Note: A comprehensive list of relevant ICD-10 Codes for audiologists is provided in the Superbill Resource on the Academy Website.
Introduction
The ICD-10 (International Classification of Diseases, 10th Revision) is an alphanumeric coding system used internationally to classify diseases and health conditions for health reporting and insurance purposes. Accurate ICD-10 coding is crucial for audiologists as it directly impacts reimbursement from insurance companies and government programs. Proper coding ensures that services rendered are appropriately documented and billed, reducing the risk of claim denials and payment delays. Additionally, accurate coding contributes to reliable data collection, which is essential for ensuring consistency in medical records and facilitating effective treatment planning. ICD-10 codes may also be used for quality improvement initiatives, epidemiological studies, and healthcare policy development.
Most audiologists will be reporting ICD-10 codes on claims for diagnostic testing or treatment (which includes prosthetic devices and supplies). The primary ICD-10 code should always be the results of the diagnostic test. Signs, symptoms, or related conditions are reported as secondary codes unless the findings of the testing are normal.
Basics of ICD-10 Coding
ICD-10 codes are organized into a hierarchical structure comprising categories, subcategories, and codes. Codes have varying depths of specificity. Each of the 22 chapters represents a broad classification of diseases and health conditions. Most hearing-related ICD-10 codes are found in Chapter 8: Diseases of the Ear and Mastoid Process.
Reporting of ICD-10 codes should be as specific as possible. This is made possible through subcategories which provide further specificity and are indicated by additional characters (e.g., H90.3 for bilateral sensorineural hearing loss). Full codes can have up to seven characters, which allow for precise documentation of a patient's condition, including laterality, severity, and other clinical details.
An example of the ICD-10 code structure is presented in Table 1. The first digit is always alphabetic, while the second and third digits are numeric. There is always a decimal after the first three digits (definition of the code category). The fourth through sixth digits indicate etiology, anatomical site, or severity and may be letters, numbers, or ‘X’ as a placeholder. The ‘X’ placeholder is commonly used as a 5th character in certain 6-digit codes to allow for future expansion. The ‘X’ must be included as part of the code to be considered valid for reporting. The seventh digit is called an “extension” which describes the encounter type (initial, subsequent, sequelae) for certain conditions such as traumatic brain injury.
Currently, there are not many diagnosis codes that audiologists report on a frequent basis that will have 7 digits.
Table 1. ICD-10 Coding Structure Example: H93.A1
| H | 9 | 3 | . | A | 1 | ||
| Chapter 8 | Other disorders of ear, not elsewhere classified | Pulsatile tinnitus, right ear | |||||
| Alpha (denoting ICD-10 Chapter) | Numeric | Numeric or Alpha |
Numeric or Alpha |
Numeric or Alpha |
Numeric or Alpha |
Numeric or Alpha |
|
| Category (or Section) | Etiology, Site, Laterality, Etc. | Extension | |||||
ICD-10 Coding Conventions
In order to correctly report a code, it is important to refer to the instructions that appear at the beginning of the code family. For example, codes, contained in the H91- family cannot be reported for a procedure in conjunction with codes from the H90- family.
Exclusion terms
Excludes1
A type 1 Excludes note is a pure excludes note. 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
A type 2 Excludes note represents “NOT INCLUDED HERE”. An Excludes2 note indicates that the condition excluded is not part of the condition represented by the code, 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, when appropriate.
Use of “Other” and “Unspecified” codes
Other codes (NEC, not elsewhere classified)
Codes titled “other” or “other specified” are for use when the information in the medical record provides detail for which a specific code does not exist. “Other” or “NEC” codes represent specific disease entities for which no specific code exists, so the term is included within a code titled “other” or “not elsewhere classified”.
Unspecified codes (NOS, not otherwise specified)
Codes titled “unspecified” are for use when the information in the medical record is insufficient to assign a more specific code. For those categories for which an unspecified code is not provided, the “other specified” code may represent both other and unspecified.
Code first
Pertains to proper sequencing of codes, as some conditions specify the underlying etiology and its manifestations. Sometimes the underlying diagnosis code should be coded first. For example, H91.0 Ototoxic hearing loss, bilateral, has “code first” and exclusion instructions.
H91.0 – Ototoxic hearing loss, bilateral
Code first poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4)
Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
H91
Excludes1: abnormal auditory perception (H93.2-)
hearing loss as classified in H90.-
impacted cerumen (H61.2-)
noise-induced hearing loss (H83.3-)
psychogenic deafness (F44.6)
transient ischemic deafness (H93.01-)
Encounter Codes
Another family of codes which are highly relevant to audiologic practice are found in the Z chapter (Z00-Z99: Factors influencing health status and contact with health services). It is important to understand that some of these codes (depending on payer) can be used as an explanation of the reason for the encounter in the absence of abnormal findings. An example is Z01.110 – Encounter for hearing examination following failed hearing screening. There are many payers that now accept this code as a primary diagnosis when the follow up testing is normal. Technically this is a better description of the reason for referral. Some payers still however prefer the hearing loss unspecified code. Z01.10, encounter for examination of the ears and hearing without abnormal findings describes an encounter of a hearing screening when the patient does not report any signs or symptoms of hearing loss or an abnormal test result during the encounter. For example, Z01.10 should not be reported when the patient presents with a concern of hearing difficulty but the results were normal. If this is the case, report a code that describes the signs or symptoms that prompted the visit.
Frequently Asked Questions
What ICD-10 codes do I report when I performed a comprehensive audiologic assessment and have no abnormal findings?
- In the absence of abnormal findings for the diagnostic testing, ICD-10 codes should be reported that describe the reported signs, symptoms, or the reason for referral – which should also be clearly stated in documentation of the encounter.
ICD-10 Documentation Best Practices and Avoiding Common Pitfalls
Audiologists should ensure that all patient encounters are thoroughly documented, including the patient's medical history, presenting symptoms, clinical findings, diagnostic test results, and treatment plans. Specificity in documentation is key: document the exact nature, laterality, and severity of the condition. For example, instead of noting "hearing loss," specify "bilateral sensorineural hearing loss."
Additionally, coding for diagnostic tests should be consistent with the following guidelines:
- Code for the result of the diagnostic test, patient history, or symptoms.
- In the case of a normal result, the next choice would be a diagnosis code that reflects the reason for the referral and/or the chief presenting complaint.
- It is helpful to include other secondary diagnosis codes only when it will help paint a clear clinical picture of why the test(s) are being performed. Using too many codes may result in an unnecessary denial.
Need more help? Contact us at reimbursement@audiology.org.
Resources
- ICD-10-CM Official Guidelines for Coding and Reporting FY 2025: https://www.cms.gov/files/document/fy-2025-icd-10-cm-coding-guidelines.pdf
- Centers for Disease Control ICD Browser Tool: https://icd10cmtool.cdc.gov/
- Centers for Disease Control ICD Information: https://www.cdc.gov/nchs/icd/icd-10-cm/index.html
- Medicare ICD-10 Guidance: https://www.cms.gov/medicare/coding-billing/icd-10-codes?redirect=/icd10/
- ICD-10 Data: http://www.icd10data.com/
CPT codes, descriptions, and other data are Copyright 1966, 1970, 1973, 1977, 1981, 1983–2025 American Medical Association. All rights reserved. CPT© is a registered trademark of the American Medical Association.
Disclaimer
The purpose of the information provided by the American Academy of Audiology Coding and Reimbursement Committee is strictly for educational guidance to audiologists. Action taken with respect to the information provided is an individual choice. The American Academy of Audiology hereby disclaims any responsibility for the consequences of any action(s) taken by any individual(s) as a result of using the information provided, and reader agrees not to take action against, or seek to hold, or hold liable, the American Academy of Audiology for the reader's use of the information provided. As used herein, the "American Academy of Audiology" shall be defined to include its directors, officers, employees, volunteers, members, and agents.
