Understand ICD-10-CM Draft Guidelines for Diseases of Ear and Mastoid Process

Published in Coding Edge – April 2007
By Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CEMC, CPMA, COBGC, CPCD, CCS-P
This month’s focus is understanding the ICD-10-CM Draft Guidelines for Diseases of the Ear and Mastoid Process.
Diseases of the Ear and Mastoid Process are in Chapter 8 of ICD-10-CM. This chapter contains the following blocks:

H60-H62 Diseases of external ear
H65-H75 Diseases of middle ear and mastoid
H80-H83 Diseases of inner ear H
H90-H95 Other disorders of ear

Review this example: A patient underwent an initial tympanoplasty (69631) without mastoidectomy in the outpatient hospital surgery department for an attic perforation of the tympanic membrane of the right ear.
Look at the comparison between ICD-9-CM and ICD-10-CM below:

ICD-9-CM

ICD-10-CM

384.2 Perforation of tympanic membrane384.20 Unspecified perforation of tympanic membrane384.21 Central perforation of tympanic membrane
384.22 Attic perforation of tympanic membrane
384.23 Other marginal perforation of tympanic membrane
384.24 Multiple perforations of tympanic membrane
384.25 Total perforation of tympanic membrane

H72 Perforation of tympanic membraneH72.0 Central perforation of tympanic membraneH72.1 Attic perforation of tympanic membrane
H72.10 Attic perforation of tympanic membrane, unspecified ear
H72.11 Attic perforation of tympanic membrane, right ear
H72.12 Attic perforation of tympanic membrane, left ear
H72.13 Attic perforation of tympanic membrane, Bilateral
H 72.2 Other marginal perforations of tympanic membrane

ICD-10-CM is more specific in identifying the effected ear. The example indicates the procedure was performed on the right ear, which is reported with H72.11 in ICD-10-CM. Review the choices for ICD-10-CM. The most appropriate diagnosis code is 384.22 (attic perforation of the tympanic membrane). ICD-9-CM is not as specific because it does not identify which ear is affected.

ICD-9-CM	ICD-10-CM
384.22 Attic perforation of tympanic membrane	H72.11 Attic perforation of tympanic membrane, right ear

The guidelines specific to this chapter involve complication of care within the body system chapter specific to the organs and structure of that body system. The condition or disease should be sequenced first followed by a complication code in block H95.

H95 Intraoperative and postprocedural complications and disorders of ear and mastoid process, not elsewhere classified

Review this example: A patient underwent a revision of the mastoidectomy with apicectomy (69605) for cholesteatoma of the left middle ear and mastoid. During the procedure, the patient experienced an intraoperative hemorrhage of the ear and mastoid process.
Review the comparison between ICD-9-CM and ICD-10-CM below:

ICD-9-CM	ICD-10-CM
385.3 Cholesteatoma of middle ear and mastoid385.30 Unspecified cholesteatoma385.31 Cholesteatoma of attic 385.32 Cholesteatoma of middle ear 385.33 Cholesteatoma of middle ear and mastoid 385.35 Diffuse cholesteatosis of middle ear and mastoid	H71.2 Cholesteatoma of mastoidH71.20 Cholesteatoma of mastoid, unspecified earH71.21 Cholesteatoma of mastoid, right ear H71.22 Cholesteatoma of mastoid, left ear H71.23 Cholesteatoma of mastoid, bilateral

In ICD-10-CM the diagnosis would be reported with code H71.22 (cholesteatoma of mastoid, left ear) and with ICD-9-CM 385.33 (cholesteatoma of middle ear and mastoid). According to the ICD-10-CM guidelines, the complication is also coded. Review the options for coding intraoperative and post procedural complications of the ear (H95.2).

H95.2 Intraoperative and postprocedural hemorrhage or hematoma complicating a procedure of the ear and mastoid process
- Excludes intraoperative hemorrhage or hematoma due to accidental puncture of laceration during a procedure on the ear (H95.3) H95.21 Intraoperative hemorrhage of the ear and mastoid process during a procedure of the ear and mastoid process
  - H95.23 Intraoperative hematoma of the ear and mastoid process during a procedure of the ear and mastoid process

The most appropriate complication code in this block is H95.23 Intraoperative hematoma of the ear and mastoid process during a procedure of the ear and mastoid process.
With ICD-9-CM the complication would be reported in category 998.1 Hemorrhage or hematoma or seroma complicating a procedure. A fifth digit is required in this category.

998.1 Hemorrhage or hematoma or seroma complicating a procedure
- 998.11 Hemorrhage complicating a procedure

Review the coding comparison between ICD-9-CM and ICD-10-CM:

ICD-9-CM	ICD-10-CM
385.33 Cholesteatoma of middle ear and mastoid998.11 Hemorrhage complicating a procedure	H71.22 Cholesteatoma of mastoid, left earH95.23 Intraoperative hematoma of the ear and mastoid process during a procedure of the ear and mastoid process