ICD-10 Code H90.6: Understanding Hearing Loss Codes

Key Takeaways

ICD-10 Code H90.6 describes mixed conductive and sensorineural hearing loss, bilateral, meaning both ears show both conductive and sensorineural components simultaneously.

H90.6 is a billable ICD-10-CM code valid for 2026 reimbursement; documentation must explicitly state bilateral presentation and both loss types to avoid claim denial.

Coders often confuse H90.6 with H90.8 (unspecified mixed) or H90.7 (unilateral mixed); selecting the wrong code without bilateral documentation is a common audit trigger.

Pabau’s claims management software and digital forms help audiology and ENT practices document bilateral mixed hearing loss precisely and submit cleaner claims.

H90.6 is the ICD-10-CM code for mixed conductive and sensorineural hearing loss affecting both ears. The term “mixed” means the patient has hearing loss arising from two distinct pathological mechanisms at the same time: a conductive component (a mechanical problem in the outer or middle ear) and a sensorineural component (damage to the inner ear or auditory nerve). “Bilateral” means this combination is present in both ears, not just one.

Conductive hearing loss occurs when sound cannot efficiently travel through the outer or middle ear structures, including the auditory canal, tympanic membrane, or ossicles. Sensorineural hearing loss arises from damage to the cochlea or the eighth cranial nerve. When both mechanisms are active simultaneously, pure-tone audiometry shows an elevated bone-conduction threshold alongside an air-bone gap, confirming the mixed nature of the loss.

Common clinical causes include chronic otitis media with secondary cochlear damage, otosclerosis with sensorineural involvement, and noise-induced sensorineural loss compounded by middle-ear pathology. Accurate diagnosis requires a full audiological evaluation, typically including pure tone average (PTA) testing, tympanometry, and speech discrimination assessment.

H90.6 code details at a glance

H90.6 Code Hierarchy and ICD-10-CM Category H90

H90.6 sits within the H90 category, which covers all conductive and sensorineural hearing loss codes. Understanding the hierarchy helps coders identify the right code level and avoid under-coding with a less specific parent code. The ICD-10-CM classification system requires the most specific code supported by clinical documentation.

The H90 category falls under the larger block H60-H95 (Diseases of the ear and mastoid process), which in turn belongs to Chapter 8 of ICD-10-CM. According to the WHO’s ICD-10 browser, this block groups all conditions affecting ear anatomy and function.

The H90 category structure is as follows:

• H90.0 – Conductive hearing loss, bilateral
• H90.1 – Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
• H90.2 – Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side
• H90.3 – Conductive hearing loss, unspecified
• H90.4 – Sensorineural hearing loss, unilateral, right ear
• H90.5 – Unspecified sensorineural hearing loss
• H90.6 – Mixed conductive and sensorineural hearing loss, bilateral (this code)
• H90.7 – Mixed conductive and sensorineural hearing loss, unilateral with unrestricted hearing on the contralateral side
• H90.8 – Mixed conductive and sensorineural hearing loss, unspecified
• H90.A – Conductive and sensorineural hearing loss with restricted hearing on the contralateral side

H90.6 is a terminal (leaf) code in this hierarchy. No additional digits refine it further. This contrasts with H90.7, which has sub-codes specifying whether the affected ear is right or left.

Documentation Requirements for ICD-10 Code H90.6

Incomplete documentation is the leading cause of claim denial when coding H90.6. Payers require the medical record to support every element of the code before approving reimbursement. Three documentation elements are non-negotiable.

• Bilateral confirmation: The record must specify that both ears are affected. “Bilateral” cannot be assumed from an audiogram alone; the clinician’s note must state it explicitly.
• Both components present: Both the conductive component (air-bone gap present, middle-ear pathology documented) and the sensorineural component (elevated bone-conduction thresholds documented) must be individually documented. A diagnosis of “mixed hearing loss” without specifying both mechanisms may default to H90.8.
• Laterality symmetry: If one ear has a significantly different pattern, the coder should review whether H90.7 (unilateral mixed) or H90.A (restricted contralateral hearing) better fits the clinical picture.

Clinicians should attach or reference audiometric reports, including pure tone average values and air-bone gap measurements, in the clinical note. The CMS ICD-10-CM coding guidelines consistently emphasize that the highest level of specificity supported by the record is required.

For ENT and audiology practices, structured digital intake forms that capture laterality, audiogram results, and both conductive and sensorineural findings at the point of care significantly reduce documentation gaps before claims are submitted.

Documentation checklist for H90.6

• Bilateral hearing loss explicitly stated in the clinician note
• Conductive component confirmed (air-bone gap, tympanic membrane or ossicular pathology noted)
• Sensorineural component confirmed (elevated bone-conduction thresholds, cochlear or neural etiology documented)
• Pure tone audiogram results attached or referenced
• Etiology documented where known (e.g., otosclerosis, chronic otitis media)
• No conflicting laterality language in different sections of the record

Cleaner claims start with better documentation

Pabau helps audiology and ENT practices capture structured clinical notes, audiogram data, and bilateral documentation at the point of care so H90.6 and related codes are always supported before submission.

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ICD-10 Code H90.6 vs H90.7, H90.8, and Related Codes

Selecting the wrong code in the H90 mixed hearing loss group is a frequent source of audits. The differences between H90.6, H90.7, and H90.8 are clinically meaningful and payer-distinguishable. Using H90.8 when documentation supports H90.6 constitutes under-coding and can trigger downcoding adjustments.

The key coding decision point: if the record documents bilateral loss with both air-bone gap and elevated bone conduction, ICD-10 Code H90.6 is correct. If only one ear has mixed loss and the other is normal, H90.7 applies. If laterality is genuinely absent from the documentation, H90.8 is acceptable but should prompt a documentation query to the clinician. The ICD List lookup tool provides a quick reference for comparing H90 sub-codes and their applicable-to notes.

Coding Guidelines and Sequencing Rules for H90.6

H90.6 functions as a diagnosis code, not a procedure code. It identifies the condition being treated and supports medical necessity for the associated audiology or ENT procedures billed on the same claim. Sequencing rules determine whether H90.6 is coded as the principal diagnosis or a secondary diagnosis.

When the primary reason for the encounter is evaluation and management of bilateral mixed hearing loss, H90.6 is the principal diagnosis. When the encounter targets a specific underlying cause (for example, otosclerosis coded as H80.x), the underlying condition may be sequenced first, with H90.6 as an additional code. The CDC/NCHS ICD-10-CM web tool provides the official tabular list guidance on sequencing instructions for the H90 category.

ICD-10-CM Official Guidelines state that when coding a condition that clinicians describe as both conductive and sensorineural, coders should assign a code from H90 that captures the combined nature, rather than coding each component separately. H90.6 satisfies this requirement for the bilateral presentation. Practices using structured patient record systems that flag audiogram data automatically can reduce the manual review step for sequencing decisions.

Excludes notes and applicable-to entries

The H90 category carries Type 1 Excludes notes that prevent certain codes from being used with H90.6:

• Excludes1: Deaf mutism NOS (H91.3) – Deaf mutism is coded separately and cannot be used alongside H90.6.
• Excludes1: Deafness NOS (H91.9-) – Non-specific deafness codes under H91 are excluded when a specific mixed bilateral hearing loss diagnosis is supported.
• Excludes1: Hearing loss NOS (H91.9-) – H91 codes apply only when the type of hearing loss is genuinely unspecified, not when mixed bilateral loss is clearly documented.

There are no Type 1 Excludes notes that prevent H90.6 from being coded alongside underlying etiology codes (such as otosclerosis H80.x or chronic suppurative otitis media H66.x). Coders should use H90.6 alongside the appropriate etiology code when documentation supports both. For practices integrating HIPAA-compliant documentation workflows, the HIPAA compliance standards for medical offices apply equally to how audiometric records and diagnosis codes are stored and transmitted.

CPT Codes Commonly Paired with ICD-10 Code H90.6

H90.6 does not generate a claim on its own. It must be paired with a CPT procedure code that reflects the service rendered. The following CPT codes are most frequently submitted alongside H90.6 in audiology and ENT settings. Practices can use the AAPC Codify ICD-10-CM lookup to verify crosswalk relationships before claim submission.

• 92557 – Comprehensive audiometry evaluation (pure tone + speech), bilateral: the most common pairing when H90.6 is the primary diagnosis code
• 92553 – Pure tone audiometry, air and bone: used when the evaluation focuses on confirming the air-bone gap component
• 92567 – Tympanometry: documents middle-ear status relevant to the conductive component
• 92587 – Otoacoustic emissions, limited: used to assess cochlear function relevant to the sensorineural component
• 69210 – Removal of impacted cerumen: may be paired if cerumen impaction is contributing to the conductive component
• L8614 (HCPCS) – Cochlear implant device: used in candidacy evaluations where H90.6 supports the medical necessity for cochlear implant assessment

Cochlear implant candidacy is a specific context where H90.6 appears frequently. When a patient presents with bilateral mixed hearing loss and is being evaluated for cochlear implant suitability, H90.6 supports the medical necessity documentation for both the evaluation (CPT 92626) and any subsequent implant procedure. An integrated claims management workflow that links diagnosis codes to procedure codes at the point of order entry can flag mismatches before submission rather than after denial.

H90.6 in Audiology and ENT Practice Management Workflows

Coding accuracy for H90.6 is ultimately a documentation workflow problem as much as a coding knowledge problem. Most denials occur not because coders select the wrong code but because the clinical documentation did not capture all required elements before they built the claim. ENT and audiology practices benefit from structured workflows that prompt clinicians to document laterality and both hearing loss components at the point of care.

Practice management systems that support structured ENT note templates can automatically surface fields for air-bone gap measurements, bone-conduction thresholds, and laterality confirmation. This reduces the documentation query cycle, which in high-volume audiology practices can add days to the billing lag. Pabau’s Echo AI clinical documentation tool assists practitioners in generating structured clinical notes that capture the specific diagnostic detail needed to support codes like H90.6 without requiring coders to go back to providers for clarification.

For practices managing pediatric bilateral mixed hearing loss, documentation requirements have an additional dimension. Pediatric patients undergoing cochlear implant evaluation, hearing aid fitting, or early intervention assessments will have H90.6 as a recurring diagnosis across multiple encounters. Maintaining a consistent, longitudinal patient management record that carries forward audiometric data across visits supports both continuity of care and coding consistency.

Multi-location ENT groups face a compounding challenge: ensuring that every site uses the same documentation template so that coders apply H90.6 consistently regardless of which clinician or location performed the evaluation. A compliance management system with standardized form templates across locations closes this gap and reduces inter-site coding variation. For practices looking at broader EHR integration strategies, consistent ICD-10 code usage across connected systems also matters for population health reporting and payer analytics.

Conclusion

ICD-10 Code H90.6 is the correct, billable code when both ears present with a combination of conductive and sensorineural hearing loss, but the claim succeeds only when documentation confirms all three required elements: bilateral presentation, conductive component, and sensorineural component. Choosing H90.8 when H90.6 is supported is under-coding; choosing H90.6 without bilateral documentation is unsupported coding.

Audiology and ENT practices that build structured documentation workflows, use templates that prompt laterality and dual-component confirmation, and link diagnosis codes to procedure codes at the point of entry will consistently file cleaner claims. Pabau’s digital forms and claims management tools are built for exactly this kind of structured, compliance-ready documentation. To see how Pabau supports ENT and audiology billing workflows, book a demo with the team.

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