 0.0567 28.04 0.0001 92546 Sinusoidal Verticl Axis Rotatal Tst 0.3815 98.69 0.0031 92547 Use Of Vertical Electrodes 1.3896 10.09 0.0012 92548 Computerized Dynamic Posturography 0.0780 122.38 0.0008 92550 Tympanometry and reflex threshold measurements 3.1811 27.36 0.0073 92551 Screening Test Pure Tone Air Only 21.5059 18.94 0.0339 92552 Pure Tone Audiometry; Air Only 9.5591 28.84 0.0230 92553 Pure Tone Audiometry; Air And Bone 0.8481 39.30 0.0028 92555 Speech Audiometry Threshold; 0.9316 25.10 0.0019 92556 Speech Audiom Threshld; W/Recognitn 0.7276 39.76 0.0024 92557 Comp Audiometry Threshold Eval 11.0676 56.61 0.0522 92559 Audiometric testing of groups 0.0008 25.40 0.0000 92560 Bekesy audiometry; screening 0.0168 18.97 0.0000 92561 Bekesy audiometry; diagnostic 0.0135 35.17 0.0000 92562 Loud Balanc Test Altern Bi/Monaural 0.0155 27.32 0.0000 92563 Tone Decay Test 0.2055 24.94 0.0004 92564 Short Increment Sensitivity Index 0.0121 25.67 0.0000 92565 Stenger Test Pure Tone 0.0201 17.54 0.0000 92567 Tympanometry 14.0999 22.28 0.0262 92568 Acoustic Reflex Testing 0.3914 17.74 0.0006 92570 Acoustic immittance testing 0.5637 40.56 0.0019 92571 Filtered Speech Test 0.0221 23.31 0.0000 92572 Staggered Spondaic Word Test 0.0022 26.19 0.0000 92575 Sensorineural Acuity Level Test 0.0026 27.15 0.0000 92576 Synthetic Sentence Id Test 0.0019 63.54 0.0000 92577 Stenger Test Speech 0.0097 22.97 0.0000 92579 Visual Reinforcement Audiometry 1.0129 54.94 0.0046 92582 Conditioning Play Audiometry 0.3501 71.21 0.0021 92583 Select Picture Audiometry 0.3694 47.30 0.0015 92584 Electrocochleography 0.1556 98.04 0.0013 92585 Aud Evokd Potnt &/ Test Cns; Comp 0.4919 146.24 0.0060

11/12/2015 8:24 AMB1-a.xlsb\ [Exh B1-a Exhibit Hearing]

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Exhibit B1-aAmerican Speech-Language Hearing AssociationCommercial Cost Model - Professional Services




Procedure Utilization Allowed per MemberCode Modifier Description Per 1,000 Unit Allowed Cost92586 Aud Evokd Potent &/ Test Cns; Ltd 1.9943 180.71 0.0300 92558 Evoked otoacoustic emissions, screening 0.4714 22.51 0.0009 92587 Distortion product evoked otoacoustic emissions; limited evaluation 6.5138 50.05 0.0272 92588 Distortion product evoked otoacoustic emissions; comprehensive

diagnostic evaluation1.7639 72.75 0.0107

92590 Hearing aid exam and selection; monaural 0.0114 86.69 0.0001 92591 Hearing aid examination and selection; binaural 0.0548 91.18 0.0004 92592 Hearing aid check; monaural 0.0138 31.25 0.0000 92593 Hearing aid check; binaural 0.0351 38.60 0.0001 92594 Electroacoustic evaluation for hearing aid; monaural 0.0041 32.51 0.0000 92595 Electroacoustic evaluation for hearing aid; binaural 0.0130 46.55 0.0001 92596 Ear protector attenuation measurements 0.0003 33.80 0.0000 92601 Dx analysis of cochlear implant, patient younger than 7 years of

age; with programming0.0033 192.71 0.0001

92602 subsequent reprogramming 0.0175 147.46 0.0002 92603 Diagnostic analysis of cochlear implant, age 7 years or older; with

programming0.0115 172.40 0.0002

92604 subsequent reprogramming 0.0937 121.31 0.0009 92620 Evaluation of central auditory function, with report; initial 60 0.0561 90.02 0.0004 92621 each additional 15 minutes 0.0905 23.09 0.0002 92625 Assessment of tinnitus 0.0763 70.00 0.0004 92626 Evaluation of auditory rehabilitation status; first hour 0.1091 83.20 0.0008 92627 each additional 15 minutes 0.0304 36.69 0.0001 92630 Auditory rehabilitation; prelingual hearing loss 0.1085 120.57 0.0011 92633 Auditory rehabilitation; postlingual hearing loss 0.0286 89.18 0.0002 92640 Diagnostic analysis with programming of auditory brainstem

implant, per hour0.0007 99.03 0.0000

L8619 Cochlear implant external speech processor 0.0080 6,813.78 0.0045 L8627 Cochlear implant, external speech processor, component,

replacement0.0000 3,767.44 0.0000

L8690 Auditory osseointegrated device, includes all internal and external components

0.0001 4,892.86 0.0001

L8691 Auditory osseointegrated device, external sound processor, replacement

0.0016 3,514.47 0.0005

L8692 Non-osseointegrated snd proc 0.0005 2,514.71 0.0001 V5010 Assessment for hearing aid 0.1414 70.20 0.0008 V5011 Fitting/Orientation/Checking of hearing aid 0.0592 100.18 0.0005 V5014 Repair/Modification of a hearing aid 0.0173 98.95 0.0001 V5020 Conformity evaluation 0.1155 41.06 0.0004 V5030 Hearing aid, monaural, body worn, air conduction 0.0003 1,718.50 0.0000 V5040 Hearing aid, monaural, body worn, bone conduction 0.0002 400.80 0.0000


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Procedure Utilization Allowed per MemberCode Modifier Description Per 1,000 Unit Allowed CostV5050 Hearing aid, monaural, in the ear 0.0225 1,430.71 0.0027 V5060 Hearing aid, monaural, behind the ear 0.0123 1,634.92 0.0017 V5070 Glasses, air conduction No Util No Util No UtilV5080 Glasses, bone conduction No Util No Util No UtilV5090 Dispensing fee, unspecified hearing aid 0.0175 221.36 0.0003 V5095 Semi-implantable middle ear hearing prosthesis (use for Vibrant

Soundbridge)No Util No Util No Util

V5100 Hearing aid, bilateral, body worn 0.0009 2,209.17 0.0002 V5110 Dispensing fee, bilateral 0.0058 254.15 0.0001 V5120 Binaural, body 0.0003 1,389.85 0.0000 V5130 Binaural, in the ear 0.0105092 2561.52382 0.002243293V5140 Binaural, behind the ear 0.0218 2683.28221 $0.0049V5150 Binaural, glasses No Util No Util No UtilV5160 Dispensing fee, binaural 0.0720 332.956993 $0.0020V5170 Hearing aid, CROS, in the ear 0.0003 1566.66571 $0.0000V5180 Hearing aid, CROS, behind the ear 0.0028 1265.40413 $0.0003V5190 Hearing aid, CROS, glasses No Util No Util No UtilV5200 Dispensing fee, CROS 0.0003 507.11875 $0.0000V5210 Hearing aid, BICROS, in the ear 0.0003 1655.16 $0.0000V5220 Hearing aid, BICROS, behind the ear 0.0036 2001.28753 $0.0006V5230 Hearing aid, BICROS, glasses No Util No Util No UtilV5240 Dispensing fee, BICROS 0.0006 351.391765 $0.0000V5241 Dispensing fee, monaural hearing aid, any type 0.0208 205.45347 $0.0004V5242 Hearing aid, analog, monaural, CIC (completely in the ear canal) 0.0001 2133.33333 $0.0000V5243 Hearing aid, analog, monaural, ITC (in the canal) 0.0001 1333.6875 $0.0000V5244 Hearing aid, digitally programmable analog, monaural CIC 0.0004 1332.00333 $0.0000V5245 Hearing aid, digitally programmable analog, monaural, ITC 0.0001 2133.33333 $0.0000V5246 Hearing aid, digitally programmable analog, monaural, ITE (in the

ear)0.0010 1048.06071 $0.0001

V5247 Hearing aid, digitally programmable analog, monaural, BTE 0.0028 1502.30947 $0.0004V5248 Hearing aid, analog, binaural, CIC 0.0006 2393.81824 $0.0001V5249 Hearing aid, analog, binaural, ITC 0.0001 1693.75 $0.0000V5250 Hearing aid, digitally programmable analog, binaural, CIC 0.0009 2385 $0.0002V5251 Hearing aid, digitally programmable analog, binaural, ITC 0.0006 2056.38412 $0.0001V5252 Hearing aid, digitally programmable, binaural, ITE 0.0174 2767.30753 $0.0040V5253 Hearing aid, digitally programmable, binaural, BTE 0.0104 2411.25108 $0.0021V5254 Hearing aid, digital, monaural, CIC 0.0249 1909.68079 $0.0040V5255 Hearing aid, digital, monaural, ITC 0.0098 1634.50557 $0.0013V5256 Hearing aid, digital, monaural, ITE 0.0128 1510.06174 $0.0016V5257 Hearing aid, digital, monaural, BTE 0.1751 1704.49292 $0.0249V5258 Hearing aid, digital, binaural, CIC 0.0365 3487.0798 $0.0106


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Procedure Utilization Allowed per MemberCode Modifier Description Per 1,000 Unit Allowed CostV5259 Hearing aid, digital, binaural, ITC 0.0141 2855.20715 $0.0033V5260 Hearing aid, digital, binaural, ITE 0.0179 2656.62751 $0.0040V5261 Hearing aid, digital, binaural, BTE 0.3256 2975.13352 $0.0807V5262 Hearing aid, disposable, any type, monaural 0.0003 2056.42857 $0.0000V5263 Hearing aid, disposable, any type, binaural 0.0002 1541.99667 $0.0000V5298 Hearing aid, not otherwise classified 0.0110 1389.2336 $0.0013V5264 Ear mold/insert, not disposable, any type 0.0637 64.8944606 $0.0003V5265 Ear mold/insert, disposable, any type 0.0051 21.3464964 $0.0000V5268 Assistive listening device, telephone amplifier, any type 0.0006 130.1375 $0.0000

Total 93.0569 60.38 $0.4682"No Util" in a field indicates no utilization was found for the specified region."No Alloc" in a field indicates insuffieient data exists to calculate a regions utiliation and/or allowed dollar specialty allocation.


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Nationwide Utilization and Allowed Service Levels - Select Hearing ProceduresSpecialty: Audiology Only


Nationwide Values

Average Monthly PerProcedure Utilization Allowed per Member

Code Modifier Description Per 1,000 Unit Allowed Cost69210 Removal Impact Cerumen 1/Both Ears 0.0079 $39.11 $0.000092531 Spontaneous nystagmus, including gaze 0.0011 6.52 0.0000 92532 Positional nystagmus test 0.0039 28.36 0.0000 92533 Caloric vestibular test, each irrigation 0.0002 46.42 0.0000 92534 Optokinetic nystagmus test 0.0002 67.47 0.0000 92540 Basic vestibular evaluation 0.1130 139.87 0.0013 92541 Spontaneous Nystagmus Test W/Record 0.0147 61.23 0.0001 92542 Pstn Nystagms Min 4 Pstn W/Record 0.0166 48.74 0.0001 92543 Caloric Vestibular Test, Each Irrigation 0.4005 33.17 0.0011 92544 Optokinetic Nystagms Bidirec/Foveal 0.0057 41.78 0.0000 92545 Oscillat Tracking Test W/Recording 0.0051 37.37 0.0000 92546 Sinusoidal Verticl Axis Rotatal Tst 0.0292 105.75 0.0003 92547 Use Of Vertical Electrodes 0.1644 8.65 0.0001 92548 Computerized Dynamic Posturography 0.0074 199.91 0.0001 92550 Tympanometry and reflex threshold measurements 0.1963 93.03 0.0015 92551 Screening Test Pure Tone Air Only 0.0063 28.98 0.0000 92552 Pure Tone Audiometry; Air Only 0.2459 53.34 0.0011 92553 Pure Tone Audiometry; Air And Bone 0.0985 43.97 0.0004 92555 Speech Audiometry Threshold; 0.1396 30.87 0.0004 92556 Speech Audiom Threshld; W/Recognitn 0.1456 47.01 0.0006 92557 Comp Audiometry Threshold Eval 2.1453 60.06 0.0107 92559 Audiometric testing of groups 0.0001 44.99 0.0000 92560 Bekesy audiometry; screening 0.0000 45.95 0.0000 92561 Bekesy audiometry; diagnostic 0.0000 83.54 0.0000 92562 Loud Balanc Test Altern Bi/Monaural 0.0004 390.92 0.0000 92563 Tone Decay Test 0.0231 53.06 0.0001 92564 Short Increment Sensitivity Index 0.0030 49.50 0.0000 92565 Stenger Test Pure Tone 0.0021 53.04 0.0000 92567 Tympanometry 0.5263 72.39 0.0032 92568 Acoustic Reflex Testing 0.0021 248.66 0.0000 92570 Acoustic immittance testing 0.0774 82.50 0.0005 92571 Filtered Speech Test 0.0136 15.77 0.0000 92572 Staggered Spondaic Word Test 0.0010 30.51 0.0000 92575 Sensorineural Acuity Level Test 0.0012 30.38 0.0000 92576 Synthetic Sentence Id Test 0.0007 62.01 0.0000 92577 Stenger Test Speech 0.0018 27.75 0.0000 92579 Visual Reinforcement Audiometry 0.1862 62.03 0.0010 92582 Conditioning Play Audiometry 0.0896 84.06 0.0006 92583 Select Picture Audiometry 0.0073 102.84 0.0001 92584 Electrocochleography 0.0240 78.01 0.0002 92585 Aud Evokd Potnt &/ Test Cns; Comp 0.0601 169.13 0.0008


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Nationwide Values


Code Modifier Description Per 1,000 Unit Allowed Cost92586 Aud Evokd Potent &/ Test Cns; Ltd 0.0888 146.05 0.0011 92558 Evoked otoacoustic emissions, screening 0.0566 96.57 0.0005 92587 Distortion product evoked otoacoustic emissions; limited evaluation 0.3180 65.66 0.0017 92588 Distortion product evoked otoacoustic emissions; comprehensive

diagnostic evaluation 0.2269 81.12 0.0015 92590 Hearing aid exam and selection; monaural 0.0071 87.90 0.0001 92591 Hearing aid examination and selection; binaural 0.0368 77.15 0.0002 92592 Hearing aid check; monaural 0.0097 39.71 0.0000 92593 Hearing aid check; binaural 0.0257 37.88 0.0001 92594 Electroacoustic evaluation for hearing aid; monaural 0.0023 40.71 0.0000 92595 Electroacoustic evaluation for hearing aid; binaural 0.0061 57.42 0.0000 92596 Ear protector attenuation measurements 0.0002 40.30 0.0000 92601 Dx analysis of cochlear implant, patient younger than 7 years of age;

with programming 0.0015 170.63 0.0000 92602 subsequent reprogramming 0.0084 130.55 0.0001 92603 Diagnostic analysis of cochlear implant, age 7 years or older; with

programming 0.0032 161.14 0.0000 92604 subsequent reprogramming 0.0326 115.40 0.0003 92620 minutes 0.0308 87.15 0.0002 92621 each additional 15 minutes 0.0650 23.07 0.0001 92625 Assessment of tinnitus 0.0300 69.87 0.0002 92626 Evaluation of auditory rehabilitation status; first hour 0.0396 77.88 0.0003 92627 each additional 15 minutes 0.0123 25.94 0.0000 92630 Auditory rehabilitation; prelingual hearing loss 0.0310 130.54 0.0003 92633 Auditory rehabilitation; postlingual hearing loss 0.0028 88.27 0.0000 92640 Diagnostic analysis with programming of auditory brainstem implant,

per hour 0.0002 50.58 0.0000 L8619 Cochlear implant external speech processor No Alloc No Alloc No AllocL8627 replacement No Alloc No Alloc No AllocL8690 Auditory osseointegrated device, includes all internal and external

components No Alloc No Alloc No AllocL8691 Auditory osseointegrated device, external sound processor,

replacement No Alloc No Alloc No AllocL8692 Non-osseointegrated snd proc No Alloc No Alloc No AllocV5010 Assessment for hearing aid 0.0762 61.78 0.0004 V5011 Fitting/Orientation/Checking of hearing aid 0.0319 88.16 0.0002 V5014 Repair/Modification of a hearing aid 0.0093 87.08 0.0001 V5020 Conformity evaluation 0.0623 36.14 0.0002 V5030 Hearing aid, monaural, body worn, air conduction 0.0002 1,512.39 0.0000 V5040 Hearing aid, monaural, body worn, bone conduction 0.0001 352.73 0.0000 V5050 Hearing aid, monaural, in the ear 0.0121 1,259.12 0.0013


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Nationwide Values


Code Modifier Description Per 1,000 Unit Allowed CostV5060 Hearing aid, monaural, behind the ear 0.0066 1,438.84 0.0008 V5070 Glasses, air conduction No Util No Util No UtilV5080 Glasses, bone conduction No Util No Util No UtilV5090 Dispensing fee, unspecified hearing aid 0.0094 194.81 0.0002 V5095 Semi-implantable middle ear hearing prosthesis (use for Vibrant

Soundbridge) No Util No Util No UtilV5100 Hearing aid, bilateral, body worn 0.0005 1,944.21 0.0001 V5110 Dispensing fee, bilateral 0.0031 223.67 0.0001 V5120 Binaural, body 0.0001 1,223.15 0.0000 V5130 Binaural, in the ear 0.0056645 2254.30222 0.00106413V5140 Binaural, behind the ear 0.0117 2361.45728 $0.0023V5150 Binaural, glasses No Util No Util No UtilV5160 Dispensing fee, binaural 0.0388 293.023116 $0.0009V5170 Hearing aid, CROS, in the ear 0.0001 1378.76446 $0.0000V5180 Hearing aid, CROS, behind the ear 0.0015 1113.6353 $0.0001V5190 Hearing aid, CROS, glasses No Util No Util No UtilV5200 Dispensing fee, CROS 0.0002 446.296426 $0.0000V5210 Hearing aid, BICROS, in the ear 0.0001 1456.645 $0.0000V5220 Hearing aid, BICROS, behind the ear 0.0019 1761.25901 $0.0003V5230 Hearing aid, BICROS, glasses No Util No Util No UtilV5240 Dispensing fee, BICROS 0.0003 309.246875 $0.0000V5241 Dispensing fee, monaural hearing aid, any type 0.0112 180.811988 $0.0002V5242 Hearing aid, analog, monaural, CIC (completely in the ear canal) 0.0001 1877.46764 $0.0000V5243 Hearing aid, analog, monaural, ITC (in the canal) 0.0001 1173.72896 $0.0000V5244 Hearing aid, digitally programmable analog, monaural CIC 0.0002 1172.24679 $0.0000V5245 Hearing aid, digitally programmable analog, monaural, ITC 0.0001 1877.46764 $0.0000V5246 ear) 0.0006 922.35941 $0.0000V5247 Hearing aid, digitally programmable analog, monaural, BTE 0.0015 1322.12692 $0.0002V5248 Hearing aid, analog, binaural, CIC 0.0003 2106.71075 $0.0001V5249 Hearing aid, analog, binaural, ITC 0.0001 1490.60663 $0.0000V5250 Hearing aid, digitally programmable analog, binaural, CIC 0.0005 2098.95015 $0.0001V5251 Hearing aid, digitally programmable analog, binaural, ITC 0.0003 1809.74748 $0.0001V5252 Hearing aid, digitally programmable, binaural, ITE 0.0094 2435.40484 $0.0019V5253 Hearing aid, digitally programmable, binaural, BTE 0.0056 2122.05275 $0.0010V5254 Hearing aid, digital, monaural, CIC 0.0134 1680.63932 $0.0019V5255 Hearing aid, digital, monaural, ITC 0.0053 1438.4678 $0.0006V5256 Hearing aid, digital, monaural, ITE 0.0069 1328.9494 $0.0008V5257 Hearing aid, digital, monaural, BTE 0.0944 1500.06108 $0.0118V5258 Hearing aid, digital, binaural, CIC 0.0197 3068.84975 $0.0050V5259 Hearing aid, digital, binaural, ITC 0.0076 2512.76204 $0.0016V5260 Hearing aid, digital, binaural, ITE 0.0096 2337.99945 $0.0019


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Nationwide Values


Code Modifier Description Per 1,000 Unit Allowed CostV5261 Hearing aid, digital, binaural, BTE 0.1755 2618.3048 $0.0383V5262 Hearing aid, disposable, any type, monaural 0.0001 1809.78661 $0.0000V5263 Hearing aid, disposable, any type, binaural 0.0001 1357.05414 $0.0000V5298 Hearing aid, not otherwise classified 0.0059 1222.61303 $0.0006V5264 Ear mold/insert, not disposable, any type 0.0343 57.1112108 $0.0002V5265 Ear mold/insert, disposable, any type 0.0027 18.7862607 $0.0000V5268 Assistive listening device, telephone amplifier, any type 0.0003 114.529193 $0.0000

Total 6.4815 195.37 $0.1055"No Util" in a field indicates no utilization was found for the specified region.

"No Alloc" in a field indicates insuffieient data exists to calculate a regions utiliation and/or allowed dollar specialty allocation.


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Exhibit C1-aAmerican Speech-Language Hearing AssociationCommercial Cost Model - Professional Services

Nationwide Utilization and Allowed Service Levels - Select Speech Language Pathology ProceduresSpecialty: All Specialities



Procedure Utilization Allowed per MemberCode Modifier Description Per 1,000 Unit Allowed Cost31575 Laryngscpy Flexible Fiberoptic; Dx 6.1377 $166.14 $0.085031579 Laryngscpy Flex/Rigid W/Stroboscpy 0.7039 331.33 0.0194 70371 Cmplx Dynamic Pharyngeal & Speech 0.0074 112.93 0.0001 74230 Swllow Funct W/Cinerad/Videoradgrph 0.0613 125.87 0.0006 76536 Us Soft Tiss Head&Nck B-Scan W/Imag 6.3494 143.97 0.0762 92507 Speech/hearing therapy 26.1707 74.55 0.1626 92507 SZ Speech-language treatment; habilitation No Util No Util No Util92508 Tx Speech Lang Voice&/Aud D/O;2/Mor 0.8153 42.36 0.0029 92511 Nasopharyngoscopy With Endoscope 0.9160 198.37 0.0151 92512 Nasal function studies 0.1170 74.29 0.0007 92516 Facial Nerve Function Studies 0.0075 57.12 0.0000 92520 Laryngeal Function Studies 0.1036 90.45 0.0008 92521 Evaluation of speech fluency 0.0561 113.69 0.0005 92522 Evaluation of speech sound production 0.1908 103.01 0.0016 92523 Evaluation of speech sound production with evaluation of language

comprehension/exp0.6037 171.13 0.0086

92524 Behavioral and qualitative analysis of voice and resonance 0.1336 138.85 0.0015 92526 Tx Swallow Dysfunct&/Oral Funct Fd 2.7330 76.41 0.0174 92551 Screening Test Pure Tone Air Only 21.5059 18.94 0.0339 92597 Eval&/Fit Voice Pros Supl Orl Spch 0.0092 135.40 0.0001 92601 Dx Analy Ci Pt Und 7 Yr Age; W/Prog 0.0033 192.71 0.0001 92602 Dx Analy Ci Pt <7 Yr; Subsqt Reprog 0.0175 147.46 0.0002 92603 Dx Analy Coch Impl 7 Yr/>; W/Prog 0.0115 172.40 0.0002 92607 Eval Rx Spch-Gen Devc F/F Pt; 1 Hr 0.0057 134.51 0.0001 92608 Eval Rx Spch-Gen Devc F/F Pt;30 Min 0.0025 32.10 0.0000 92609 Tx Srvc Use Spch-Gen Devc Prog&Mod 0.1080 98.63 0.0009 92610 Eval Orl&Pharyngeal Swallwing Funct 0.3441 90.84 0.0026 92611 Mot Fluoro Eval Swallw Cine/Video 0.0283 207.28 0.0005 92612 Flexible fiberoptic endoscopic evaluation of swallowing by cine or

video recording0.0210 300.49 0.0005

92613 interpretation and report only 0.0134 82.98 0.0001 92614 Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing

by cine or video0.0045 165.59 0.0001

92615 interpretation and report only 0.0059 41.58 0.0000 92616 Flexible fiberoptic endoscopic evaluation of swallow, laryngeal

sensory testing by cine v0.0301 215.30 0.0005

92617 interpretation and report only 0.0151 54.11 0.0001 92626 Evaluation of auditory rehabilitation status; first hour 0.1091 83.20 0.0008 92627 each additional 15 minutes 0.0304 36.69 0.0001 92630 Auditory rehabilitation; prelingual hearing loss 0.1085 120.57 0.0011 92633 Auditory rehabilitation; postlingual hearing loss 0.0286 89.18 0.0002

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Nationwide Utilization and Allowed Service Levels - Select Speech Language Pathology ProceduresSpecialty: All Specialities



Procedure Utilization Allowed per MemberCode Modifier Description Per 1,000 Unit Allowed Cost96105 Assessment Aphasia W/I&R Per Hour 0.0246 131.26 0.0003 96110 Dvlpmentl Testing; Limited W/I&R 22.1882 16.95 0.0313 96111 Dvlpmentl Tst; Ext W/I&R Per Hour 0.6866 153.38 0.0088 96125 Cognitive testing 0.0444 137.15 0.0005 97530 Tx Actv Dir Pt Cntc Prov Ea 15 Min 60.3103 46.43 0.2333 97532 Dev Congnitive Skill-1:1-Ea 15 Min 0.5437 179.57 0.0081 97535 Self-care/home management training 5.8114 35.89 0.0174 99366 Medical team conference; direct care, non-physician 0.0366 60.22 0.0002 99368 Medical team conference; without direct care; non-physician 0.0254 92.24 0.0002 L8509 Tracheo-esophageal voice prosthesis, inserted by a lic. health care

provider, any type0.0045 180.30 0.0001

L8510 Voice amplifier 0.0004 170.62 0.0000 E2500 Speech generating device, digitized speech 0.0002 102.00 0.0000 E2502 Speech generating device No Util No Util No Util

E2504 Speech generating device No Util No Util No Util



E2510 Speech generating device 0.0015 4,374.12 0.0005

Total 157.1876 56.18 $0.7359

"No Util" in a field indicates no utilization was found for the specified region.


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Nationwide Utilization and Allowed Service Levels - Select Speech Language Pathology ProceduresSpecialty: Speech Language Therapy Only



Procedure Utilization Allowed per MemberCode Modifier Description Per 1,000 Unit Allowed Cost31575 Laryngscpy Flexible Fiberoptic; Dx 0.0024 $187.91 $0.000031579 Laryngscpy Flex/Rigid W/Stroboscpy 0.0081 363.70 0.0002 70371 Cmplx Dynamic Pharyngeal & Speech 0.0001 104.13 0.0000 74230 Swllow Funct W/Cinerad/Videoradgrph 0.0001 87.00 0.0000 76536 Us Soft Tiss Head&Nck B-Scan W/Imag 0.0054 282.36 0.0001 92507 Speech/hearing therapy 13.1918 80.79 0.0888 92507 SZ Speech-language treatment; habilitation No Util No Util No Util92508 Tx Speech Lang Voice&/Aud D/O;2/Mor 0.2931 49.37 0.0012 92511 Nasopharyngoscopy With Endoscope 0.0003 556.12 0.0000 92512 Nasal function studies 0.0001 149.51 0.0000 92516 Facial Nerve Function Studies 0.0000 43.64 0.0000 92520 Laryngeal Function Studies 0.0034 77.42 0.0000 92521 Evaluation of speech fluency 0.0018 97.32 0.0000 92522 Evaluation of speech sound production 0.0062 88.18 0.0000 92523 Evaluation of speech sound production with evaluation of

language comprehension/exp0.0197 146.49 0.0002

92524 Behavioral and qualitative analysis of voice and resonance 0.0044 118.85 0.0000 92526 Tx Swallow Dysfunct&/Oral Funct Fd 1.7567 77.96 0.0114 92551 Screening Test Pure Tone Air Only 0.0027 20.37 0.0000 92597 Eval&/Fit Voice Pros Supl Orl Spch 0.0023 159.02 0.0000 92601 Dx Analy Ci Pt Und 7 Yr Age; W/Prog - No Util No Util92602 Dx Analy Ci Pt <7 Yr; Subsqt Reprog 0.0002 256.04 0.0000 92603 Dx Analy Coch Impl 7 Yr/>; W/Prog 0.0002 149.17 0.0000 92607 Eval Rx Spch-Gen Devc F/F Pt; 1 Hr 0.0013 149.73 0.0000 92608 Eval Rx Spch-Gen Devc F/F Pt;30 Min 0.0020 27.48 0.0000 92609 Tx Srvc Use Spch-Gen Devc Prog&Mod 0.0603 106.34 0.0005 92610 Eval Orl&Pharyngeal Swallwing Funct 0.1188 100.13 0.0010 92611 Mot Fluoro Eval Swallw Cine/Video 0.0055 270.21 0.0001 92612 Flexible fiberoptic endoscopic evaluation of swallowing by cine or

video recording0.0008 301.68 0.0000

92613 interpretation and report only 0.0021 57.32 0.0000 92614 Flexible fiberoptic endoscopic evaluation, laryngeal sensory

testing by cine or video0.0000 168.03 0.0000

92615 interpretation and report only 0.0001 46.09 0.0000 92616 Flexible fiberoptic endoscopic evaluation of swallow, laryngeal

sensory testing by cine v0.0003 224.78 0.0000

92617 interpretation and report only 0.0003 66.33 0.0000 92626 Evaluation of auditory rehabilitation status; first hour 0.0269 92.42 0.0002 92627 each additional 15 minutes 0.0044 111.96 0.0000 92630 Auditory rehabilitation; prelingual hearing loss 0.0423 112.97 0.0004 92633 Auditory rehabilitation; postlingual hearing loss 0.0202 88.47 0.0001

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Nationwide Utilization and Allowed Service Levels - Select Speech Language Pathology ProceduresSpecialty: Speech Language Therapy Only



Procedure Utilization Allowed per MemberCode Modifier Description Per 1,000 Unit Allowed Cost96105 Assessment Aphasia W/I&R Per Hour 0.0123 172.45 0.0002 96110 Dvlpmentl Testing; Limited W/I&R 0.0117 30.16 0.0000 96111 Dvlpmentl Tst; Ext W/I&R Per Hour 0.0655 163.95 0.0009 96125 Cognitive testing 0.0323 165.97 0.0004 97530 Tx Actv Dir Pt Cntc Prov Ea 15 Min 29.5865 56.19 0.1385 97532 Dev Congnitive Skill-1:1-Ea 15 Min 0.0458 117.58 0.0004 97535 Self-care/home management training 2.1505 51.29 0.0092 99366 Medical team conference; direct care, non-physician 0.0043 63.48 0.0000 99368 Medical team conference; without direct care; non-physician 0.0020 55.03 0.0000 L8509 Tracheo-esophageal voice prosthesis, inserted by a lic. health care

provider, any typeNo Alloc No Alloc No Alloc

L8510 Voice amplifier No Alloc No Alloc No AllocE2500 Speech generating device, digitized speech No Alloc No Alloc No AllocE2502 Speech generating device No Util No Util No Util




E2510 Speech generating device No Alloc No Alloc No Alloc

Total 47.4954 64.31 $0.2545

"No Util" in a field indicates no utilization was found for the specified region.


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Chapter 12: Documentation GuidanceDocumentation Tips

• No “universal template” or documentation style exists - specific documentation requirements or formats may vary by institution or payer.

• Remember: “If you didn’t document it, it didn’t happen.”

Clinical documentation is one of a clinician’s most important tasks. The clinical record is an overall indicator of clinical and service quality and serves as a basis for planning care and for service continuity. Medicare and Medicaid have specific guidelines on documentation, and commercial payers may have certain rules as well. Remember that documentation is often reviewed by nurses, rather than speech-language pathologists (SLPs) or audiologists, and an SLP or audiologist should not assume that the reviewer will understand why the service requires the skill of an SLP or all aspects of hearing assessment. This manual covers Medicare documentation requirements and outlines very specific rules.

Documentation for Audiology, Based on Medicare RequirementsDocumentation justifies why the patient was seen, what was done, what was found, and what was recommended. Together, these components of documentation support the respective selections for procedure and diagnosis codes.

In general, documentation should include, in addition to the signature and service date:

• History. The history section of a report includes the patient’s chief complaints, signs, and symptoms; pertinent medical, social, and family history; and the referral source. History should be sufficient to justify the medical necessity of the patient’s visit and the procedures that were performed.

• Procedures performed. This portion of the report documents the procedures executed and the diagnostic test results for each procedure.

• Clinical assessment. This section is an interpretation of the findings. Sufficient detail and discussion should be included so that the unfamiliar reader may understand not only what was found, but also why the findings affect the overall well-being of the patient.

• Recommendations. This section should be a logical conclusion to the flow of information from the previous three sections; recommendations should be specific and cover follow-up, referral, discharge, and/or plan of care, as appropriate.

For Medicare documentation, audiologists should write clear and comprehensive information in each patient’s records detailing the physician/NPP referral or order, the services and procedures performed, and the follow-up provided to the referring physician. Specific Medicare instructions for audiology documentation follow:

Documenting Audiological TestsThe reason for performing the test should be included on the order, and/or the audiological evaluation report, and/or the patient’s medical record. Examples of appropriate reasons include but are not limited to:

• Evaluation of suspected change in hearing, tinnitus, or balance;

• Evaluation of the cause of disorders of hearing, tinnitus, or balance;

• Determination of the effect of medication, surgery, or other treatment.

Reevaluation is appropriate to follow-up changes in hearing, tinnitus, or balance that may be caused by, but not limited to, such conditions as otosclerosis, atelectatic tympanic membrane, tymposclerosis, cholesteatoma, resolving middle ear infection, Ménière’s disease, sudden idiopathic sensorineural hearing loss, autoimmune inner ear disease, acoustic neuroma, demyelinating diseases, ototoxicity secondary to medications, genetic, or vascular or viral conditions. Screening tests are not payable, but failure of a screening test may be an appropriate reason to conduct diagnostic audiological tests.

The medical record should identify the name and professional identity of the person who ordered the evaluation and the person who actually performed the service. When the medical record is subject to medical review, it is necessary that the contractor determine that the service qualifies as an audiological diagnostic test that requires the skills of an audiologist. Services by audiologists must be documented and billed by the audiologist. For Medicare, audiologists cannot supervise technicians – that must be done by physicians.

Documentation should also include a section describing the procedures that were completed and their outcomes; a section on clinical assessment of the findings; recommendations; signature; and date of service.

The Medicare “other diagnostic tests” benefit requires an order from a physician, or, where allowed by state and local law, by a non-physician practitioner. The reason for the test should be documented either on the order, on the audiological evaluation report, or in the patient’s medical record.

Examples of appropriate reasons include but are not limited to:

• Evaluation of suspected change in hearing, tinnitus, or balance.

• Evaluation of the cause of disorders of hearing, tinnitus, or balance.

• Determination of the effect of medication, surgery or other treatment.


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Speech-Language PathologyThe documentation required by the Centers for Medicare & Medicaid Services (CMS) for Medicare payment is summarized below:

• Summary

• Evaluation

• Plan of Care/Certification of the Plan of Care

• Progress reports

• Treatment encounter notes

• Discharge note

SummaryIn general, Medicare requires that therapy services are of appropriate type, frequency, intensity, and duration for the individual needs of the patient. Documentation should:

• Establish the variables that influence the patient’s condition, especially those factors that influence the clinician’s decision to provide more services than are typical for the individual’s condition.

• Establish through objective measurements that the patient is making progress toward goals. CMS realizes that regression and plateaus can happen during treatment. CMS recommends that the reasons for lack of progress be noted and the justification for continued treatment be documented, if treatment continues after regression or plateaus.

EvaluationThe initial evaluation, or the plan of care including an evaluation, should document the necessity for a course of therapy through objective findings. Documentation of the evaluation should list the conditions and complexities and describe the impact of the conditions and complexities on the prognosis and/or the plan for treatment so that it is clear to a reviewer that the services planned are appropriate for the individual.

Evaluation shall include the following:

• A diagnosis and description of the specific problem(s) to be evaluated and/or treated. The diagnosis should be specific and as relevant as possible to the problem to be treated. The treatment diagnosis may or may not be identified by the therapist, depending on his or her scope of practice. Where a diagnosis is not allowed, CMS advises the use of a condition description similar to the appropriate ICD-9 code.

• Results of ASHA’s National Outcomes Measurement System (NOMS), is optional. Additional information can be found on the NOMS section of the ASHA website.

• If NOMS is not used, the record shall contain documentation indicating objective, measurable beneficiary physical function, including, for

example, (a) functional assessment individual item and summary scores (and comparisons to prior assessment scores) from commercially available therapy outcomes instruments other than those listed above, or (b) functional assessment scores (and comparisons to prior assessment scores) from tests and measurements validated in the professional literature that are appropriate for the condition/function being measured, or (c) other measurable progress towards identified goals for functioning in the home environment at the conclusion of this therapy episode of care.

When an evaluation is the only service provided in an episode of treatment, the evaluation serves as the plan of care provided that it contains (a) a diagnosis or states where a therapist may not diagnose, and (b) a description of the condition from which a diagnosis may be determined by the referring physician/non-physician practitioner (NPP). The goal, frequency, intensity, and duration of treatment are implied in the diagnosis and one-time service. The referral/order of a physician/NPP is the certification that the evaluation is needed and that the patient is under the care of a physician.

Plan of Care/Certification of the Plan of CareThe plan of care shall be consistent with the related evaluation. The evaluation and plan may be reported in two separate documents or a single combined document. The certified plan of care ensures that the patient is under the care of a physician or NPP. Long-term treatment goals should be developed for the entire episode of care. The plan of care should contain the following information:

• Diagnoses

• Long-term treatment goals

• Type, amount, duration, and frequency of therapy services

The amount of treatment refers to the number of times in a day the type of treatment will be provided. The frequency refers to the number of times in a week the type of treatment will be provided. The duration is the number of weeks or the number of treatment sessions.

Progress ReportsThe progress report provides justification for the medical necessity of treatment. A clinician must complete a progress report at least once every 10 treatment days or at least once during each certification interval, whichever is appropriate. The beginning of the first reporting period is the first day of the episode of treatment, regardless of whether the service provided on that day is an evaluation, re-evaluation, or treatment.

Progress notes should contain:

• An assessment of improvement - extent of progress (or lack thereof) toward each goal;


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• Plans for continuing treatment, reference to additional evaluation results, and/or treatment plan revisions documented in the clinician’s progress report;

• Changes to long or short-term goals, discharge, or an updated plan of care that is sent to the physician/NPP for certification of the next interval of treatment;

• The alphanumeric G-codes and severity modifiers, along with the tool or method used to determine the patient severity in the clinical assessment.

Documentation should justify the necessity of the services provided during the reporting period and include, for example, objective evidence or a clinically supportable statement of expectation that the patient’s condition has the potential to improve or is improving in response to therapy; maximum improvement is yet to be attained; and there is an expectation that the anticipated improvement is attainable in a reasonable and generally predictable period of time. Additionally, Medicare must cover services that prevent deterioration and maintain functional levels—not just those that result in functional progress—according to the recent settlement of Jimmo v. Sebelius (January 2013), which requires CMS to revise its policy manuals by January 2014 to reflect the elimination of the Medicare Improvement Standard that requires patients show functional progress in order to continue to receive rehabilitation services.

Objective evidence consists of standardized patient assessment instruments, outcomes measurement tools, or measurable assessments of functional outcomes (e.g., per NOMS). Use of objective measures at the beginning, during, and/or after treatment is recommended to quantify progress and support justifications for continued treatment. Such tools are not required, but their use will enhance the justification for needed therapy.

CMS Example of a SLP Progress NoteThe Plan states diagnosis is 787.2 - Dysphagia secondary to other late effects of CVA. Patient is on a restricted diet and wants to drink thick liquids.

Therapy is planned 3X week, 45 minute sessions for 6 weeks.

Long-term goal is to consume a mechanical soft diet with thin liquids without complications, such as aspiration pneumonia.

Short-Term Goals:

Goal 1: Patient will improve rate of laryngeal elevation/timing of closure by using the super-supraglottic swallow on saliva swallows without cues on 90% of trials.

Goal 2: Patient will compensate for reduced laryngeal elevation by controlling bolus size to a ½ teaspoon without cues on 100% of trials.

The Progress Report for 1/3/06 to 1/29/06 states:

1. Improved to 80% of trials;

2. Achieved. Comments: Highly motivated; spouse assists with practicing, patient compliant with current restrictions.

New Goal: Patient will implement above strategies to swallow a sip of water without coughing for 5 consecutive trials.

Mary Johns, CCC-SLP, 1/29/06

Note the provider is billing 92526 three times a week, consistent with the plan; progress is documented; skilled treatment is documented.

Treatment NotesThe purpose of the treatment note is to create a record of all encounters and skilled intervention. Documentation is required for every treatment day and every therapy service and must include:

• the encounter note must record the name of the treatment, intervention of activity provided;

• total treatment time; and

• signature of the professional furnishing the services.

If a treatment is added or changed between the progress note intervals, the change must be recorded and justified in the medical record. Frequent professional judgments resulting in upgrades to the patient’s activity show skilled treatment. Objective measurement showing patient improvement is also helpful.

If there is no improvement, the clinician should provide information to explain the setbacks, illness, new condition, and/or social circumstances that are impeding progress and why he/she believes that progress is still attainable.

Discharge NoteThe discharge note is required and is a progress report written by a clinician that should cover the reporting period from the last progress report to the date of discharge. The discharge note should include all treatment provided since the last progress report and indicate that the therapist reviewed the notes and agrees to the discharge.

There is an important distinction between progress notes and treatment encounter notes, which document every treatment day and every treatment service. The purpose of the encounter note is to create a record of all encounters and skilled interventions by qualified professionals to justify the use of the billing codes on the claim (patient bill to Medicare). The progress note documents medical necessity or appropriateness of ongoing services.


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documenting each treatment encounter:

• Date of treatment

• Treatment minutes and total treatment time for timed codes. (The amount of time for each specific intervention provided to the patient is not required because it is indicated in the billing of the codes.) However, billing and total timed code treatment minutes must be consistent.

• Identification of each specific intervention/type of treatment provided and billed for both timed and untimed codes.

Electronic Health RecordsThe advent of electronic health records (EHR) has both streamlined and complicated clinical documentation. Electronic records can use free text, structured text (“macros” or “boilerplate”) and interactive text that includes clinical decision-support functions. Electronic records may be supplemented by bar coding (for tracking supplies used, medications administered, etc.) and identity recognition programs that authenticate users.

There has been a federal push towards electronic medical records (EMRs) for a number of years. While incentives for EMR adoption are aimed primarily at physicians and health care facilities at this time, other health care providers, such as audiologists and SLPs, may also be encouraged and incentivized to use EMRs in the future.

There are commercial practice management software programs available that address everything from billing to documentation and scheduling. Providers may also set-up their own programs or develop their own electronic templates. Consideration must be given to the Health Insurance Portability and Accountability Act (HIPAA) for privacy and security as well as other applicable state and federal laws.


ICD-9-CM Code

ICD-9-CM Description ICD-10-CM Code

ICD-10-CM Description

380.00 Perichondritis of pinna, unspecified

H61.001 Unspecified perichondritis of right external ear

H61.002 Unspecified perichondritis of left external ear

H61.003 Unspecified perichondritis of external ear, bilateral

H61.009 Unspecified perichondritis of external ear, unspecified ear

380.01 Acute perichondritis of pinna H61.011 Acute perichondritis of right external ear

H61.012 Acute perichondritis of left external ear

H61.013 Acute perichondritis of external ear, bilateral

H61.019 Acute perichondritis of external ear, unspecified ear

380.02 Chronic perichondritis of pinna H61.021 Chronic perichondritis of right external ear

H61.022 Chronic perichondritis of left external ear

H61.023 Chronic perichondritis of external ear, bilateral

H61.029 Chronic perichondritis of external ear, unspecified ear

380.03 Chondritis of pinna H61.031 Chondritis of right external ear

H61.032 Chondritis of left external ear

H61.033 Chondritis of external ear, bilateral

H61.039 Chondritis of external ear, unspecified ear

380.10 Infective otitis externa, unspecified H60.00 Abscess of external ear, unspecified ear

H60.01 Abscess of right external ear

H60.02 Abscess of left external ear

H60.03 Abscess of external ear, bilateral

H60.10 Cellulitis of external ear, unspecified ear

H60.11 Cellulitis of right external ear

H60.12 Cellulitis of left external ear

H60.13 Cellulitis of external ear, bilateral

H60.311 Diffuse otitis externa, right ear

H60.312 Diffuse otitis externa, left ear

H60.313 Diffuse otitis externa, bilateral

H60.319 Diffuse otitis externa, unspecified ear

H60.321 Hemorrhagic otitis externa, right ear

H60.322 Hemorrhagic otitis externa, left ear

H60.323 Hemorrhagic otitis externa, bilateral

H60.329 Hemorrhagic otitis externa, unspecified ear

H60.391 Other infective otitis externa, right ear

H60.392 Other infective otitis externa, left ear

H60.393 Other infective otitis externa, bilateral


Appendix & ResourcesICD-9-CM Conversion to ICD-10-CM

AudiologyDisclaimer: This product is NOT comprehensive and consists only of codes commonly related to audiology services. Mappings are only to ICD-10-CM codes, not ICD-10-PCS. Every effort was made to accurately map codes using detailed analysis. Keep in mind, however, that while many codes in ICD-9-CM map directly to codes in ICD-10-CM, in some cases, additional clinical analysis may be required to determine which code or codes should be selected for your situation. Always review mapping results before applying them.

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ICD-9-CM Code



380.11 Acute infection of pinna H61.90 Disorder of external ear, unspecified, unspecified ear




380.12 Acute swimmers’ ear Beach ear Tank ear

H60.331 Swimmer’s ear, right ear

H60.332 Swimmer’s ear, left ear

H60.333 Swimmer’s ear, bilateral

H60.339 Swimmer’s ear, unspecified ear

380.13 Other acute infections of external ear

H62.40 Otitis externa in other diseases classified elsewhere, unspecified ear

H62.41 Otitis externa in other diseases classified elsewhere, right ear

H62.42 Otitis externa in other diseases classified elsewhere, left ear

H62.43 Otitis externa in other diseases classified elsewhere, bilateral

H62.8X1 Other disorders of right external ear in diseases classified elsewhere

H62.8X2 Other disorders of left external ear in diseases classified elsewhere

H62.8X3 Other disorders of external ear in diseases classified elsewhere, bilateral

H62.8X9 Other disorders of external ear in diseases classified elsewhere, unspecified ear

380.14 Malignant otitis externa H60.20 Malignant otitis externa, unspecified ear

H60.21 Malignant otitis externa, right ear

H60.22 Malignant otitis externa, left ear

H60.23 Malignant otitis externa, bilateral

380.15 Chronic myotic otitis externa H62.8X1 Other disorders of right external ear in diseases classified elsewhere

H62.8X2 Other disorders of left external ear in diseases classified elsewhere

H62.8X3 Other disorders of external ear in diseases classified elsewhere, bilateral

H62.8X9 Other disorders of external ear in diseases classified elsewhere, unspecified ear

380.16 Other chronic infective otitis externa


380.30 Disorder of pinna, unspecified H61.101 Unspecified noninfective disorders of pinna, right ear

H61.102 Unspecified noninfective disorders of pinna, left ear

H61.103 Unspecified noninfective disorders of pinna, bilateral

H61.109 Unspecified noninfective disorders of pinna, unspecified ear

380.31 Hematoma of auricle or pinna H61.121 Hematoma of pinna, right ear

H61.122 Hematoma of pinna, left ear

H61.123 Hematoma of pinna, bilateral

H61.129 Hematoma of pinna, unspecified ear

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ICD-9-CM Code



380.32 Acquired deformities of auricle or pinna

H61.111 Acquired deformity of pinna, right ear

H61.112 Acquired deformity of pinna, left ear

H61.113 Acquired deformity of pinna, bilateral

H61.119 Acquired deformity of pinna, unspecified ear

380.39 Other noninfectious disorders of pinna

H61.191 Noninfective disorders of pinna, right ear

H61.192 Noninfective disorders of pinna, left ear

H61.193 Noninfective disorders of pinna, bilateral

H61.199 Noninfective disorders of pinna, unspecified ear

380.4 Impacted cerumen Wax in ear

H61.20 Impacted cerumen, unspecified ear

H61.21 Impacted cerumen, right ear

H61.22 Impacted cerumen, left ear

H61.23 Impacted cerumen, bilateral

380.51 Acquired stenosis of external ear canal secondary to trauma

H61.311 Acquired stenosis of right external ear canal secondary to trauma

H61.312 Acquired stenosis of left external ear canal secondary to trauma

H61.313 Acquired stenosis of external ear canal secondary to trauma, bilateral

H61.319 Acquired stenosis of external ear canal secondary to trauma, unspecified ear

380.81 Exostosis of external ear canal H61.811 Exostosis of right external canal

H61.812 Exostosis of left external canal

H61.813 Exostosis of external canal, bilateral

H61.819 Exostosis of external canal, unspecified ear

380.89 Other disorders of external ear H61.891 Other specified disorders of right external ear

H61.892 Other specified disorders of left external ear

H61.893 Other specified disorders of external ear, bilateral

H61.899 Other specified disorders of external ear, unspecified ear

380.9 Unspecified disorder of external ear

H61.90 Disorder of external ear, unspecified, unspecified ear




381.00 Acute nonsuppurative otitis media, unspecified

H65.191 Other acute nonsuppurative otitis media, right ear

H65.192 Other acute nonsuppurative otitis media, left ear

H65.193 Other acute nonsuppurative otitis media, bilateral

H65.194 Other acute nonsuppurative otitis media, recurrent, right ear

H65.195 Other acute nonsuppurative otitis media, recurrent, left ear

H65.196 Other acute nonsuppurative otitis media, recurrent, bilateral

H65.197 Other acute nonsuppurative otitis media recurrent, unspecified ear

H65.199 Other acute nonsuppurative otitis media, unspecified ear


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CodeICD-9-CM Description ICD-10-CM

CodeICD-10-CM Description

381.01 Acute serous otitis media Acute or subacute secretory otitis media

H65.00 Acute serous otitis media, unspecified ear

H65.01 Acute serous otitis media, right ear

H65.02 Acute serous otitis media, left ear

H65.03 Acute serous otitis media, bilateral

H65.04 Acute serous otitis media, recurrent, right ear

H65.05 Acute serous otitis media, recurrent, left ear

H65.06 Acute serous otitis media, recurrent, bilateral

H65.07 Acute serous otitis media, recurrent, unspecified ear

381.02 Acute mucoid otitis media Acute or subacute seromucinous otitis media Blue drum syndrome









381.03 Acute sanguinous otitis media H65.111 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear









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381.04 Acute allergic serous otitis media H65.111 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear







H65.119 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous),unspecified ear

381.05 Acute allergic mucoid otitis media H65.111 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear








381.06 Acute allergic sanguinous otitis media










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381.10 Chronic serous otitis media, simple or unspecified





381.19 Other chronic otitis media Serosanguinous chronic otitis media





381.20 Chronic mucoid otitis media, simple or unspecified





381.29 Other (Chronic mucoid otitis media) Mucosanguinous chronic otitis media





381.3 Other and unspecified chronic nonsuppurative otitis media

H65.411 Chronic allergic otitis media, right ear

H65.412 Chronic allergic otitis media, left ear

H65.413 Chronic allergic otitis media, bilateral

H65.419 Chronic allergic otitis media, unspecified ear

H65.491 Other chronic nonsuppurative otitis media, right ear

H65.492 Other chronic nonsuppurative otitis media, left ear

H65.493 Other chronic nonsuppurative otitis media, bilateral

H65.499 Other chronic nonsuppurative otitis media, unspecified ear

381.4 Nonsuppurative otitis media, not specified as acute or chronic

H65.90 Unspecified nonsuppurative otitis media, unspecified ear

H65.91 Unspecified nonsuppurative otitis media, right ear

H65.92 Unspecified nonsuppurative otitis media, left ear

H65.93 Unspecified nonsuppurative otitis media, bilateral

382.00 Acute suppurative otitis media without spontaneous rupture of ear drum

H66.001 Acute suppurative otitis media without spontaneous rupture of ear drum, right ear

H66.002 Acute suppurative otitis media without spontaneous rupture of ear drum, left ear

H66.003 Acute suppurative otitis media without spontaneous rupture of ear drum, bilateral

H66.004 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear

H66.005 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left ear

H66.006 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, bilateral

H66.007 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, unspecified ear

H66.009 Acute suppurative otitis media without spontaneous rupture of ear drum, unspecified ear


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382.01 Acute suppurative otitis media with spontaneous rupture of ear drum

H66.011 Acute suppurative otitis media with spontaneous rupture of ear drum, right ear

H66.012 Acute suppurative otitis media with spontaneous rupture of ear drum, left ear

H66.013 Acute suppurative otitis media with spontaneous rupture of ear drum, bilateral

H66.014 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, right ear

H66.015 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, left ear

H66.016 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, bilateral

H66.017 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, unspecified ear

H66.019 Acute suppurative otitis media with spontaneous rupture of ear drum, unspecified ear

382.02 Acute suppurative otitis media in diseases classified elsewhere

H67.1 Otitis media in diseases classified elsewhere, right ear

H67.2 Otitis media in diseases classified elsewhere, left ear

H67.3 Otitis media in diseases classified elsewhere, bilateral

H67.9 Otitis media in diseases classified elsewhere, unspecified ear

382.1 Chronic tubotympanic supprative otitis media Benign chronic suppurative otitis media (with anterior perforation of ear drum) Chronic tubotympanic disease (with anterior perforation of ear drum)

H66.10 Chronic tubotympanic suppurative otitis media, unspecified

H66.11 Chronic tubotympanic suppurative otitis media, right ear

H66.12 Chronic tubotympanic suppurative otitis media, left ear

H66.13 Chronic tubotympanic suppurative otitis media, bilateral

382.2 Chronic atticoantral suppurative otitis media Chronic atticoantral disease (with posterior or superior marginal perforation of ear drum) Persistent mucosal disease (with posterior or superior marginal perforation of ear drum)

H66.20 Chronic atticoantral suppurative otitis media, unspecified ear

H66.21 Chronic atticoantral suppurative otitis media, right ear

H66.22 Chronic atticoantral suppurative otitis media, left ear

H66.23 Chronic atticoantral suppurative otitis media, bilateral

382.3 Unspecified chronic suppurative otitis media Chronic purulent otitis media

H66.3X1 Other chronic suppurative otitis media, right ear

H66.3X2 Other chronic suppurative otitis media, left ear

H66.3X3 Other chronic suppurative otitis media, bilateral

H66.3X9 Other chronic suppurative otitis media, unspecified ear

382.4 Unspecified suppurative otitis media Purulent otitis media NOS

H66.40 Suppurative otitis media, unspecified, unspecified ear

H66.41 Suppurative otitis media, unspecified, right ear

H66.42 Suppurative otitis media, unspecified, left ear

H66.43 Suppurative otitis media, unspecified, bilateral


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382.9 Unspecified otitis media H66.90 Otitis media, unspecified, unspecified ear

H66.91 Otitis media, unspecified, right ear

H66.92 Otitis media, unspecified, left ear

H66.93 Otitis media, unspecified, bilateral

384.00 Acute myringitis, unspecified H73.001 Acute myringitis, right ear

H73.002 Acute myringitis, left ear

H73.003 Acute myringitis, bilateral

H73.009 Acute myringitis, unspecified ear

384.01 Bullous myringitis H73.011 Bullous myringitis, right ear

H73.012 Bullous myringitis, left ear

H73.013 Bullous myringitis, bilateral

H73.019 Bullous myringitis, unspecified ear

384.1 Chronic myringitis without mention of otitis media Chronic tympanitis

H73.091 Other acute myringitis, right ear

H73.092 Other acute myringitis, left ear

H73.093 Other acute myringitis, bilateral

H73.099 Other acute myringitis, unspecified ear

384.20 Perforation of tympanic membrane, unspecified

H72.90 Unspecified perforation of tympanic membrane, unspecified ear

H72.91 Unspecified perforation of tympanic membrane, right ear

H72.92 Unspecified perforation of tympanic membrane, left ear

H72.93 Unspecified perforation of tympanic membrane, bilateral

384.21 Central perforation of tympanic membrane

H72.00 Central perforation of tympanic membrane, unspecified ear

H72.01 Central perforation of tympanic membrane, right ear

H72.02 Central perforation of tympanic membrane, left ear

H72.03 Central perforation of tympanic membrane, bilateral

384.22 Attic perforation of tympanic membrane Pars flaccida

H72.10 Attic perforation of tympanic membrane, unspecified ear

H72.11 Attic perforation of tympanic membrane, right ear

H72.12 Attic perforation of tympanic membrane, left ear

H72.13 Attic perforation of tympanic membrane, bilateral

384.23 Other marginal perforation of tympanic membrane

H72.2X1 Other marginal perforations of tympanic membrane, right ear

H72.2X2 Other marginal perforations of tympanic membrane, left ear

H72.2X3 Other marginal perforations of tympanic membrane, bilateral

H72.2X9 Other marginal perforations of tympanic membrane, unspecified ear

384.24 Multiple perforations of tympanic membrane

H72.811 Multiple perforations of tympanic membrane, right ear

H72.812 Multiple perforations of tympanic membrane, left ear

H72.813 Multiple perforations of tympanic membrane, bilateral

H72.819 Multiple perforations of tympanic membrane, unspecified ear


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384.25 Total perforation of tympanic membrane

H72.821 Total perforations of tympanic membrane, right ear

H72.822 Total perforations of tympanic membrane, left ear

H72.823 Total perforations of tympanic membrane, bilateral

H72.829 Total perforations of tympanic membrane, unspecified ear

384.81 Atrophic flaccid tympanic membrane Healed perforation of ear drum

H73.811 Atrophic flaccid tympanic membrane, right ear

H73.812 Atrophic flaccid tympanic membrane, left ear

H73.813 Atrophic flaccid tympanic membrane, bilateral

H73.819 Atrophic flaccid tympanic membrane, unspecified ear

384.82 Atrophic nonflaccid tympanic membrane

H73.821 Atrophic nonflaccid tympanic membrane, right ear

H73.822 Atrophic nonflaccid tympanic membrane, left ear

H73.823 Atrophic nonflaccid tympanic membrane, bilateral

H73.829 Atrophic nonflaccid tympanic membrane, unspecified ear

384.9 Unspecified disorder of tympanic membrane

H73.90 Unspecified disorder of tympanic membrane, unspecified ear

H73.91 Unspecified disorder of tympanic membrane, right ear

H73.92 Unspecified disorder of tympanic membrane, left ear

H73.93 Unspecified disorder of tympanic membrane, bilateral

385.00 Tympanosclerosis, unspecified as to involvement





385.01 Tympanosclerosis involving tympanic membrane only





385.02 Tympanosclerosis involving tympanic membrane and ear ossicles





385.03 Tympanosclerosis involving tympanic membrane, ear ossicles, and middle ear





385.09 Tympanosclerosis involving other combination of structures





385.10 Adhesive middle ear disease, unspecified as to involvement






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385.11 Adhesions of drum head to incus H74.11 Adhesive right middle ear disease




385.12 Adhesions of drum head to stapes H74.11 Adhesive right middle ear disease




385.13 Adhesions of drum head to promontorium





385.19 Other adhesions and combinations





385.21 Impaired mobility of malleus Ankylosis of malleus





385.22 Impaired mobility of other ear ossicles Ankylosis of ear ossicles, except malleus





385.23 Discontinuity or dislocation of ear ossicles

H74.20 Discontinuity and dislocation of ear ossicles, unspecified ear

H74.21 Discontinuity and dislocation of right ear ossicles

H74.22 Discontinuity and dislocation of left ear ossicles

H74.23 Discontinuity and dislocation of ear ossicles, bilateral

385.24 Partial loss or necrosis of ear ossicles

H74.321 Partial loss of ear ossicles, right ear

H74.322 Partial loss of ear ossicles, left ear

H74.323 Partial loss of ear ossicles, bilateral

H74.329 Partial loss of ear ossicles, unspecified ear

385.30 Cholesteatoma, unspecified H71.90 Unspecified cholesteatoma, unspecified ear

H71.91 Unspecified cholesteatoma, right ear

H71.92 Unspecified cholesteatoma, left ear

H71.93 Unspecified cholesteatoma, bilateral

385.31 Cholesteatoma of attic H71.00 Cholesteatoma of attic, unspecified ear

H71.01 Cholesteatoma of attic, right ear

H71.02 Cholesteatoma of attic, left ear

H71.03 Cholesteatoma of attic, bilateral

385.32 Cholesteatoma of middle ear H71.10 Cholesteatoma of tympanum, unspecified ear

H71.11 Cholesteatoma of tympanum, right ear

H71.12 Cholesteatoma of tympanum, left ear

H71.13 Cholesteatoma of tympanum, bilateral


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H71.20 Cholesteatoma of mastoid, unspecified ear

H71.21 Cholesteatoma of mastoid, right ear

H71.22 Cholesteatoma of mastoid, left ear

H71.23 Cholesteatoma of mastoid, bilateral

385.35 Diffuse cholesteatosis H71.30 Diffuse cholesteatosis, unspecified ear

H71.31 Diffuse cholesteatosis, right ear

H71.32 Diffuse cholesteatosis, left ear

H71.33 Diffuse cholesteatosis, bilateral

385.82 Cholesterin granuloma H74.8X1 Other specified disorders of right middle ear and mastoid




385.83 Retained foreign body of middle ear





385.89 Other (Other disorders of middle ear and mastoid)





385.9 Unspecified disorder of middle ear and mastoid

H74.90 Unspecified disorder of middle ear and mastoid, unspecified ear

H74.91 Unspecified disorder of right middle ear and mastoid

H74.92 Unspecified disorder of left middle ear and mastoid

H74.93 Unspecified disorder of middle ear and mastoid, bilateral

386.00 Ménière’s disease, unspecified Ménière’s disease (active)





386.01 Active Ménière’s disease, cochleovestibular





386.02 Active Ménière’s disease, cochlear H81.01 Ménière’s disease, right ear





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386.03 Active Ménière’s disease, vestibular





386.04 Inactive Ménière’s diseaseMénière’s disease in remission





386.10 Peripheral vertigo, unspecified H81.391 Other peripheral vertigo, right ear

H81.392 Other peripheral vertigo, left ear

H81.393 Other peripheral vertigo, bilateral

H81.399 Other peripheral vertigo, unspecified ear

386.11 Benign paroxysmal positional vertigo Benign paroxysmal positional nystagmus

H81.10 Benign paroxysmal vertigo, unspecified ear




386.12 Vestibular neuronitis Acute (and recurrent) peripheral vestibulopathy

H81.20 Vestibular neuronitis, unspecified ear

H81.21 Vestibular neuronitis, right ear

H81.22 Vestibular neuronitis, left ear

H81.23 Vestibular neuronitis, bilateral

386.19 Other (Other and unspecified vertigo) Aural vertigo Otogenic vertigo

H81.311 Aural vertigo, right ear

H81.312 Aural vertigo, left ear

H81.313 Aural vertigo, bilateral

H81.319 Aural vertigo, unspecified ear

386.2 Vertigo of central origin Central positional nystagmusMalignant positional vertigo

H81.41 Vertigo of central origin, right ear

H81.42 Vertigo of central origin, left ear

H81.43 Vertigo of central origin, bilateral

H81.49 Vertigo of central origin, unspecified ear

386.31 Serous labyrinthitis Diffuse labyrinthitis





386.30 Labyrinthitis, unspecified H83.01 Labyrinthitis, right ear




386.32 Circumscribed labyrinthitis Focal labyrinthitis





386.33 Suppurative labyrinthitis H83.01 Labyrinthitis, right ear





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386.34 Toxic labyrinthitis H83.01 Labyrinthitis, right ear




386.35 Viral labyrinthitis H83.01 Labyrinthitis, right ear




386.40 Labyrinthine fistula, unspecified H83.11 Labyrinthine fistula, right ear




386.41 Round window fistula H83.11 Labyrinthine fistula, right ear




386.42 Oval window fistula H83.11 Labyrinthine fistula, right ear




386.43 Semicircular canal fistula H83.11 Labyrinthine fistula, right ear




386.48 Labyrinthine fistula of combined sites

H83.11 Labyrinthine fistula, right ear




386.50 Labyrinthine dysfunction, unspecified





386.51 Hyperactive labyrinth, unilateral H83.2X1 Labyrinthine dysfunction, right ear



386.52 Hyperactive labyrinth, bilateral H83.2X3 Labyrinthine dysfunction, bilateral


386.53 Hypoactive labyrinth, unilateral H83.2X1 Labyrinthine dysfunction, right ear



386.54 Hypoactive labyrinth, bilateral H83.2X3 Labyrinthine dysfunction, bilateral



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386.55 Loss of labyrinthine reactivity, unilateral




386.56 Loss of labyrinthine reactivity, bilateral



386.58 Other forms and combinations (Labyrinthine dysfunction)





386.8 Other disorders of labyrinth H81.8X1 Other disorders of vestibular function, right ear

H81.8X2 Other disorders of vestibular function, left ear

H81.8X3 Other disorders of vestibular function, bilateral

H81.8X9 Other disorders of vestibular function, unspecified ear

H82.1 Vertiginous syndromes in diseases classified elsewhere, right ear

H82.2 Vertiginous syndromes in diseases classified elsewhere, left ear

H82.3 Vertiginous syndromes in diseases classified elsewhere, bilateral

H82.9 Vertiginous syndromes in diseases classified elsewhere, unspecified ear

H83.8X1 Other specified diseases of right inner ear

H83.8X2 Other specified diseases of left inner ear

H83.8X3 Other specified diseases of inner ear, bilateral

H83.8X9 Other specified diseases of inner ear, unspecified ear

386.9 Unspecified vertiginous syndromes and labyrinthine disorders

H81.90 Unspecified disorder of vestibular function, unspecified ear

H81.91 Unspecified disorder of vestibular function, right ear

H81.92 Unspecified disorder of vestibular function, left ear

H81.93 Unspecified disorder of vestibular function, bilateral

H83.90 Unspecified disease of inner ear, unspecified ear

H83.91 Unspecified disease of right inner ear

H83.92 Unspecified disease of left inner ear

H83.93 Unspecified disease of inner ear, bilateral

387.0 Otosclerosis involving oval window, nonobliterative

H80.00 Otosclerosis involving oval window, nonobliterative, unspecified ear

H80.01 Otosclerosis involving oval window, nonobliterative, right ear

H80.02 Otosclerosis involving oval window, nonobliterative, left ear

H80.03 Otosclerosis involving oval window, nonobliterative, bilateral


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387.1 Otosclerosis involving oval window, obliterative

H80.10 Otosclerosis involving oval window, obliterative, unspecified ear

H80.11 Otosclerosis involving oval window, obliterative, right ear

H80.12 Otosclerosis involving oval window, obliterative, left ear

H80.13 Otosclerosis involving oval window, obliterative, bilateral

387.2 Cochlear otosclerosis H80.20 Cochlear otosclerosis, unspecified ear

H80.21 Cochlear otosclerosis, right ear

H80.22 Cochlear otosclerosis, left ear

H80.23 Cochlear otosclerosis, bilateral

387.8 Other otosclerosis H80.80 Other otosclerosis, unspecified ear

H80.81 Other otosclerosis, right ear

H80.82 Other otosclerosis, left ear

H80.83 Other otosclerosis, bilateral

387.9 Otosclerosis, unspecified H80.90 Unspecified otosclerosis, unspecified ear

H80.91 Unspecified otosclerosis, right ear

H80.92 Unspecified otosclerosis, left ear

H80.93 Unspecified otosclerosis, bilateral

388.00 Degenerative and vascular disorders, unspecified

H93.091 Unspecified degenerative and vascular disorders of right ear

H93.092 Unspecified degenerative and vascular disorders of left ear

H93.093 Unspecified degenerative and vascular disorders of ear, bilateral

H93.099 Unspecified degenerative and vascular disorders of unspecified ear

388.01 Presbyacusis H91.10 Presbycusis, unspecified ear




388.02 Transient ischemic deafness H93.011 Transient ischemic deafness, right ear

H93.012 Transient ischemic deafness, left ear

H93.013 Transient ischemic deafness, bilateral

H93.019 Transient ischemic deafness, unspecified ear






388.11 Acoustic trauma (explosive) to ear Otitic blast injury





388.12 Noise-induced hearing loss H83.3X1 Noise effects on right inner ear





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388.2 Sudden hearing loss, unspecified H91.20 Sudden idiopathic hearing loss, unspecified ear

H91.21 Sudden idiopathic hearing loss, right ear

H91.22 Sudden idiopathic hearing loss, left ear

H91.23 Sudden idiopathic hearing loss, bilateral

388.30 Tinnitus, unspecified H93.11 Tinnitus, right ear




388.31 Subjective tinnitus H93.11 Tinnitus, right ear




388.32 Objective tinnitus H93.11 Tinnitus, right ear





H93.291 Other abnormal auditory perceptions, right ear

H93.292 Other abnormal auditory perceptions, left ear

H93.293 Other abnormal auditory perceptions, bilateral


388.41 Diplacusis H93.221 Diplacusis, right ear

H93.222 Diplacusis, left ear

H93.223 Diplacusis, bilateral

H93.229 Diplacusis, unspecified ear

388.42 Hyperacusis H93.231 Hyperacusis, right ear

H93.232 Hyperacusis, left ear

H93.233 Hyperacusis, bilateral

H93.239 Hyperacusis, unspecified ear



388.44 Recruitment H93.211 Auditory recruitment, right ear






388.5 Disorders of acoustic nerve H93.3X1 Disorders of right acoustic nerve

H93.3X2 Disorders of left acoustic nerve

H93.3X3 Disorders of bilateral acoustic nerves

H93.3X9 Disorders of unspecified acoustic nerve

388.60 Unspecified otorrhea H92.10 Otorrhea, unspecified ear

H92.11 Otorrhea, right ear

H92.12 Otorrhea, left ear

H92.13 Otorrhea, bilateral

388.61 Cerebrospinal fluid otorrhea G96.0 Cerebrospinal fluid leak


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388.69 Other otorrhea H92.20 Otorrhagia, unspecified ear

H92.21 Otorrhagia, right ear

H92.22 Otorrhagia, left ear

H92.23 Otorrhagia, bilateral

388.70 Unspecified otalgia H92.01 Otalgia, right ear

H92.02 Otalgia, left ear

H92.03 Otalgia, bilateral

H92.09 Otalgia unspecified ear

388.71 Otogenic pain H92.09 Otalgia, unspecified ear


















389.04 Conductive hearing loss, inner ear H90.0 Conductive hearing loss, bilateral




389.05 Conductive hearing loss, unilateral H90.11 Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side


389.06 Conductive hearing loss, bilateral H90.0 Conductive hearing loss, bilateral







ICD-9-CM Code





389.11 Sensory hearing loss, bilateral H90.3 Sensorineural hearing loss, bilateral

389.12 Neural hearing loss, bilateral H90.3 Sensorineural hearing loss, bilateral

389.13 Neural hearing loss, unilateral H90.41 Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side


389.14 Central hearing loss H90.3 Sensorineural hearing loss, bilateral









389.17 Sensory hearing loss, unilateral H90.41 Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side




389.20 Mixed hearing loss, unspecified H90.8 Mixed conductive and sensorineural hearing loss, unspecified

389.21 Mixed hearing loss, unilateral H90.71 Mixed conductive and sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side


389.22 Mixed hearing loss, bilateral H90.6 Mixed conductive and sensorineural hearing loss, bilateral

389.7 Deaf nonspeaking, not elsewhere classifiable

H91.3 Deaf nonspeaking, not elsewhere classified

389.8 Other specified forms of hearing loss

H91.01 Ototoxic hearing loss, right ear

H91.02 Ototoxic hearing loss, left ear

H91.03 Ototoxic hearing loss, bilateral

H91.09 Ototoxic hearing loss, unspecified ear





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389.9 Unspecified hearing loss Deafness NOS

H91.90 Unspecified hearing loss, unspecified ear

H91.91 Unspecified hearing loss, right ear

H91.92 Unspecified hearing loss, left ear

H91.93 Unspecified hearing loss, bilateral

744.00 Unspecified anomaly of ear with impairment of hearing

Q16.9 Congenital malformation of ear causing impairment of hearing, unspecified Congenital absence of ear NOS

744.01 Absence of external ear (Anomalies of ear causing impairment of hearing)

Q16.0 Congenital absence of (ear) auricle (Congenital malformations of ear causing impairment of hearing)

744.02 Other anomalies of external ear with impairment of hearing

Q16.1 Congenital absence, atresia and stricture of auditory canal (external) Congenital atresia or stricture of osseous meatus

744.03 Anomalies of middle ear, except ossicles (Anomalies of ear causing impairment of hearing)

Q16.4 Other congenital malformations of middle ear (Congenital malformations of ear causing impairment of hearing)

744.04 Anomalies of ear ossicles (Anomalies of ear causing impairment of hearing)

Q16.3 Congenital malformation of ear ossicles (Congenital malformations of ear causing impairment of hearing) Congenital fusion of ear ossicles

744.05 Anomalies of inner ear (Anomalies of ear causing impairment of hearing)

Q16.5 Congenital malformation of inner ear (Congenital malformations of ear causing impairment of hearing) Congenital anomaly of membranous labyrinth Congenital anomaly of organ of Corti

744.09 Other (Anomalies of ear causing impairment of hearing) Absence of ear, congenital

Q16.9 Congenital malformation of ear causing impairment of hearing, unspecified Congenital absence of ear NOS

744.1 Accessory auricle Q17.0 Accessory auricle

744.21 Absence of ear lobe, congenital Q17.8 Other specified congenital malformations of ear Congenital absence of lobe of ear

744.22 Macrotia Q17.1 Macrotia

744.23 Microtia Q17.2 Microtia

744.24 Specified anomalies of Eustachian tube Absence of Eustachian tube


744.29 Other (Other specified anomalies of ear) Bat ear Darwin’s tubercle Pointed ear Prominence of auricle

Q17.3 Other misshapen ear Pointed ear

Q17.4 Misplaced ear Low-set ears Excludes1: cervical auricle (Q18.2)

Q17.5 Prominent ear Bat ear

Q17.8 Other specified congenital malformations of ear Congenital absence of lobe of ear

744.3 Unspecified anomaly of ear Q17.9 Congenital malformation of ear, unspecified Congenital anomaly of ear NOS

780.4 Dizziness and giddiness R42 Dizziness and giddiness Light-headedness Vertigo NOS Excludes1: vertiginous syndromes (H81.-), vertigo from infrasound (T75.23)

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794.00 Abnormal function study, unspecified (Brain and central nervous system)

R94.09 Abnormal results of other function studies of central nervous system (Abnormal results of function studies of central nervous system)

794.09 Other (Brain and central nervous system) Abnormal brain scan

R94.02 Abnormal brain scan (Abnormal results of function studies of central nervous system)


794.13 Abnormal visually evoked potential (Peripheral nervous system and special senses)

R94.112 Abnormal visually evoked potential [VEP] (Abnormal results of function studies of peripheral nervous system and special senses)

794.15 Abnormal auditory function studies (Peripheral nervous system and special senses)

R94.120 Abnormal auditory function study (Abnormal results of function studies of peripheral nervous system and special senses)

794.16 Abnormal vestibular function studies (Peripheral nervous system and special senses)

R94.121 Abnormal vestibular function study (Abnormal results of function studies of peripheral nervous system and special senses)

V13.64 Personal history of (corrected) congenital malformation of eye, ear, face and neck Corrected cleft lip and palate




V15.52 History of traumatic brain injury Z87.820 Personal history of traumatic brain injury



V44.0 Tracheostomy Z93.0 Tracheostomy status

V49.85 Dual-sensory impairment Z73.82 Dual sensory impairment

V52.8 Fitting and adjustment of prosthetic device and implant, Other specified prosthetic device


V52.9 Unspecified prosthetic device Z44.9 Encounter for fitting and adjustment of unspecified external prosthetic device

V53.2 Fitting and adjustment of other device, hearing aid


V57.3 Speech-language therapy Z51.89 Encounter for other specified aftercare





V80.01 Special screening for neurological, eye, and ear diseases, traumatic brain injury


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290.10 Presenile dementia, uncomplicated

F03.90 Unspecified dementia without behavioral disturbance

290.40 Vascular dementia, uncomplicated F01.50 Vascular dementia without behavioral disturbance

290.41 Vascular dementia with delirium F01.51 Vascular dementia with behavioral disturbance

294.10 Dementia in conditions classified elsewhere without behavioral disturbance

F02.80 Dementia in other diseases classified elsewhere without behavioral disturbance

294.11 Dementia in conditions classified elsewhere

F02.81 Dementia in other diseases classified elsewhere with behavioral disturbance

299.00 Autistic disorder (current or active state)

F84.0 Autistic disorder Excludes1: Asperger’s syndrome (F84.5)

299.80 Other specified pervasive developmental disorders (current or active state) Aspergers’s disorder



299.90 Unspecified pervasive developmental disorder (current or active state)

F84.9 Pervasive developmental disorder, unspecified

307.0 Adult onset fluency disorder F98.5 Adult onset fluency disorder Excludes1: childhood onset fluency disorder (F80.81), dysphasia (R47.02), fluency disorder in conditions classified elsewhere (R47.82), fluency disorder (stuttering) following cerebrovascular disease (I69. with final characters -23), tic disorders (F95.-)

310.81 Pseudobulbar affect Involuntary emotional expression disorder

F48.2 Pseudobulbar affect Involuntary emotional expression disorder Code first underlying cause, if known, such as: amyotrophic lateral sclerosis (G12.21), multiple sclerosis (G35), sequelae of cerebrovascular disease (I69.-), sequelae of traumatic intracranial injury (S06.-)

310.89 Other specified nonpsychotic mental disorders following organic brain damage Mild memory disturbance Other focal (partial) organic psychosyndromes Postencephalitic syndrome Excludes: memory loss of unknown cause (780.93)

F07.89 Other personality and behavioral disorders due to known physiological condition Postencephalitic syndrome Right hemispheric organic affective disorder

313.23 Selective mutism F94.0 Selective mutism Elective mutism Excludes2: pervasive developmental disorders (F84.-), schizophrenia (F20.-), specific developmental disorders of speech and language (F80.-), transient mutism as part of separation anxiety in young children (F93.0)

Speech-Language PathologyDisclaimer: This product is NOT comprehensive and consists only of codes commonly related to speech-language pathology services. Mappings are only to ICD-10-CM codes, not ICD-10-PCS. Every effort was made to accurately map codes using detailed analysis. Keep in mind, however, that while many codes in ICD-9-CM map directly to codes in ICD-10-CM, in some cases, additional clinical analysis may be required to determine which code or codes should be selected for your situation. Always review mapping results before applying them.


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314.00 Without mention of hyperactivity (Attention deficit disorder)


314.01 With hyperactivity (Attention deficit disorder)

F90.0 Attention-deficit hyperactivity disorder, predominantly inattentive type

F90.1 Attention-deficit hyperactivity disorder, predominantly hyperactive type

F90.2 Attention-deficit hyperactivity disorder, combined type

F90.8 Attention-deficit hyperactivity disorder, other type


315.00 Reading disorder, unspecified F81.0 Specific reading disorder ‘Backward reading’ Developmental dyslexia Specific reading retardation Excludes1: alexia NOS (R48.0), dyslexia NOS (R48.0)

315.01 Alexia R48.0 Dyslexia and alexia

315.02 Developmental dyslexia F81.0 Specific reading disorder ‘Backward reading’ Developmental dyslexia Specific reading retardation Excludes1: alexia NOS (R48.0), dyslexia NOS (R48.0)

315.09 Other (specific reading disorder) Specific spelling difficulty

F81.81 Disorder of written expression Specific spelling disorder

315.1 Mathematics disorder Dyscalculia

F81.2 Mathematics disorder Developmental acalculia Developmental arithmetical disorder Developmental Gerstmann’s syndrome Excludes1: acalculia NOS (R48.8) Excludes2: arithmetical difficulties associated with a reading disorder (F81.0), arithmetical difficulties associated with a spelling disorder (F81.81), arithmetical difficulties due to inadequate teaching (Z55.8)

315.2 Other specific delays in development Disorder of written expression

F81.81 Disorder of written expression Specific spelling disorder


315.31 Expressive language disorder (Developmental speech or language disorder)

F80.1 Expressive language disorder Developmental dysphasia or aphasia, expressive type Excludes1: mixed receptive-expressive language disorder (F80.2), dysphasia and aphasia NOS (R47.-) Excludes2: acquired aphasia with epilepsy [Landau-Kleffner] (G40.80-), selective mutism (F94.0), intellectual disabilities (F70-F79), pervasive developmental disorders (F84.-)


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315.32 Mixed receptive-expressive language disorder Central auditory processing disorder

F80.2 Mixed receptive-expressive language disorder Developmental dysphasia or aphasia, receptive type Developmental Wernicke’s aphasia Excludes1: central auditory processing disorder (H93.25), dysphasia or aphasia NOS (R47.-), expressive language disorder (F80.1), expressive type dysphasia or aphasia (F80.1), word deafness (H93.25) Excludes2: acquired aphasia with epilepsy [Landau-Kleffner] (G40.80-), pervasive developmental disorders (F84.-), selective mutism (F94.0), intellectual disabilities (F70-F79)

H93.25 Central auditory processing disorder Congenital auditory imperception Word deafness Excludes1: mixed receptive-expressive language disorder (F80.2)


F80.4 Speech and language developmental delay due to hearing loss Code also: type of hearing loss (H90.-, H91.-)

315.35 Childhood onset fluency disorder Cluttering NOS Stuttering NOS

F80.81 Childhood onset fluency disorder Excludes1: adult onset fluency disorder (F98.5), fluency disorder in conditions classified elsewhere (R47.82), fluency disorder (stuttering) following cerebrovascular disease (I69. with final characters-23)

315.39 Other (developmental speech or language disorder) Developmental articulation disorder Dyslalia Phonological disorder

F80.0 Phonological disorder Dyslalia Functional speech articulation disorder Lalling Lisping Phonological developmental disorder Speech articulation developmental disorder Excludes1: speech articulation impairment due to aphasia NOS (R47.01), speech articulation impairment due to apraxia (R48.2) Excludes2: speech articulation impairment due to hearing loss (F80.4), speech articulation impairment due to intellectual disabilities (F70-F79), speech articulation impairment with expressive language developmental disorder (F80.1), speech articulation impairment with mixed receptive expressive language developmental disorder (F80.2)


F80.9 Developmental disorder of speech and language, unspecified Communication disorder NOS Language disorder NOS

315.4 Developmental coordination disorder Clumsiness syndrome Dyspraxia syndrome Specific motor development disorder

F82 Specific developmental disorder of motor function


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315.5 Mixed developmental disorder F82 Specific developmental disorder of motor function Clumsy child syndrome Developmental coordination disorder Developmental dyspraxia Excludes1: abnormalities of gait and mobility (R26.-) lack of coordination (R27.-) Excludes2: lack of coordination secondary to intellectual disabilities (F70-F79)

315.8 Other specific delays in development

F88 Other disorders of psychological development Developmental agnosia

315.9 Unspecified delay in development Developmental disorder NOS Learning disorder NOS

F81.9 Developmental disorder of scholastic skills, unspecified Knowledge acquisition disability NOS Learning disability NOS Learning disorder NOS

F89 Unspecified disorder of psychological development Developmental disorder NOS

317 Mild intellectual disabilities F70 Mild intellectual disabilities IQ level 50-55 to approximately 70 Mild mental subnormality

318.0 Moderate intellectual disabilities F71 Moderate intellectual disabilities IQ level 35-40 to 50-55 Moderate mental subnormality

318.1 Severe intellectual disabilities F72 Severe intellectual disabilities IQ 20-25 to 35-40 Severe mental subnormality

318.2 Profound intellectual disabilities F73 Profound intellectual disabilities IQ level below 20-25 Profound mental subnormality

319 Unspecified intellectual disabilities F78 Other intellectual disabilities

F79 Unspecified intellectual disabilities

330.8 Other specified cerebral degenerations in childhood (Rett’s syndrome)

F84.2 Rett’s syndrome Excludes1: Asperger’s syndrome (F84.5) Autistic disorder (F84.0) Other childhood disintegrative disorder (F84.3)

331.0 Alzheimer’s disease G30.0 Alzheimer’s disease with early onset

G30.1 Alzheimer’s disease with late onset

G30.8 Other Alzheimer’s disease

G30.9 Alzheimer’s disease, unspecified

331.83 Mild cognitive impairment, so stated

G31.84 Mild cognitive impairment, so stated

332.0 Paralysis agitans parkinsonism or Parkinson’s disease

G20 Parkinson’s disease Hemiparkinsonism Idiopathic parkinsonism or Parkinson’s disease Paralysis agitansParkinsonism or Parkinson’s disease NOS Primary Parkinsonism or Parkinson’s disease Excludes1: dementia with parkinsonism (G31.83)

G21.4 Vascular parkinsonism


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332.1 Secondary parkinsonism G21.11 Neuroleptic induced parkinsonism Use additional code for adverse effect, if applicable, to identify drug (T43.3X5, T43.4X5, T43.505,T43.595) Excludes1: malignant neuroleptic syndrome (G21.0)

G21.19 Other drug induced secondary parkinsonism Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

G21.2 Secondary parkinsonism due to other external agents Code first: (T51-T65) to identify external agent

G21.3 Postencephalitic parkinsonism

G21.8 Other secondary parkinsonism

G21.9 Secondary parkinsonism, unspecified

335.20 Amyotrophic lateral sclerosis (Lou Gehrig’s disease) Motor neuron disease (bulbar) (mixed type)

G12.21 Amyotrophic lateral sclerosis Progressive spinal muscle atrophy

340 Multiple sclerosis G35 Multiple sclerosis Disseminated multiple sclerosis Generalized multiple sclerosis Multiple sclerosis NOS Multiple sclerosis of brain stem Multiple sclerosis of cord

343.0 Diplegic (Infantile cerebral palsy) G80.1 Spastic diplegic cerebral palsy Spastic cerebral palsy NOS

343.1 Hemiplegic (Infantile cerebral palsy)


343.2 Quadriplegic (Infantile cerebral palsy)

G80.0 Spastic quadriplegic cerebral palsy Congenital spastic paralysis (cerebral)

343.3 Monoplegic (Infantile cerebral palsy)

G80.8 Other cerebral palsy Mixed cerebral palsy syndromes

343.4 Infantile hemiplegia (Infantile cerebral palsy)


343.8 Other specified infantile cerebral palsy

G80.4 Ataxic cerebral palsy

G80.8 Other cerebral palsy Mixed cerebral palsy syndromes

343.9 Infantile cerebral palsy, unspecified

G80.9 Cerebral palsy, unspecified

345.00 Generalized nonconvulsive epilepsy (without mention of intractable epilepsy)

G40.309 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus Generalized idiopathic epilepsy and epileptic syndromes NOS

345.8 Other forms of epilepsy and recurrent seizures

G40.801 Other epilepsy, not intractable, with status epilepticus

G40.802 Other epilepsy, not intractable, without status epilepticus Other epilepsy NOS Other epilepsy without intractability without status epilepticus

G40.803 Other epilepsy, intractable, with status epilepticus

G40.804 Other epilepsy, intractable, without status epilepticus

351.0 Bell’s palsy G51.0 Bell’s palsy


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438.0 Cognitive deficits (Late effects of cerebrovascular disease)

I69.01 Cognitive deficits following nontraumatic subarachnoid hemorrhage

I69.11 Cognitive deficits following nontraumatic intracerebral hemorrhage

I69.21 Cognitive deficits following other nontraumatic intracranial hemorrhage

I69.31 Cognitive deficits following cerebral infarction

I69.81 Cognitive deficits following other cerebrovascular disease

I69.91 Cognitive deficits following unspecified cerebrovascular disease

438.10 Speech and language deficits, unspecified (Late effects of cerebrovascular disease)


438.11 Aphasia (Late effects of cerebrovascular disease)





I69.820 Aphasia following other cerebrovascular disease

I69.920 Aphasia following unspecified cerebrovascular disease

438.12 Dysphasia (Late effects of cerebrovascular disease)

I69.021 Dysphasia following nontraumatic subarachnoid hemorrhage

I69.121 Dysphasia following nontraumatic intracerebral hemorrhage

I69.221 Dysphasia following other nontraumatic intracranial hemorrhage

I69.321 Dysphasia following cerebral infarction

I69.821 Dysphasia following other cerebrovascular disease

I69.921 Dysphasia following unspecified cerebrovascular disease

438.13 Dysarthria (Late effects of cerebrovascular disease)

I69.022 Dysarthria following nontraumatic subarachnoid hemorrhage

I69.122 Dysarthria following nontraumatic intracerebral hemorrhage

I69.222 Dysarthria following other nontraumatic intracranial hemorrhage

I69.322 Dysarthria following cerebral infarction

I69.822 Dysarthria following other cerebrovascular disease

I69.922 Dysarthria following unspecified cerebrovascular disease


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438.14 Fluency disorder (Late effects of cerebrovascular disease) Stuttering due to late effect of CVA

I69.023 Fluency disorder following nontraumatic subarachnoid hemorrhage Stuttering following nontraumatic subarachnoid hemorrhage

I69.123 Fluency disorder following nontraumatic intracerebral hemorrhage Stuttering following nontraumatic subarachnoid hemorrhage

I69.223 Fluency disorder following other nontraumatic intracranial hemorrhage Stuttering following nontraumatic subarachnoid hemorrhage

I69.323 Fluency disorder following cerebral infarction Stuttering following nontraumatic subarachnoid hemorrhage

I69.823 Fluency disorder following other cerebrovascular disease Stuttering following nontraumatic subarachnoid hemorrhage

I69.923 Fluency disorder following unspecified cerebrovascular disease Stuttering following nontraumatic subarachnoid hemorrhage

438.19 Other speech and language deficits (Late effects of cerebrovascular disease)

I69.028 Other speech and language deficits following nontraumatic subarachnoid hemorrhage

I69.128 Other speech and language deficits following nontraumatic intracerebral hemorrhage

I69.228 Other speech and language deficits following other nontraumatic intracranial hemorrhage

I69.328 Other speech and language deficits following cerebral infarction

I69.828 Other speech and language deficits following other cerebrovascular disease


438.81 Apraxia (Other late effects of cerebrovascular disease)

I69.090 Apraxia following nontraumatic subarachnoid hemorrhage

I69.190 Apraxia following nontraumatic intracerebral hemorrhage

I69.290 Apraxia following other nontraumatic intracranial hemorrhage

I69.390 Apraxia following cerebral infarction

I69.890 Apraxia following other cerebrovascular disease

I69.990 Apraxia following unspecified cerebrovascular disease


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438.82 Dysphagia (Other late effects of cerebrovascular disease)

I69.091 Dysphagia following nontraumatic subarachnoid hemorrhage

I69.191 Dysphagia following nontraumatic intracerebral hemorrhage

I69.291 Dysphagia following other nontraumatic intracranial hemorrhage

I69.391 Dysphagia following cerebral infarction

I69.891 Dysphagia following other cerebrovascular disease

I69.991 Dysphagia following unspecified cerebrovascular disease

438.83 Facial weakness (Other late effects of cerebrovascular disease) Facial droop

I69.092 Facial weakness following nontraumatic subarachnoid hemorrhage Facial droop following nontraumatic subarachnoid hemorrhage

I69.192 Facial weakness following nontraumatic intracerebral hemorrhage Facial droop following nontraumatic intracerebral hemorrhage

I69.292 Facial weakness following other nontraumatic intracranial hemorrhage Facial droop following other nontraumatic intracranial hemorrhage

I69.392 Facial weakness following cerebral infarction Facial droop following cerebral infarction

I69.892 Facial weakness following other cerebrovascular disease Facial droop following other cerebrovascular disease

I69.992 Facial weakness following unspecified cerebrovascular disease Facial droop following unspecified cerebrovascular disease

438.84 Ataxia (Other late effects of cerebrovascular disease)

I69.093 Ataxia following nontraumatic subarachnoid hemorrhage

I69.193 Ataxia following nontraumatic intracerebral hemorrhage

I69.293 Ataxia following other nontraumatic intracranial hemorrhage

I69.393 Ataxia following cerebral infarction

I69.893 Ataxia following other cerebrovascular disease

I69.993 Ataxia following unspecified cerebrovascular disease

438.85 Vertigo (Other late effects of cerebrovascular disease)

I69.998 Other sequelae following unspecified cerebrovascular disease Alteration in sensation following unspecified cerebrovascular disease Disturbance of vision following unspecified cerebrovascular disease Use additional code to identify the sequelae


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I69.098 Other sequelae following nontraumatic subarachnoid hemorrhage Alterations of sensation following nontraumatic subarachnoid hemorrhage Disturbance of vision following nontraumatic subarachnoid hemorrhage

I69.198 Other sequelae of nontraumatic intracerebral hemorrhage Alteration of sensations following nontraumatic intracerebral hemorrhage Disturbance of vision following nontraumatic intracerebral hemorrhage

I69.298 Other sequelae of other nontraumatic intracranial hemorrhage Alteration of sensation following other nontraumatic intracranial hemorrhage Disturbance of vision following other nontraumatic intracranial hemorrhage

I69.398 Other sequelae of cerebral infarction Alteration of sensation following cerebral infarction Disturbance of vision following cerebral infarction

I69.898 Other sequelae of other cerebrovascular disease Alteration of sensation following other cerebrovascular disease Disturbance of vision following other cerebrovascular disease

I69.998 Other sequelae following unspecified cerebrovascular disease Alteration in sensation following unspecified cerebrovascular disease Disturbance of vision following unspecified cerebrovascular disease

438.9 Unspecified late effects of cerebrovascular disease

I69.00 Unspecified sequelae of nontraumatic subarachnoid hemorrhage

I69.10 Unspecified sequelae of nontraumatic intracerebral hemorrhage

I69.20 Unspecified sequelae of other nontraumatic intracranial hemorrhage

I69.30 Unspecified sequelae of cerebral infarction

I69.80 Unspecified sequelae of other cerebrovascular disease

I69.90 Unspecified sequelae of unspecified cerebrovascular disease

478.30 Paralysis, unspecified (Paralysis of vocal cords or larynx)

J38.00 Paralysis of vocal cords and larynx, unspecified

478.31 Unilateral, partial (Paralysis of vocal cords or larynx)


478.32 Unilateral, complete (Paralysis of vocal cords or larynx)


478.33 Bilateral, partial (Paralysis of vocal cords or larynx)


478.34 Bilateral, complete (Paralysis of vocal cords or larynx)


478.4 Polyp of vocal cord or larynx J38.1 Polyp of vocal cord and larynx


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478.5 Other diseases of vocal cords J38.2 Nodules of vocal cords Chorditis (fibrinous)(nodosa)(tuberosa) Singer’s nodes

J38.3 Other diseases of vocal cords Abscess of vocal cords Cellulitis of vocal cords Granuloma of vocal cords Leukokeratosis of vocal cords Leukoplakia of vocal cords

478.6 Edema of larynx J38.4 Edema of larynx Edema (of) glottis Subglottic edema Supraglottic edema

478.70 Unspecified disease of larynx J38.7 Other diseases of larynx Abscess of larynx Cellulitis of larynx Disease of larynx NOS Necrosis of larynx Pachyderma of larynx Perichondritis of larynx Ulcer of larynx

478.71 Cellulitis and perichondritis of larynx

J38.7 Other diseases of larynx Abscess of larynx Cellulitis of larynx Disease of larynx NOS Necrosis of larynx Pachyderma of larynx Perichondritis of larynx Ulcer of larynx

478.74 Stenosis of larynx J38.6 Stenosis of larynx

478.75 Laryngeal spasm J38.5 Laryngeal spasm

478.79 Other diseases of the larynx J38.7 Other diseases of larynx Abscess of larynx Cellulitis of larynx Disease of larynx NOS Necrosis of larynx Pachyderma of larynx Perichondritis of larynx Ulcer of larynx

478.8 Upper respiratory tract hypersensitivity reaction, site unspecified

J39.3 Upper respiratory tract hypersensitivity reaction, site unspecified

507.0 Due to inhalation of food or vomitus (Pneumonitis due to solids and liquids)

J69.0 Pneumonitis due to inhalation of food and vomit Aspiration pneumonia NOS Aspiration pneumonia (due to) food (regurgitated) Aspiration pneumonia (due to) gastric secretions Aspiration pneumonia (due to) milk Aspiration pneumonia (due to) vomit

524.00 Unspecified anomaly (Major anomalies of jaw size)

M26.00 Unspecified anomaly of jaw size

524.01 Maxillary hyperplasia M26.01 Maxillary hyperplasia

524.02 Mandibular hyperplasia M26.03 Mandibular hyperplasia

524.03 Maxillary hypoplasia M26.02 Maxillary hypoplasia


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524.04 Mandibular hypoplasia M26.04 Mandibular hypoplasia

524.05 Macrogenia M26.05 Macrogenia

524.06 Microgenia M26.06 Microgenia

524.07 Excessive tuberosity of jaw M26.07 Excessive tuberosity of jaw

524.09 Other specified anomaly (Major anomalies of jaw size)

M26.09 Other specified anomalies of jaw size

524.10 Unspecified anomaly (Anomalies of relationship of jaw to cranial base) Prognathism Retrognathism

M26.10 Unspecified anomaly of jaw-cranial base relationship

524.11 Maxillary asymmetry M26.11 Maxillary asymmetry

524.12 Other jaw asymmetry M26.12 Other jaw asymmetry

524.19 Other specified anomaly (Anomalies of relationship of jaw to cranial base)

M26.19 Other specified anomalies of jaw-cranial base relationship

524.20 Anomalies of dental arch relationship Anomaly of dental arch

M26.20 Unspecified anomaly of dental arch relationship

524.21 Malocclusion, Angle’s class I Neutro-occlusion

M26.211 Malocclusion, Angle’s class I Neutro-occlusion

524.22 Malocclusion, Angle’s class II Disto-occlusion Division I Disto-occlusion Division II

M26.212 Malocclusion, Angle’s class II Disto-occlusion Division I Disto-occlusion Division II

524.23 Malocclusion, Angle’s class III Mesio-occlusion

M26.213 Malocclusion, Angle’s class III Mesio-occlusion

524.24 Open anterior occlusal relationshipAnterior open bite

M26.220 Open anterior occlusal relationship Anterior openbite

524.25 Open posterior occlusal relationship Posterior open bite

M26.221 Open posterior occlusal relationship Posterior openbite

524.26 Excessive horizontal overlap Excessive horizontal overjet

M26.23 Excessive horizontal overlap Excessive horizontal overjet

524.27 Reverse articulation Anterior articulation Crossbite Posterior articulation

M26.24 Reverse articulation Crossbite (anterior) (posterior)

524.28 Anomalies of interarch distance Excessive interarch distance Inadequate interarch distance

M26.25 Anomalies of interarch distance

524.29 Other anomalies of dental arch relationship Other anomalies of dental arch

M26.29 Other anomalies of dental arch relationship Midline deviation of dental arch Overbite (excessive) deep Overbite (excessive) horizontal Overbite (excessive) vertical Posterior lingual occlusion of mandibular teeth

524.50 Dentofacial function abnormality, unspecified

M26.50 Dentofacial functional abnormalities, unspecified

524.51 Abnormal jaw closure M26.51 Abnormal jaw closure

524.52 Limited mandibular range of motion

M26.52 Limited mandibular range of motion


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524.53 Deviation in opening and closing of the mandible

M26.53 Deviation in opening and closing of the mandible

524.54 Insufficient anterior guidance M26.54 Insufficient anterior guidance Insufficient anterior occlusal guidance

524.55 Centric occlusion maximum intercuspation discrepancy

M26.55 Centric occlusion maximum intercuspation discrepancy Excludes1: centric occlusion NOS (M26.59)

524.56 Non-working side interference M26.56 Non-working side interference Balancing side interference

524.57 Lack of posterior occlusal support M26.57 Lack of posterior occlusal support

524.59 Other dentofacial functional abnormalities Abnormal swallowing Mouth breathing Sleep postures Tongue, lip, or finger habits

M26.59 Other dentofacial functional abnormalities Centric occlusion (of teeth) NOS Malocclusion due to abnormal swallowing Malocclusion due to mouth breathing Malocclusion due to tongue, lip or finger habits

524.64 Temporomandibular joint sounds on opening and/or closing the jaw (Temporomandibular joint disorders)

M26.69 Other specified disorders of temporomandibular joint

524.75 Vertical displacement of alveolus and teeth (Dental alveolar anomalies)


524.76 Occlusal plane deviation (Dental alveolar anomalies)


524.81 Anterior soft tissue impingement (Other specified dentofacial anomalies)

M26.81 Anterior soft tissue impingement Anterior soft tissue impingement on teeth

524.82 Posterior soft tissue impingement (Other specified dentofacial anomalies)

M26.82 Posterior soft tissue impingement Posterior soft tissue impingement on teeth



528.9 Other and unspecified diseases of the oral soft tissues

K13.70 Unspecified lesions of oral mucosa

K13.79 Other lesions of oral mucosa

529.8 Other specified conditions of the tongue

K14.8 Other diseases of tongue Atrophy of tongue Crenated tongue Enlargement of tongue Glossocele Glossoptosis Hypertrophy of tongue

530.81 Esophageal reflux K21.0 Gastro-esophageal reflux disease with esophagitis Reflux esophagitis

K21.9 Gastro-esophageal reflux disease without esophagitis Esophageal reflux NOS

741.00 Spina bifida with hydrocephalus (Unspecified region)

Q05.4 Unspecified spina bifida with hydrocephalus

Q05.9 Spina bifida, unspecified

742.1 Microcephalus (Other congenital anomalies of nervous system)

Q02 Microcephaly

748.2 Web of larynx (Congenital anomalies of respiratory system)

Q31.0 Web of larynx (Congenital malformations of larynx)


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748.3 Other anomalies of larynx, trachea and bronchus (Congenital anomalies of respiratory system)

Q31.1 Congenital subglottic stenosis

Q31.3 Laryngocele

Q31.8 Other congenital malformations of larynx

Q32.1 Other congenital malformations of trachea

Q32.4 Other congenital malformations of bronchus

749.00 Cleft palate, unspecified Q35.1 Cleft hard palate

Q35.3 Cleft soft palate

Q35.5 Cleft hard palate with cleft soft palate


749.01 Unilateral cleft palate, complete Q35.9 Cleft palate, unspecified

749.02 Unilateral cleft palate, incomplete Cleft uvula

Q35.7 Cleft uvula


749.03 Bilateral cleft palate, complete Q35.9 Cleft palate, unspecified

749.04 Bilateral cleft palate, incomplete Q35.9 Cleft palate, unspecified

749.10 Cleft lip, unspecified Q36.9 Cleft lip, unilateral

749.11 Unilateral cleft lip, complete Q36.1 Cleft lip, median

Q36.9 Cleft lip, unilateral

749.12 Unilateral cleft lip, incomplete Q36.9 Cleft lip, unilateral

749.13 Bilateral cleft lip, complete Q36.0 Cleft lip, bilateral

749.14 Bilateral cleft lip, incomplete Q36.0 Cleft lip, bilateral

749.20 Cleft palate with cleft lip, unspecified


749.21 Unilateral cleft palate with cleft lip, complete





749.22 Unilateral cleft palate with cleft lip, incomplete





749.23 Bilateral cleft palate with cleft lip, complete





749.24 Bilateral cleft palate with cleft lip, incomplete





749.25 Other combinations (Cleft palate and cleft lip)


750.0 Tongue tie Ankyloglossia

Q38.1 Ankyloglossia Tongue tie


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750.10 Anomalies of tongue, unspecified Q38.3 Other congenital malformations of tongue Aglossia Bifid tongue Congenital adhesion of tongue Congenital fissure of tongue Congenital malformation of tongue NOS Double tongue Hypoglossia Hypoplasia of tongue Microglossia

750.11 Aglossia Q38.3 Other congenital malformations of tongue Aglossia Bifid tongue Congenital adhesion of tongue Congenital fissure of tongue Congenital malformation of tongue NOS Double tongue Hypoglossia Hypoplasia of tongue Microglossia

750.12 Congenital adhesions of tongue Q38.3 Other congenital malformations of tongue Aglossia Bifid tongue Congenital adhesion of tongue Congenital fissure of tongue Congenital malformation of tongue NOS Double tongue Hypoglossia Hypoplasia of tongue Microglossia

750.13 Fissure of tongue Q38.3 Other congenital malformations of tongue Aglossia Bifid tongue Congenital adhesion of tongue Congenital fissure of tongue Congenital malformation of tongue NOSDouble tongueHypoglossiaHypoplasia of tongueMicroglossia

750.15 Macroglossia Q38.2 Macroglossia Congenital hypertrophy of tongue

750.16 Microglossia Hypoplasia of tongue

Q38.3 Other congenital malformations of tongueAglossiaBifid tongueCongenital adhesion of tongueCongenital fissure of tongueCongenital malformation of tongue NOSDouble tongue HypoglossiaHypoplasia of tongueMicroglossia


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750.19 Other (Other anomalies of tongue) Q38.3 Other congenital malformations of tongueAglossiaBifid tongueCongenital adhesion of tongueCongenital fissure of tongue Congenital malformation of tongue NOS Double tongue Hypoglossia Hypoplasia of tongue Microglossia

750.29 Other specified anomalies of pharynx

Q38.8 Other congenital malformations of pharynx

754.0 Of skull, face, and jaw (Certain congenital musculoskeletal deformities)

Q67.0 Congenital facial asymmetry

Q67.1 Congenital compression facies

Q67.2 Dolichocephaly

Q67.3 Plagiocephaly

Q67.4 Other congenital deformities of skull, face and jaw Congenital depressions in skull Congenital hemifacial atrophy or hypertrophy Deviation of nasal septum, congenital Squashed or bent nose, congenital Excludes1: dentofacial anomalies [including malocclusion] (M26-), syphilitic saddle nose (A50.5)

758.0 Down’s syndrome Mongolism Translocation Down’s syndrome Trisomy: 21 or 22, G

Q90.0 Trisomy 21, nonmosaicism (meiotic nondisjunction) (Down syndrome)

Q90.1 Trisomy 21, mosaicism (mitotic nondisjunction) (Down syndrome)

Q90.2 Trisomy 21, translocation (Down syndrome)

Q90.9 Down syndrome, unspecified Trisomy 21 NOS

758.2 Edward’s syndrome Trisomy: 18, E3





758.31 Cri-du-chat syndrome Q93.4 Deletion of short arm of chromosome 5 Cri-du-chat syndrome

758.32 Velo-cardio-facial syndrome Q93.81 Velo-cardio-facial syndrome Deletion 22q11.2

758.33 Other microdeletions Miller-Dieker syndrome Smith-Magenis syndrome

Q93.88 Other microdeletions Miller-Dieker syndrome Smith-Magenis syndrome

758.7 Klinefelter’s syndrome (males only) XXY syndrome

Q98.0 Klinefelter syndrome karyotype 47, XXY

Q98.1 Klinefelter syndrome, male with more than two X chromosomes

Q98.3 Other male with 46, XX karyotype

Q98.4 Klinefelter syndrome, unspecified

Q98.5 Karyotype 47, XYY


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779.31 Feeding problems in newborn Slow feeding in newborn

P92.1 Regurgitation and rumination of newborn

P92.2 Slow feeding of newborn

P92.8 Other feeding problems of newborn

P92.9 Feeding problem of newborn, unspecified

780.93 Memory loss Amnesia (retrograde) Memory loss NOS

R41.2 Retrograde amnesia

R41.3 Other amnesia Amnesia NOS Memory loss NOS Excludes1: amnestic disorder due to known physiologic condition (F04), amnestic syndrome due to psychoactive substance use (F10-F19 with 5th character .6), mild memory disturbance due to known physiological condition (F06.8), transient global amnesia (G45.4)

781.3 Lack of coordination Ataxia NOS Muscular incoordination

R27.0 Ataxia, unspecified Excludes1: ataxia following cerebrovascular disease (I69. with final characters -93)

R27.8 Other lack of coordination

R27.9 Unspecified lack of coordination

781.8 Neurological neglect syndrome R41.4 Neurologic neglect syndrome

781.94 Facial weakness Facial droop

R29.810 Facial weakness Facial droop Excludes1: Bell’s palsy (G51.0), facial weakness following cerebrovascular disease (I69. with final characters-92)

783.3 Feeding difficulties and mismanagement Feeding problem (elderly) (infant)

R63.3 Feeding difficulties Feeding problem (elderly) (infant) NOS Excludes1: feeding problems of newborn (P92.-), infant feeding disorder of nonorganic origin (F98.2-)

783.40 Lack of normal physiological development, unspecified Inadequate development Lack of development

R62.50 Unspecified lack of expected normal physiological development in childhood Infantilism NOS

783.41 Failure to thrive Failure to gain weight

R62.51 Failure to thrive (child) Failure to gain weight Excludes1: failure to thrive in child under 28 days old (P92.6)

783.42 Delayed milestones Late talker Late walker

R62.0 Delayed milestone in childhood Delayed attainment of expected physiological developmental stage Late talker Late walker

784.3 Aphasia R47.01 Aphasia Excludes1: aphasia following cerebrovascular disease (I69. with final characters -20), progressive isolated aphasia (G31.01)

784.40 Voice and resonance disorder, unspecified

R49.9 Unspecified voice and resonance disorder Change in voice NOS Resonance disorder NOS

784.41 Aphonia Loss of voice

R49.1 Aphonia Loss of voice

784.42 Dysphonia Hoarseness

R49.0 Dysphonia Hoarseness

784.43 Hypernasality R49.21 Hypernasality


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784.44 Hyponasality R49.22 Hyponasality

784.49 Other voice and resonance disorders Change in voice



784.51 Dysarthria R47.1 Dysarthria and anarthria Excludes1: dysarthria following cerebrovascular disease (I69. with final characters -22)

784.52 Fluency disorder in conditions classified elsewhere Stuttering in conditions classified elsewhere

R47.82 Fluency disorder in conditions classified elsewhere Stuttering in conditions classified elsewhere Code first underlying disease or condition, such as: Parkinson’s disease (G20) Excludes1: adult onset fluency disorder (F98.5), childhood onset fluency disorder (F80.81), fluency disorder (stuttering) following cerebrovascular disease (I69. with final characters-23)

784.59 Other speech disturbance Dysphasia Slurred speech Speech disturbance NOS



R47.02 Dysphasia Excludes1: dysphasia following cerebrovascular disease (I69. with final characters -21)

R47.9 Unspecified speech disturbances

784.60 Symbolic dysfunction, unspecified R48.9 Unspecified symbolic dysfunctions

784.61 Alexia and dyslexia Alexia (with agraphia)


784.69 Other (Other symbolic dysfunction) Acalculia Agnosia Agraphia NOS Apraxia

R48.1 Agnosia Astereognosia (astereognosis) Autotopagnosia Excludes1: visual object agnosia (R48.3)

R48.2 Apraxia Excludes1: apraxia following cerebrovascular disease (I69. with final characters -90)

R48.8 Other symbolic dysfunctions Acalculia Agraphia

786.09 Other (Dyspnea and respiratory abnormalities) Respiratory distress Respiratory insufficiency

R06.00 Dyspnea, unspecified

R06.09 Other forms of dyspnea

R06.3 Periodic breathing Cheyne-Stokes breathing

R06.89 Other abnormalities of breathing Breath-holding (spells) Sighing

786.2 Cough R05 Cough Excludes1: cough with hemorrhage (R04.2), smoker’s cough (J41.0)

787.20 Dysphagia, unspecified R13.10 Dysphagia, unspecified Difficulty in swallowing NOS

787.21 Dysphagia, oral phase R13.11 Dysphagia, oral phase

787.22 Dysphagia, oropharyngeal phase R13.12 Dysphagia, oropharyngeal phase

787.23 Dysphagia, pharyngeal phase R13.13 Dysphagia, pharyngeal phase




ICD-9-CM Code



787.29 Other dysphagia Cervical dysphagia Neurogenic dysphagia

R13.19 Other dysphagia Cervical dysphagia Neurogenic dysphagia

794.00 Abnormal function study, unspecified (Brain and central nervous system)


794.09 Other (Brain and central nervous system) Abnormal brain scan

R94.02 Abnormal brain scan (Abnormal results of function studies of central nervous system)


794.15 Abnormal auditory function studies (Peripheral nervous system and special senses)

R94.120 Abnormal auditory function study (Abnormal results of function studies of peripheral nervous system and special senses)

794.16 Abnormal vestibular function studies (Peripheral nervous system and special senses)

R94.121 Abnormal vestibular function study (Abnormal results of function studies of peripheral nervous system and special senses)

799.51 Attention or concentration deficit (Signs and symptoms involving cognition)

R41.840 Attention and concentration deficit (Other specified cognitive deficit) Excludes1: attention-deficit hyperactivity disorders (F90.-)

799.52 Cognitive communication deficit (Signs and symptoms involving cognition)

R41.841 Cognitive communication deficit (Other specified cognitive deficit)

799.53 Visuospatial deficit (Signs and symptoms involving cognition)

R41.842 Visuospatial deficit (Other specified cognitive deficit)

799.54 Psychomotor deficit (Signs and symptoms involving cognition)

R41.843 Psychomotor deficit (Other specified cognitive deficit)

799.55 Frontal lobe and executive function deficit (Signs and symptoms involving cognition)

R41.844 Frontal lobe and executive function deficit (Other specified cognitive deficit)

799.59 Other signs and symptoms involving cognition

R41.89 Other symptoms and signs involving cognitive functions and awareness Anosognosia

V13.64 Personal history of (corrected) congenital malformation of eye, ear, face and neck Corrected cleft lip and palate




V15.52 History of traumatic brain injury Z87.820 Personal history of traumatic brain injury



V44.0 Tracheostomy Z93.0 Tracheostomy status

V49.85 Dual-sensory impairment Z73.82 Dual sensory impairment

V52.8 Fitting and adjustment of prosthetic device and implant, Other specified prosthetic device


V52.9 Unspecified prosthetic device Z44.9 Encounter for fitting and adjustment of unspecified external prosthetic device

V53.2 Fitting and adjustment of other device, hearing aid


V57.3 Speech-language therapy Z51.89 Encounter for other specified aftercare

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V80.01 Special screening for neurological, eye, and ear diseases, traumatic brain injury



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Official ICD-10-CM Web Resources• Centers for Medicare & Medicaid Services:

www.cms.gov/ICD10/

• ICD-10-CM Official Guidelines for Coding and Reporting: http://www.cdc.gov/nchs/data/icd/10cmguidelines_2016_final.pdf

• ICD-10-CM Tabular List of Diseases and Injuries: http://www.cdc.gov/nchs/data/icd/icd10cm/2016/ICD10CM_FY2016_Full_PDF.ZIP

ASHA Resources• ASHA ICD-9 to ICD-10 Mapping Tool for Audiologists and Speech-Language Pathologists:

www.asha.org/icdmapping.aspx

• ASHA ICD-10-CM Diagnosis Codes for Audiology and Speech-Language Pathology: www.asha.org/Practice/reimbursement/coding/ICD-10/

• ASHA’s Coding, Reimbursement, and Advocacy Modules: http://icohere-presentations.com/presentations/ASHA2010/04-ModuleFour/player.html

• ASHA’s Skilled Versus Unskilled Guidelines: www.asha.org/Practice/reimbursement/medicare/Documentation-of-Skilled-Versus-Unskilled-Care-for-Medicare-Beneficiaries/

Documentation• Functional Communication Measures:

www.asha.org/NOMS/

• Inpatient Rehabilitation Therapy Services: Complying with Documentation Requirements: www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Inpatient_Rehab_Fact_Sheet_ICN905643.pdf

• Outpatient Rehabilitation Therapy Services: Complying with Documentation Requirements: www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Outpatient_Rehabilitation_Fact_Sheet_ICN905365.pdf

http://www.cdc.gov/nchs/data/icd/10cmguidelines_2016_final.pdf

http://www.asha.org/Practice/reimbursement/medicare/Documentation-of-Skilled-Versus-Unskilled-Care-for-Medicare-Beneficiaries/

http://www.asha.org/Practice/reimbursement/medicare/Documentation-of-Skilled-Versus-Unskilled-Care-for-Medicare-Beneficiaries/

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Inpatient_Rehab_Fact_Sheet_ICN905643.pdf

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Inpatient_Rehab_Fact_Sheet_ICN905643.pdf

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Outpatient_Rehabilitation_Fact_Sheet_ICN905365.pdf

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Outpatient_Rehabilitation_Fact_Sheet_ICN905365.pdf

Audiology Most Commonly Used Codes

CPT Procedure CodesAudiological Assessment Procedures 92550 Tympanometry and reflex threshold

measurements

92551 Screening test, pure tone, air only

92552 Pure tone audiometry (threshold); air only

92553 Pure tone audiometry (threshold); air and bone

92555 Speech audiometry threshold

92556 Speech audiometry threshold; w/speech recognition

92557 Comprehensive audiometry threshold evaluation and speech recognition

92567 Tympanometry (impedance testing)

92568 Acoustic reflex testing, threshold

92570 Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing

92579 Visual reinforcement audiometry (VRA)

92582 Conditioning play audiometry

92585 Auditory evoked potentials, comprehensive

92586 Auditory evoked potentials, limited

92558 Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis

92587 Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report

92588 Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report

92620 Evaluation of central auditory function, with report; initial 60 minutes


92625 Assessment of tinnitus (includes pitch, loudness matching, and masking)

Hearing Aid Assessment and Fitting Procedures92590 Hearing aid exam and selection; monaural

92591 Hearing aid exam and selection; binaural

Habilitative and Rehabilitative Services92626 Evaluation of auditory rehabilitation status,

1st hour


92630 Auditory rehabilitation; pre-lingual hearing loss

92633 Auditory rehabilitation; post-lingual hearing loss

Cochlear Implant92601 Diagnostic analysis of cochlear implant,

patient younger than 7 years of age, with programming


92603 Diagnostic analysis of cochlear implant, age 7 years or older, with programming


92640 Diagnostic analysis with programming of auditory brainstem implant, per hour

ICD-9-CM Diagnostic Codes386.10 Peripheral vertigo, unspecified

386.11 Benign paroxysmal positional vertigo

388.01 Presbyacusis


388.11 Acoustic trauma (explosive) to ear

388.12 Noise-induced hearing loss

388.2 Sudden hearing loss, unspecified

388.30 Tinnitus, unspecified

388.31 Subjective tinnitus

388.32 Objective tinnitus



388.44 Recruitment






389.04 Conductive hearing loss, inner ear

389.05 Conductive hearing loss, unilateral

389.06 Conductive hearing loss, bilateral



389.11 Sensory hearing loss, bilateral

389.12 Neural hearing loss, bilateral

389.13 Neural hearing loss, unilateral

389.14 Central hearing loss



389.17 Sensory hearing loss, unilateral


389.20 Mixed hearing loss, unspecified

389.21 Mixed hearing loss, unilateral

389.22 Mixed hearing loss, bilateral

780.4 Dizziness and giddiness

ICD-10-CM Diagnostic Codes (Effective 10-1-2015)H81.10 Benign paroxysmal vertigo, unspecified ear
















H90.6 Mixed conductive and sensorineural hearing loss, bilateral

H90.71 Mixed conductive and sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side


H90.8 Mixed conductive and sensorineural hearing loss, unspecified

H91.10 Presbycusis, unspecified ear




H93.11 Tinnitus, right ear




H93.211 Auditory recruitment, right ear




H93.25 Central auditory processing disorder

R42 Dizziness and giddiness




Speech-Language Pathology Most Commonly Used Codes

CPT Procedure CodesSpeech and Language92521 Evaluation of speech fluency (e.g., stuttering, cluttering)

92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria)

92523 with evaluation of language comprehension and expression (e.g., receptive/expressive language)

92524 Behavioral and qualitative analysis of voice and resonance

92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder, individual

92508 group, two or more individuals

97532 Development of cognitive skills to improve attention, memory, problem solving, direct one-on-one patient contact by the provider; each 15 minutes

96105 Assessment of aphasia

96125 Standardized cognitive performance testing (e.g., Ross Information Processing Assessment) per hour

Swallowing Function92526 Treatment of swallowing dysfunction and/or oral function

for feeding

92610 Evaluation of oral & pharyngeal swallowing function

92611 Motion fluoroscopic evaluation of swallowing function by cine or video recording

Augmentative and Alternative Communication92597 Evaluation for use/fitting of voice prosthetic device to

supplement oral speech

92607 Evaluation for prescription for speech-generating augmentative and alternative communication device; face-to-face with the patient; first hour


92609 Therapeutic services for the use of speech-generating device, including programming and modification

ICD-9-CM Diagnostic Codes299.00 Autistic disorder

299.80 Other specified pervasive developmental disorders; Asperger’s disorder

315.31 Expressive language disorder

315.32 Mixed receptive-expressive language disorder Central auditory processing disorder


315.35 Childhood onset fluency disorder

315.39 Developmental articulation disorder

438.11 Aphasia, per CVA

438.12 Dysphasia, per CVA

438.13 Dysarthria, per CVA

438.81 Apraxia, per CVA

438.82 Dysphagia, per CVA Use additional code to identify the type of dysphagia, if known (787.20-787.29)

783.42 Delayed milestones; Late talker; Late walker

784.3 Aphasia, not related to CVA

784.41 Aphonia; Loss of voice

784.42 Dysphonia; Hoarseness

784.43 Hypernasality

784.44 Hyponasality

784.49 Other voice and resonance disorders

784.51 Dysarthria


784.60 Symbolic dysfunction, unspecified

784.61 Alexia and dyslexia

784.69 Other symbolic dysfunction; agnosia, agraphia, apraxia

787.20 Dysphagia, unspecified

787.21 Dysphagia, oral phase

787.22 Dysphagia, oropharyngeal phase

787.23 Dysphagia, pharyngeal phase


799.51 Attention or concentration deficit

799.52 Cognitive communication deficit

799.53 Visuospatial deficit

799.55 Frontal lobe and executive function deficit

ICD-10-CM Diagnostic Codes (Effective 10-1-2015)F80.0 Phonological disorder

F80.1 Expressive language disorder

F80.2 Mixed receptive-expressive language disorder

F80.4 Speech and language development delay due to hearing loss

F80.81 Childhood onset fluency disorder

F84.0 Autistic disorder







I69.820 Aphasia following other cerebrovascular disease (See entire I69 series, sequelae of cerebrovascular disease)

Q38.3 Other congenital malformations of tongue


R13.11 Dysphagia, oral phase

R13.12 Dysphagia, oropharyngeal phase

R13.13 Dysphagia, pharyngeal phase


R13.19 Other dysphagia

R41.840 Attention and concentration deficit

R41.841 Cognitive communication deficit

R41.842 Visuospatial deficit

R41.844 Frontal lobe and executive function deficit

R47.01 Aphasia (not related to CVA)

R47.02 Dysphasia

R47.1 Dysarthria and anarthria


R47.82 Fluency disorder in conditions classified elsewhere



R48.1 Agnosia

R48.2 Apraxia

R48.8 Other symbolic dysfunctions; acalculia; agraphia

R49.0 Dysphonia; Hoarseness

R49.1 Aphonia; Loss of voice

R49.21 Hypernasality

R49.22 Hyponasality



R62.0 Delayed milestone in childhood; Late talker; Late walker

10967

Coding and Billing for Audiology and Speech-Language Pathology

10967

This essential resource is a one-stop shop for billing and coding your services to file claims with health plans, including private health plans, Medicare, and Medicaid.

Assigning codes to describe and bill for your services is a professional responsibility. This comprehensive reference guide provides all the details you need to code diagnoses and treatments in order to file claims and receive payment successfully.

Inside, you’ll find:

Knowledge helps you code with confidence.

for AUDIOLOGY and SPEECH-LANGUAGE PATHOLOGY

Coding and Billing

• Guidance on implementing ICD-10-CM diagnostic codes

• The most recent first-quarter Milliman charge data to help you evaluate how your fees compare nationwide

• New HCPCS codes and information

• New, more detailed descriptor text for specific codes

• Additional information about ICD-10-PCS, which provides procedures codes used in inpatient hospital settings only

• CPT procedure codes

• G-code outcomes reporting for Medicare claims

• Sample superbills

• PQRS information, which supports improvements in quality of care to Medicare patients

• Documentation guidance

• A pullout laminated sheet with the codes most commonly used by audiologists and speech-language pathologists

ebook: 2016 coding and billing for audiology and …2016 coding and billing for audiology and...

Documents