Novitas Revises Medicare LCD for Vestibular and Audiologic Function Studies (L35007): Adds ICD-10 Codes for Conductive Hearing Loss and Dizziness and Giddiness (R42)
In late 2015, the Academy received reports from audiologists reporting denials for pertinent and appropriate ICD-10 codes that supported medical necessity for the audiology procedure codes being billed. Upon further research, the Academy discovered that the Novitas Medicare LCD for Vestibular and Audiologic Function Studies was missing key audiology-specific ICD-10 codes, including the codes for conductive hearing loss, and R42, dizziness and giddiness, one of the diagnosis codes in the denominator for PQRS Measure #261, Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness. The Academy's Coding and Reimbursement Committee submitted a reconsideration request to Novitas, requesting the addition of these codes.
On February 11, 2016, Novitas released a revision of this LCD, which included the addition of many new ICD-10 codes, including the conductive hearing loss codes. In their correspondence with the Academy, Novitas had informed us that more revisions were scheduled for release. On April 14, 2016, Novitas issued another revision of this LCD to include R42 (dizziness and giddiness). This update is effective for dates of service on or after January 1, 2016. View the updated LCD. The Academy will continue to monitor future updates to this LCD.