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Sensorineural Hearing Loss and Device Coding

young girl with sensorineural hearing loss has a cochlear device implanted
A young girl with sensorineural hearing loss is treated with a cochlear implantation device

The Coding Challenge

Question:

A 9-year-old patient with sensorineural hearing loss, bilaterally, is treated with a bilateral cochlear implantation device. The area of the scalp behind the left ear is shaved and cleaned, and a small incision is made in the skin. The surgeon then drills into the mastoid bone and the inner ear and inserts the electrode array into the cochlea. The same procedure is done on the right ear.

A. H90.5, 92603-50
B. H90.3, 69930-50
C. H90.5, 69930, 69501
D. H90.41, H90.42, 92603

Answer: 

B.  H90.3, 69930-50

Locate and Verify

ICD-10-CM

To locate sensorineural hearing loss in the ICD-10-CM coding manual, go to Deafness (acquired) (complete) (hereditary) (partial)/sensorineural/bilateral  H90.3. In the Tabular, this code can be verified as:

H90.3, Sensorineural hearing loss, bilateral

If you were to start by looking up the main term Loss (of)/ hearing, it tells us to “see also Deafness”, so I would start with Deafness. Also, the subterms listed under Loss (of)/hearing do not take us to the correct code.  

CPT

To locate the correct code, look in the CPT coding Index under Device/insertion/cochlear  69930. This code can be verified in the Tabular as:

69930, Cochlear device implantation, with or without mastoidectomy 

Another way to find the code is to look up Cochlear implant/insertion, and it takes us to the same code (69930).

According to the documentation, a mastoidectomy was not performed during the procedure. And if it were performed, it would still be covered by 69930. The implantation was performed on bilateral ears during the same session. Therefore, modifier -50 needs to be appended to the procedure code, making the correct code 69930-50.


If a mastoidectomy is performed, a drill and burs are used to enter the mastoid bone and remove the mastoid air cells. If a mastoidectomy is not performed, a drill is used to enter the mastoid bone to the inner ear. 


Be sure to check the individual payers for their coverage and coding requirements, as some require modifier -50 to be appended to the procedure code, yet others may require -LT and -RT to be appended.

Incorrect Answers

A, C, and D are incorrect. 

A. H90.5, 92603-50. H90.5 refers to Unspecified sensorineural hearing loss. CPT code 92603 refers to Diagnostic analysis of cochlear implant, age 7 years or older; with programming.

C. H90.5, 69930, 69501. Again, H90.5 refers to Unspecified sensorineural hearing loss. CPT 69930 is missing modifier -50. Code 69501 refers to Transmastoid antrotomy (simple mastoidectomy).

D. H90.41, H90.42, 92603. H90.41 refers to Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side. H90.42 refers to Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side. CPT 92603 refers to Diagnostic analysis of cochlear implant, age 7 years or older; with programming.

label diagram of the outer ear, middle ear, and inner ear.

Cochlear Implantation For Hearing Loss

Cochlear implantation is a common treatment for hearing loss, particularly in individuals with severe sensorineural hearing loss. Sensorineural hearing loss (SNHL) is a condition involving the inner ear, or cochlea, and/or the auditory nerve that connects the inner ear to the brain, according to the American Academy of Otolaryngology-Head and Neck Surgery Foundation. SNHL occurs when tiny hair cells in the cochlear and/or auditory nerve become damaged. 

Auditory nerve abnormalities may be the cause of sensorineural hearing loss, but there are many other potential causes, such as aging, head trauma, Meniere’s disease, and vestibular schwannoma. 

Treatment options for sensorineural hearing loss are based on the specific cause. A conventional hearing aid may be recommended by an ENT specialist and/or audiologist. However, if the hearing aid proves to be inadequate, a cochlear implant may be necessary. 

According to the American Academy of Audiology, a traditional hearing aid is placed on the outside of the ear to send sound through the entire ear. A cochlear implant, on the other hand, is surgically placed within the inner ear, inside of the damaged cochlea. A device is then placed with a magnet on the outside of the head and sends signals to the implant, and the implant sends electrical sound signals directly to the auditory nerve. 

Cochlear Implant and Its Components

Sensorineural Hearing Loss and Cochlear Implantation Device on a girl

A cochlear implant does not restore normal hearing, but it can assist the person in understanding speech. The implant is an electronic device that consists of an external portion that is placed under the skin by surgical incision. According to the National Institute of Deafness and Other Communication Disorders (NIDCD), an implant contains the following components:

  • Microphone – takes in sounds from the environment.
  • Speech processor – selects and arranges sounds taken in by the microphone.
  • Transmitter and receiver/stimulator – receives signals from the speech processor and converts them into electric pulses.
  • Electrode array – a group of electrodes that collects the impulses from the stimulator and sends them to different areas of the auditory nerve.
image of the mastoid bone and temporal bone

Procedure

Cochlear device implantation may be performed with or without a mastoidectomy. In the above coding case, a mastoidectomy was not performed.

When a mastoidectomy is performed, it allows the surgeon to have good visualization while inserting the cochlear implant into the inner ear at the right angle.

The mastoid bone is part of the temporal bone of the skull, which forms the area around and above the ear. The mastoid process is one of its features and is the bump felt behind the ear. 

The surgical procedure lasts two to four hours and is performed under general anesthesia. The procedure can be done in a hospital or clinic.

According to Find-A-Code, the surgeon makes a C-shaped incision above the ear and around the back of the ear. If a mastoidectomy is performed, a drill and burs are used to enter the mastoid bone and remove the mastoid air cells. If a mastoidectomy is not performed, a drill is used to enter the mastoid bone to the inner ear.

The surgeon inserts the electrode array into the cochlea before creating a small indentation in the mastoid bone to place the receiver/stimulator and attach it to the skull. The incisions are then closed. This internal processor is then used with external components (microphone, speech processor, transmitting cables, and a transmitting coil) that sends the electrical signals from the skin to the implanted receiver/stimulator.

Once the cochlear implant is in place, it must be initially programmed and adjusted from time to time.

** This article has been reviewed and reflects the ICD-10-CM Coding Guidelines for FY 2023. **


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2 Comments

  1. This is very informative as I have had hearing/ear problems all my life. Instructions were very good as I had a hard time finding the information.

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