ICD 10 Coding Alert

Heads up: The conditions will have their own chapter in ICD-10. 

When ICD-10 goes into effect, you’ll find diagnosis codes for ear and mastoid conditions in a new place – a chapter of their own, rather than part of the Nervous System and Sense Organ chapter as they currently are in ICD-9. The breakdown of categories in the new chapter will be as follows: 

• H60-H62 – Diseases of the external ear
• H65-H75 – Diseases of the middle ear and mastoid
• H80-H83 – Diseases of the inner ear
• H90-H94 – Other disorders of the ear
• H95 – Intraoperative and postprocedural complications and disorders of the ear and mastoid process, not otherwise classified. 

When you begin reporting these codes, focusing on three factors will help you make the correct choice every time. 

Factor 1: Sequence the Codes Correctly 

ICD-10 requires coders to first report the patient’s underlying disease, then code the manifestation. For example, the physician diagnoses otitis externa due to impetigo. You would first code the impetigo (L01.0), then follow with H62.4 (Otitis externa in other diseases classified elsewhere). 

Tip: In ICD-10’s Alphabetic Index, you’ll see these conditions designated with [] brackets. For example, an Alphabetic Index entry could read: 

• Otitis
• Externa
• In (due to)
• Parasitic disease NEC B89 [H62.40]. 

In the Tabular List, codes will include a “use additional code” notation for the etiology and a “code first” note for the manifestation code. 

Factor 2: Look for Laterality Notes 

Most diagnoses related to ear and mastoid conditions include choices for right, left, and bilateral in ICD-10. Your practitioners should include these details in their notes so you can select the most appropriate diagnosis. For example, the choices for diffuse otitis externa will include: 

• H60.311 – Diffuse otitis externa, right ear
• H60.312 – Diffuse otitis externa, left ear 
• H60.313 – Diffuse otitis externa, bilateral
• H60.319 – Diffuse otitis externa, unspecified ear. 

Factor 3: Pay Attention to Includes and Excludes Notes 

The “excludes” notes of the Tabular List help explain the relationship between multiple diagnoses for a patient. Conditions listed as “Excludes 1” under a particular diagnosis should never be reported with the diagnosis in question. 

Example 1: Diagnosis H72 (Perforation of tympanic membrane) lists Excludes 1 codes of H66.01- (Acute suppurative otitis media with spontaneous rupture of ear drum) and S09.2- (Traumatic rupture of ear drum). You should not report any code from H66.01- or S09.2- with H72. 

When you see “Excludes 2” under a diagnosis, it means that the excludes condition isn’t part of the condition represented by the first-listed diagnosis code, but the patient might have both conditions at the same time and if documented, you can use the “Excludes 2” code(s). 

Example 2: Diagnosis H71 (Cholesteatoma of middle ear) is associated with Excludes 2 codes H60.4- (Cholesteatoma of external ear) and H95.0- (Recurrent cholesteatoma of postmastoidectomy cavity). If the patient has either of these conditions along with cholesteatoma of the middle ear, you can submit both diagnoses (assuming you have adequate documentation supporting each diagnosis). 

Bottom line: Providers will need to document which ear(s) are affected by the condition so you can select the best diagnosis code. Otherwise, you’ll be reporting choices such as H60.319 for “unspecified” anatomic sites. Many providers should already be making note of laterality in their notes, so the shift to ICD-10’s higher specificity shouldn’t be a difficult adjustment.