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ICD-10 Guide
ICD-10 CodesH91.11

H91.11

Billable

Presbycusis, right ear

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/12/2025

Code Description

ICD-10 H91.11 is a billable code used to indicate a diagnosis of presbycusis, right ear.

Key Diagnostic Point:

Presbycusis is a type of age-related hearing loss that typically affects both ears, but can be unilateral, as in the case of H91.11, which specifies the right ear. It is characterized by a gradual decline in hearing ability, primarily affecting the ability to hear high-frequency sounds. Patients may experience difficulty understanding speech, especially in noisy environments, and may report a sensation of fullness in the ear. The condition is often progressive, with symptoms worsening over time. The underlying pathophysiology involves degeneration of the hair cells in the cochlea, changes in the auditory nerve, and alterations in the central auditory pathways. Diagnosis is typically made through audiometric testing, which reveals a characteristic pattern of hearing loss. Management may include hearing aids, auditory rehabilitation, and counseling to help patients cope with their hearing loss. It is important for healthcare providers to document the onset, progression, and impact of the hearing loss on the patient’s daily life to ensure appropriate coding and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between presbycusis and other types of hearing loss
  • Documenting the specific ear affected
  • Understanding the nuances of age-related hearing loss
  • Potential overlap with other auditory conditions

Audit Risk Factors

  • Inadequate documentation of hearing loss severity
  • Failure to specify the affected ear
  • Misclassification of presbycusis as conductive hearing loss
  • Lack of supporting audiometric test results

Specialty Focus

Medical Specialties

Otolaryngology

Documentation Requirements

Detailed audiometric test results, patient history, and treatment plans.

Common Clinical Scenarios

Evaluation of patients with gradual hearing loss, fitting of hearing aids, and management of age-related auditory changes.

Billing Considerations

Ensure that the documentation clearly indicates the type of hearing loss and any interventions performed.

Audiology

Documentation Requirements

Comprehensive audiological evaluations, including pure-tone audiometry and speech discrimination scores.

Common Clinical Scenarios

Routine hearing assessments for elderly patients, counseling on hearing aids, and rehabilitation strategies.

Billing Considerations

Document the impact of hearing loss on daily activities and quality of life.

Coding Guidelines

Inclusion Criteria

Use H91.11 When
  • According to ICD
  • 10 guidelines, presbycusis is classified under diseases of the ear and mastoid process
  • It is important to document the specific ear affected and the nature of the hearing loss

Exclusion Criteria

Do NOT use H91.11 When
  • Exclusion criteria include other specified types of hearing loss that may require different coding

Related ICD-10 Codes

Related CPT Codes

92557CPT Code

Comprehensive audiometry threshold evaluation and speech recognition

Clinical Scenario

Used when performing a detailed hearing assessment for a patient suspected of presbycusis.

Documentation Requirements

Audiometric test results, patient history, and any relevant medical history.

Specialty Considerations

Otolaryngologists and audiologists should ensure thorough documentation to support the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of hearing loss conditions, including presbycusis. This specificity aids in better tracking of age-related hearing loss and improves the accuracy of reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of hearing loss conditions, including presbycusis. This specificity aids in better tracking of age-related hearing loss and improves the accuracy of reimbursement.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    American Academy of Otolaryngology - Head and Neck Surgery

Coding & Billing References

  • •
    American Academy of Otolaryngology - Head and Neck Surgery

Frequently Asked Questions

What is presbycusis?

Presbycusis is age-related hearing loss that typically affects both ears but can be unilateral. It is characterized by a gradual decline in hearing ability, particularly for high-frequency sounds.

How is presbycusis diagnosed?

Diagnosis is made through audiometric testing, which reveals a characteristic pattern of high-frequency hearing loss. A thorough patient history is also essential.

What are the treatment options for presbycusis?

Management may include hearing aids, auditory rehabilitation, and counseling to help patients cope with their hearing loss.