ICD-10 code H90.8: mixed hearing loss guide

Key Takeaways

ICD-10 Code H90.8 is a billable ICD-10-CM diagnosis code for mixed conductive and sensorineural hearing loss, unspecified, valid for the 2026 edition effective October 1, 2025

Use H90.8 only when laterality is not documented; if bilateral or unilateral laterality is known, use the more specific H90.6 or H90.7 instead

Documentation must confirm both a conductive component and a sensorineural component of hearing loss, with no laterality specified in the clinical record

Practice management software like Pabau helps audiology and ENT practices document laterality accurately before H90.8 reaches a claim, using structured clinical note templates that prompt for the missing detail at the point of care

ICD-10 Code H90.8 is a billable ICD-10-CM code for mixed conductive and sensorineural hearing loss, unspecified. It applies when the chart confirms both a conductive and a sensorineural component but doesn’t document which ear is affected.

H90.8 gets used more often than it should. Audiograms almost always report laterality, so a more specific code, H90.6 or H90.7, is usually the correct choice instead.

This reference page covers the 2026 ICD-10-CM edition definition of H90.8, the full H90 code family for laterality decisions, documentation requirements, billing context, and the ICD-9-CM crosswalk. It also flags the most common coding errors that lead to claim denials or audit risk.

ICD-10 Code H90.8: definition and billable status

ICD-10 Code H90.8 is a valid, billable ICD-10-CM diagnosis code. Its full official description is: Mixed conductive and sensorineural hearing loss, unspecified. The code is current for the 2026 edition of ICD-10-CM and became effective on October 1, 2025, as confirmed by the CDC/NCHS ICD-10-CM web tool.

H90.8 sits within the H90 category (Conductive and sensorineural hearing loss), which falls under the H60-H95 chapter range covering diseases of the ear and mastoid process. It is the least specific code in the H90 mixed subgroup, reserved for encounters where the chart confirms both loss types but does not document laterality.

Understanding mixed conductive and sensorineural hearing loss

Accurate use of ICD-10 Code H90.8 starts with understanding what distinguishes the three hearing loss types. Conductive hearing loss involves a problem in the outer or middle ear that blocks sound transmission. Sensorineural hearing loss (SNHL) involves damage to the inner ear cochlea or the auditory nerve. Mixed hearing loss means both components are present simultaneously in the same patient.

A common clinical scenario: a patient with chronic otitis media (a conductive cause) who also has age-related cochlear damage (a sensorineural cause). The audiogram shows an air-bone gap alongside a depressed bone conduction threshold, confirming both pathways are affected.

Conductive vs sensorineural vs mixed: key differences

For medical forms serving ENT or audiology patients, documenting the audiometric basis for the mixed classification is essential. A note that says “mixed hearing loss” without referencing audiometric results will not meet payer documentation standards for H90.8.

ICD-10 Code H90.8 in the H90 group: laterality and code selection

Excluding the H90.A series (covered separately below), the H90 category contains 12 billable codes organized by hearing loss type and laterality. Three of the subcategory codes, H90.1, H90.4, and H90.7, aren’t billable on their own: each needs a sixth character marking the right or left ear before a claim can be submitted. H90.8 is the unspecified-laterality code for mixed hearing loss. Understanding the full hierarchy prevents the most common error: defaulting to H90.8 when a more specific code is available and documentable.

When to use H90.8 vs H90.6 and H90.7

The decision tree is straightforward. ICD-10-CM official guidelines require the highest level of specificity available. For mixed hearing loss, that means laterality must be coded when documented.

• Use H90.6 when the chart documents bilateral mixed hearing loss (both ears affected, both conductive and sensorineural components confirmed).
• Use H90.7 when the chart documents unilateral mixed hearing loss with the contralateral ear having unrestricted (normal) hearing.
• Use H90.8 only when the chart confirms mixed hearing loss type but does not specify whether it affects one ear, both ears, or which ear. This is genuinely uncommon in well-documented audiology encounters.

The most common error is using H90.8 as a default when the audiologist’s report clearly identifies bilateral involvement. That constitutes undercoding under ICD-10-CM Section I.C guidelines, and payers may flag it during retrospective audits.

Where H90.A fits: restricted hearing on the other ear

The H90 category also includes the H90.A subgroup, added for unilateral hearing loss where the unaffected ear isn’t fully normal either. This changes the applicable code family, not just the laterality digit.

• H90.7 codes unilateral mixed hearing loss when the contralateral ear has unrestricted (normal) hearing.
• H90.A3 codes unilateral mixed hearing loss when the contralateral ear has restricted hearing, meaning some hearing loss is present there too, just not of the mixed type.
• H90.8 applies when laterality itself isn’t documented, regardless of contralateral hearing status.

H90.A3 is itself a non-billable subcategory: H90.A31 codes the right ear as affected, with restricted hearing on the left, and H90.A32 codes the left ear as affected, with restricted hearing on the right. The same right/left split applies to H90.A1 (conductive-only) and H90.A2 (sensorineural-only), giving coders a parallel structure to H90.1 and H90.4 whenever the unaffected ear has hearing loss of its own.

Documentation requirements for H90.8

Meeting the documentation standard for ICD-10 Code H90.8 requires the clinical record to satisfy three conditions. Missing any one of them creates coding or audit risk. Practitioners managing clinical compliance requirements across allied health specialties will recognize this same specificity standard in broader ICD-10-CM guidance.

• Confirmed mixed type: The note must document both a conductive component (e.g., middle ear pathology, ossicular chain abnormality, effusion) and a sensorineural component (e.g., cochlear damage, auditory nerve deficit). Both must be explicitly named, not implied.
• Audiometric evidence: Audiogram results supporting the mixed classification must be present in the record. An air-bone gap alongside a depressed bone conduction threshold is the standard audiometric signature. A note that mentions mixed hearing loss without referencing test results will not withstand payer scrutiny.
• Laterality absent or genuinely unknown: The chart must not contain documentation of whether the loss is bilateral, right-sided, or left-sided. If laterality appears anywhere in the record (including in the audiogram header), H90.6 or H90.7 is required instead.

Using structured patient records with fields that prompt for laterality at the point of documentation can prevent the undercoding problem before it reaches the billing stage. The fix is upstream in the clinical workflow, not at the claim.

Includes, excludes, and coding notes for H90.8

The H90 category carries official ICD-10-CM includes and excludes notes that govern all codes within it, including H90.8. These notes are not optional guidance. They are binding coding rules.

Excludes notes for H90

The following conditions are explicitly excluded from H90 and must be coded elsewhere. Using H90.8 for any of these is a coding error.

• Deaf nonspeaking NEC (H91.3) – use H91.3, not H90.8
• Deafness NOS (H91.9) – use H91.9
• Hearing loss NOS (H91.9) – use H91.9
• Noise-induced hearing loss (H83.3) – use H83.3
• Ototoxic hearing loss (H91.0) – use H91.0
• Sudden (idiopathic) hearing loss (H91.2) – use H91.2

H90.8 is also not the appropriate code for hearing loss where the etiology is noise-induced or medication-related, even if the resulting audiometric pattern resembles mixed loss. The etiology-specific codes take precedence under ICD-10-CM’s code-first and use-additional-code rules.

H90.8 medical billing and reimbursement

ICD-10 Code H90.8 is accepted by Medicare, Medicaid, and most commercial payers as a valid primary or secondary diagnosis code for audiology and ENT encounters. Reimbursement is not automatic, however. Coverage depends on the payer’s local coverage determination (LCD), the nature of the encounter, and the CPT codes paired with H90.8. The CMS ICD-10 codes page provides the authoritative reference for annual updates and coverage guidance.

Common CPT codes paired with H90.8 in audiology and ENT billing include audiometric testing codes (92551-92557), hearing aid evaluation codes, and tympanometry. Pairings vary by payer. Never assume a specific CPT code is automatically covered with H90.8 without reviewing the applicable LCD.

Audiology and ENT practices that want diagnosis coding and clinical documentation working from the same system can use speech therapy practice software that carries the ICD-10-CM code from the note into the billing queue, cutting the manual step of re-entering H90.8 on a claim. Compliance management software that keeps the diagnosis and audiometric evidence together in the record reduces the transcription errors that show up between the clinical note and the submitted claim.

Reduce hearing loss coding errors with Pabau

Pabau's structured clinical note templates help audiology and ENT practices code H90.8 accurately, prompting for laterality documentation before it becomes a billing problem.

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ICD-9-CM crosswalk for H90.8

For practices reviewing historical records, legacy system imports, or retrospective claim audits, H90.8 crosswalks to ICD-9-CM code 389.20. This crosswalk is an approximation. The AAPC Codify ICD-10-CM lookup and the CMS General Equivalence Mappings (GEMs) file confirm 389.20 (mixed hearing loss, unspecified) as the primary predecessor.

The crosswalk is approximate because ICD-9-CM 389.20 did not distinguish laterality. The more granular bilateral and unilateral variants in ICD-10-CM (H90.6 and H90.7) have no direct ICD-9 equivalents. When converting legacy records, review the original documentation to determine whether H90.6, H90.7, or H90.8 is the appropriate ICD-10 assignment.

Common coding errors and how to avoid them

H90.8 is involved in a predictable set of errors that coders in audiology and ENT see regularly. Most stem from documentation habits rather than misunderstanding of the code itself. Digital intake forms that capture laterality and hearing loss type before the clinical encounter can eliminate several of these at source.

• Defaulting to H90.8 when laterality is documented. This is the most frequent error. If the audiogram or clinical note identifies the affected ear, H90.6 or H90.7 must be used. Using H90.8 is undercoding and can trigger payer audit flags.
• Using H90.8 for noise-induced or ototoxic mixed patterns. These etiologies have their own codes (H83.3 and H91.0). The H90 excludes notes prohibit using any H90 code for these conditions, even when the audiometric pattern superficially resembles mixed loss.
• Applying H90.8 when hearing loss type is unspecified, not laterality. H90.8’s “unspecified” refers to laterality, not hearing loss type. If the type (conductive, sensorineural, or mixed) is unknown, the correct code is H91.9 (hearing loss, unspecified), not H90.8.
• Omitting comorbid codes. H90.8 is often assigned alongside codes for the underlying cause (e.g., chronic otitis media, otosclerosis). Missing the etiology code when documented is an incomplete coding error that affects HCC risk scoring and clinical data quality.

For practices using AI-assisted clinical documentation, structured note templates that prompt for hearing loss type and laterality at the point of care reduce the missing documentation that forces coders to default to H90.8. The fix belongs in the clinical workflow, not the billing queue.

How Pabau supports accurate ICD-10 coding for hearing loss

Reference-only ICD-10 lookup tools identify the code but don’t connect it to the clinical note, the billing queue, or the submitted claim. Coding errors tend to start at that disconnect.

Pabau’s practice management platform integrates ICD-10-CM code selection directly into clinical documentation for audiology and ENT practices. Clinical note templates can be configured to prompt for hearing loss type and laterality before a note is finalized, reducing the conditions that lead to H90.8 being used when H90.6 is warranted. Once the diagnosis code is confirmed in the note, it carries through to billing without a separate re-entry step.

Practices also benefit from EHR integration that connects the coding context to the full patient record, so laterality documented in a prior visit’s audiogram isn’t missed when coding a follow-up encounter. Because sensorineural damage often brings vestibular symptoms too, some ENT and audiology practices also run balance rehab through physical therapy EMR software, keeping the audiogram findings and the therapy notes in the same record.

Conclusion

H90.8 is a billable code with a narrow intended use: mixed hearing loss where laterality is genuinely undocumented. Most denials and audit findings tied to this code come not from the code itself but from applying it when a more specific code was available and documentable. The laterality check, the excludes notes, and the distinction between unspecified type versus unspecified laterality are the three points where coders most often need to pause.

If your practice sees frequent H90.8 submissions, the most effective intervention is a documentation workflow change, not a coding policy change. Pabau’s structured clinical templates help audiology and ENT practices get laterality into the note before it becomes a billing problem. To see how Pabau supports hearing loss documentation, speak with the team.

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