To the Editor The article by Qian et al is interesting and has several valid points. But there are some limitations that can influence the interpretation of the findings. First, the authors based the qualifying patient search on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes of which almost half were listed as "unspecified." It may well be that these unspecified diagnosis codes represent children who had normal hearing outcomes. When the diagnostic conclusion is normal, we are required to code the type of problem that represents either the chief complaint or the primary concern that caused us to do the diagnostic test. For my part, I will code "sensorineural hearing loss, laterality unspecified" under the ICD-10 system when hearing sensitivity is normal. One of the major drawback s in the ICD coding system is that no one is allowed to be normal. The working assumption is that a valid health-related complaint caused the individual to seek health care services for which we must document. As a result of using ICD codes for participant selection, the percentages reported for the diagnostics need to be taken with a grain of salt.
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