October 13, 2008

Coding for Cochlear Implants and Hearing Loss
For The Record
Vol. 20 No. 21 P. 27

The cochlear implant is a small device that utilizes electrical impulses to stimulate auditory nerve fibers and significantly improve hearing. Cochlear implants are used in patients with profound hearing loss due to disease, injury, or toxins. They cannot restore normal hearing but will allow patients to hear rhythms of speech and intonation of voice.

The cochlear prosthetic device consists of several components. Electrodes are implanted in the cochlea, and a receiver (also called an internal coil) is implanted in the skull behind the ear. A wire connects the electrodes to the receiver. An external transmitter (also called an external coil) is worn directly over the receiver. The transmitter is connected to a microphone and a sound (or speech) processor. The sound processor can be worn in a pocket or special holster. The microphone is placed in a hearing aid worn behind the ear.

ICD-9-CM Code Assignment
Implantation of a complete cochlear implant is assigned to ICD-9-CM codes 20.96 to 20.98. The specific code assignment depends on whether the device is single channel or multichannel. Code 20.97 is for the implantation of a single-channel cochlear prosthetic device. Code 20.98 is for implantation of a multiple-channel cochlear prosthetic device. Code 20.96 is for implantation of a cochlear prosthetic device not otherwise specified. According to Coding Clinic, “Code 20.96 should be assigned only if the coder cannot determine whether the cochlear implant was a single channel or a multiple channel” (AHA Coding Clinic for ICD-9-CM, 1989, fourth quarter, pages 6-9). Code 20.99 is for the implantation of the electrode only or the receiver only.

Codes 20.96 to 20.98 include the code for mastoidectomy, if performed. Therefore, do not assign a code for the mastoidectomy when performed with the cochlear implant procedure. In addition, codes 20.96 to 20.98 include the replacement or removal with reimplantation of the complete cochlear prosthetic device. The complete device includes the electrodes and the receiver. If only the electrode or the receiver was replaced, code 20.99 would be assigned. Code 20.99 also includes the repair or removal of the cochlear implant. Code 95.49 includes the repair of external components only. Code 95.49 is also assigned for the adjustment of external components of the cochlear prosthetic device. The external components include the external transmitter, the microphone, and the sound processor.

Other hearing devices used to treat hearing loss include the following:

• Externally-worn, battery-powered hearing aid (95.49): This device is the most common and least expensive. The hearing aid includes a microphone to pick up sounds, an amplifier to increase the sound’s volume, and a speaker to transmit the amplified sounds. This nonsurgical device is generally used for mild to moderate conductive hearing loss.

• Implantable bone conduction (electromagnetic) hearing device (20.95): This device is surgically implanted on the surface of the mastoid bone. It is generally performed for conductive hearing loss. Although it is not as effective or as comfortable as the battery-powered hearing aid, it is used by patients who cannot wear the hearing aid.

Hearing Loss
Hearing loss is assigned to category 389. Conductive hearing loss (389.0x) is the impairment in the ear canal or middle ear that blocks the conduction of sound. The fifth-digit code assignment depends on the location of the impairment, such as the external ear, tympanic membrane, middle ear, or inner ear, and whether it is unilateral or bilateral.

Sensorineural hearing loss (389.1x) is the failure of transmission of sound impulses within the inner ear or brain. The fifth-digit code assignment depends on the type of sensorineural hearing loss.

Sensory hearing loss (389.11) is when the inner ear/cochlea is affected. Neural hearing loss (389.12) is when the auditory/acoustic nerve or auditory nerve pathways in the brain are affected. Central hearing loss (389.14) is when the central neural pathways in the brain are affected. If the patient has both conductive and sensorineural hearing loss, code 389.2 is assigned.

Deaf mutism, which is the loss of both hearing and speech, is assigned to code 389.7. Code 951.5 is assigned for traumatic deafness or hearing loss due to a traumatic injury. Noise-induced hearing loss is assigned to code 388.12, and sudden hearing loss, unspecified, is assigned to code 388.2.

Coding and sequencing for cochlear implants are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 4,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.