ICD-10 code H90.0: Conductive hearing loss, bilateral

Key Takeaways

ICD-10 code H90.0 describes conductive hearing loss, bilateral: a billable ICD-10-CM code valid for FY2026 (October 1, 2025 through September 30, 2026).

Laterality is mandatory: H90.0 requires explicit bilateral documentation. Use H90.11/H90.12 for unilateral conductive hearing loss, and H90.2 only when laterality is unspecified.

H90.0 is commonly confused with H90.3 (sensorineural) and H90.8 (mixed). The type of hearing loss must be clinician-documented before coding.

Practice management software like Pabau supports accurate ICD-10 code entry, structured clinical documentation, and audit-ready records for audiology and ENT practices.

ICD-10 code H90.0 is the billable ICD-10-CM diagnosis code for conductive hearing loss, bilateral: a mechanical or structural problem in the outer or middle ear that reduces sound transmission in both ears. It gets misapplied when clinicians use it for sensorineural loss, document “hearing loss” without specifying the mechanism, or omit bilateral confirmation entirely. This reference covers the code’s structure, documentation requirements, excludes notes, MS-DRG mapping, and the related codes most frequently confused with H90.0.

According to the Centers for Medicare and Medicaid Services (CMS), ICD-10-CM codes are updated annually on October 1. H90.0 has remained a stable, billable code through FY2026, making it one of the most referenced codes in audiology practices that submit HIPAA-covered electronic claims. This guide follows the ICD-10-CM Official Guidelines for Coding and Reporting and the CDC/NCHS ICD-10-CM code set for FY2026.

ICD-10 code H90.0: code details at a glance

The table below summarizes the essential facts coders need before submitting a claim using ICD-10 code H90.0. All values reflect the FY2026 edition of ICD-10-CM, effective October 1, 2025 through September 30, 2026.

What is conductive hearing loss, bilateral?

Conductive hearing loss occurs when sound cannot travel efficiently through the outer or middle ear to reach the cochlea and auditory nerve. The problem is mechanical, not neurological: fluid in the middle ear, a perforated eardrum, cerumen impaction, otosclerosis, or ossicular chain disruption can all reduce the transmission of sound waves. When this affects both ears, the condition is bilateral. Clear laterality documentation determines whether H90.0 or its unspecified-laterality sibling, H90.2, applies.

The clinical distinction matters beyond coding. Conductive hearing loss is often reversible with treatment (removal of impacted cerumen, antibiotics for otitis media, tympanoplasty for perforation), while sensorineural hearing loss typically is not. A coder applying H90.0 is implying that the mechanism is conductive. If the audiogram or physician note documents a mixed or sensorineural picture, a different code applies.

• Common causes documented alongside H90.0: otitis media with effusion, cerumen impaction (H61.2x), tympanic membrane perforation (H72.x), and cholesteatoma. Otosclerosis is also a common structural cause of conductive hearing loss, but it is coded separately under category H80.x, not alongside H90.0. It is not one of the H90 Excludes1 conditions listed below, so document the specific structural cause whenever it is identified
• Required laterality language: “bilateral,” “both ears,” or individual documentation of right ear and left ear loss of the same conductive type
• Audiogram role: air-bone gap on pure-tone audiometry supports a conductive diagnosis. Without it, physician attestation in the record must establish the type

Note that the etiology code (e.g., otitis media) should be coded separately when documented. The code H90.0 itself does not establish causation. That linkage must come from the clinician’s documented assessment.

H90.0 within the ICD-10-CM code hierarchy

Understanding where ICD-10 code H90.0 sits in the classification tree helps coders navigate quickly and select the right level of specificity. The WHO ICD-10 classification forms the international framework. The US ICD-10-CM applies clinical modifications, and H90.0 belongs to the following hierarchy.

Because H90.0 is a full-specificity (leaf-node) code in the ICD-10-CM tabular list, it can be submitted directly on HIPAA-covered claims without further sub-coding. The parent code H90 itself is not billable. Always code to the highest level of specificity the documentation supports. For practices managing EHR integrations across audiology and ENT workflows, having the code hierarchy mapped in your system prevents coders from accidentally submitting the non-billable parent.

Conductive vs sensorineural vs mixed hearing loss: choosing the right ICD-10 code H90.0 or sibling

The H90 category contains nine four-character sub-codes covering three types of hearing loss (conductive, sensorineural, mixed) across three laterality options (bilateral, unilateral, unspecified). Three of those nine, H90.1, H90.4, and H90.7, are not billable on their own: each needs a fifth character specifying right or left ear before a claim can be submitted. Selecting the wrong sub-code is the single most common denial trigger in audiology billing. Use the table below to map the documented clinical picture to the correct code. Refer to the AAPC ICD-10-CM code lookup for additional cross-reference data.

Practices using structured patient records that capture audiogram findings alongside the physician’s diagnostic assessment make this code selection faster and more defensible at audit.

H90.A: unilateral loss with restricted contralateral hearing

The category also includes H90.A, for unilateral hearing loss with restricted (rather than unrestricted) hearing on the contralateral side, for example H90.A11 (right ear) and H90.A21 (left ear). These sit alongside H90.1, H90.4, and H90.7 as a more specific sibling set, so the “unrestricted contralateral hearing” codes above are not the complete unilateral picture.

Includes, Excludes1, and Excludes2 notes for ICD-10 code H90.0

ICD-10-CM excludes notes are legally significant: misreading an Excludes1 as an Excludes2 can result in claim denials, overpayments, or audit exposure. Here is how the notes apply to H90.0 and its parent category H90.

• Includes (H90 category-level): Conductive and sensorineural hearing loss. H90.0 falls within this parent, so no additional “includes” note is listed at the sub-code level.
• Excludes1 (never code together): Deaf nonspeaking, NEC (H91.3), deafness NOS (H91.9x), hearing loss NOS (H91.9x), noise-induced hearing loss (H83.3x), ototoxic hearing loss (H91.0x), sudden (idiopathic) hearing loss (H91.2x). If any of these more specific conditions is documented, code the more specific code instead of H90.0.
• Excludes2 (may code together if both present): Presbycusis (H91.1x). A patient can have age-related sensorineural hearing loss coded alongside bilateral conductive hearing loss if both are independently documented.

The practical impact: if a coder sees “sudden bilateral hearing loss” in the note and applies H90.0, that is a misapplication. Sudden idiopathic hearing loss maps to H91.2x, which is an Excludes1 condition for the H90 category. The HIPAA compliance implications of repeated misapplication extend beyond the claim: payers flagging a practice for pattern coding errors can trigger a full medical record audit.

Documentation requirements for accurate H90.0 coding

The clinical note must do three things before a coder can defensibly apply ICD-10 code H90.0: establish the type (conductive), confirm the laterality (bilateral), and link the diagnosis to clinical findings. Vague documentation like “hearing loss” or “bilateral ear complaints” forces coders to default to unspecified codes, which payers flag as insufficiently specific.

• Type documentation: The physician or audiologist must explicitly state “conductive” hearing loss or document findings consistent with a mechanical pathway issue (air-bone gap on audiometry, negative bone conduction with depressed air conduction).
• Laterality documentation: “Bilateral” must appear explicitly. Separate right and left ear findings that both show conductive loss also satisfy this requirement.
• Audiogram or physical exam findings: An air-bone gap of 10 dB or more typically supports a conductive diagnosis. The audiogram results should be part of the clinical record, not just referenced verbally.
• Etiology (when documented): If the physician documents otitis media with effusion as the cause, code the otitis media separately. The causal relationship must be stated in the note. Inferred linkages are not sufficient for dual-code submission.

Common coding errors to avoid with H90.0

These are the mistakes audiology and ENT coders most commonly make when working with the H90 code family.

• Using H90.0 for sensorineural or mixed loss: The note says “bilateral hearing loss” with no type specified. The coder defaults to H90.0 because it is the most familiar bilateral hearing loss code. This is wrong if the audiogram shows a sensorineural pattern.
• Unspecified laterality: Using H90 (the parent, non-billable code) rather than drilling to H90.0 for bilateral, H90.11/H90.12 for unilateral, or H90.2 when laterality is unspecified.
• Ignoring Excludes1 conditions: Coding H90.0 when the documented diagnosis is ototoxic hearing loss (H91.0x) or sudden hearing loss (H91.2x), which are Excludes1 conditions.
• Omitting the etiology code: When a physician documents bilateral conductive hearing loss secondary to otitis media with effusion, coding only H90.0 and not the otitis media code results in incomplete diagnostic capture and potentially missed diagnosis-related reimbursement.

MS-DRG mapping and reimbursement context for H90.0

MS-DRG (Medicare Severity Diagnosis-Related Group) mapping applies to inpatient hospital claims. When H90.0 appears as a secondary diagnosis on an inpatient record, it can contribute to DRG assignment depending on the principal diagnosis. Because conductive hearing loss is rarely the reason for an acute inpatient admission, H90.0 typically functions as a comorbidity or complication (CC) rather than a principal diagnosis in the inpatient setting.

When conductive hearing loss does drive DRG assignment, for example as the reason for an ENT-focused inpatient stay, H90.0 groups to MS-DRG 154, 155, or 156 (“Other ear, nose, mouth and throat diagnoses,” with MCC, with CC, or without CC/MCC), under Major Diagnostic Category (MDC) 03.

The specific DRG grouping for a given admission depends on the principal diagnosis and any CC/MCC designations. Consult the current CMS IPPS final rule for the FY2026 DRG weights and payment rates applicable to your facility. MS-DRG weights change annually and specific dollar reimbursement amounts should not be relied on from secondary sources.

Present on Admission (POA) indicator for H90.0

The POA indicator is required for all diagnoses on inpatient claims submitted to Medicare and Medicaid. It does not apply to outpatient or professional fee claims. For H90.0, the acceptable POA values are:

Related ICD-10-CM codes and when to use them

Audiology and ENT encounters often involve conditions that either cause conductive hearing loss or co-exist with it. The table below covers the codes most frequently submitted alongside ICD-10 code H90.0, including common etiologies and related diagnoses. Each requires independent physician documentation. Do not infer a relationship from proximity alone, and always code to the highest level of specificity the documentation supports.

How H90.0 integrates with practice management software

Audiology and ENT practices submit ICD-10 diagnosis codes on every claim, and the accuracy of that submission depends on how well the practice’s software captures and validates the clinical documentation upstream. This holds whether a practice operates independently or as part of a broader multi-specialty group that also offers speech therapy or runs on shared therapy practice management software across specialties. For ICD-10 code H90.0 specifically, three workflow points tend to generate errors when software lacks proper integration.

First, diagnosis code entry. When coders manually type codes into a billing module, laterality errors occur. A system with a searchable ICD-10 code library that surfaces H90.0, H90.1, and H90.2 as a grouped laterality set reduces the chance of a coder selecting the unilateral code when the note documents bilateral loss. Pabau includes structured diagnosis code entry built to support accurate documentation across specialties.

Second, clinical note documentation. The audiogram findings and the physician’s diagnostic interpretation both need to be in the patient record before coding begins. Practices using digital intake and clinical forms can standardize the capture of laterality and hearing loss type at the point of care, reducing the coding errors caused by incomplete documentation downstream. Pabau’s AI-powered clinical documentation tools can assist in structuring consultation notes so the key clinical elements coders need are consistently present.

Third, audit trail. When a payer requests records to support an H90.0 claim, the practice needs the audiogram, the physician’s note, and the diagnosis code entry available together. Practices using integrated patient management software that links clinical notes to the codes entered against them have a defensible audit trail that disconnected, standalone tools cannot easily produce.

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Frequently asked questions.

The questions below address the most common coder queries about ICD-10 code H90.0 in audiology billing.

Conclusion

Getting H90.0 right comes down to documentation specificity at the point of care. When clinical notes confirm bilateral conductive hearing loss with supporting audiometric findings and the coder applies the correct laterality code, the claim moves cleanly. When those elements are missing, the claim denies, the rework eats staff time, and repeated patterns attract payer scrutiny.

Pabau’s integrated platform connects the clinical note, diagnosis code entry, and audit-ready documentation in one workflow, helping audiology and ENT practices get ICD-10 coding right from the outset. To see how it works for your practice, explore Pabau’s practice management platform or speak to the team about your specific documentation workflow.

Continue your research

Need the sibling code for unspecified-laterality conductive hearing loss? ICD-10 code H90.2 covers conductive hearing loss where laterality has not been documented.

Need the sensorineural equivalent? ICD-10 code H90.5 covers unspecified sensorineural hearing loss, the sensorineural counterpart to H90.2.

Working with mixed hearing loss diagnoses? ICD-10 code H91.91 covers unspecified hearing loss in the right ear, a code frequently confused with the H90 family.