Otolaryngology Coding Alert

" Report otomycosis' underlying disease, ICD-9 instructions indicate When chart notes contain elusive terms, such as ear effusions"" and ""fungal otitis externa" " following ICD-9 Coding Conventions will keep you coding like an otolaryngology expert.

To submit the correct diagnostic codes for complicated ear diagnoses remember these rules. Start With 'A' First you should always look up the key terms in ICD-9's Alphabetic Index. "Sometimes you'll find the diagnosis the otolaryngologist listed " says Cindy M. Austin facility manager at Dothan ENT Allergy and Asthma PC in Dothan Ala. 2 Sources Unlock Possible Diagnoses When you're confronted by anatomic or medical terms that don't appear in ICD-9's Alphabetic Index - and you're not familiar with the phrases - you should use your sources. "Look up the key terms in a good medical dictionary " says John F. Bishop PA-C CPC president and CEO of Bishop & Associates Inc. in Tampa Fla. The information may point you to a listed ICD-9 diagnosis.

Example: An otolaryngologist states that the diagnosis for tubes is "ear effusions." When you look up the key phrase "effusion" in ICD-9's Alphabetic Index you find no listing. A search for "effusion" produces the following information:

Otitis Media With Effusion
Alternative Names: Glue Ear OME Secretory Otitis Media Serous Otitis Media Silent Ear Infection Silent Otitis Media
  Definition: Otitis media is an inflammation of the middle ear. Otitis media with effusion (OME) refers to fluid in the middle ear space but without the symptoms of an acute infection.

Therefore you know to look up "otitis media" in ICD-9's Alphabetic Index. When you locate "otitis" you find among the entries one of the above synonyms "serous":

serous 381.4
acute or subacute 381.01
chronic (simple) 381.10.

The listing points you to nonspecified otitis media code 381.4 (Nonsuppurative otitis media not specified as acute or chronic) which includes "otitis media: serous" and "otitis media: with effusion." If you have further information as to whether the patient has acute or chronic OM you can use the specific diagnosis of 381.01 or 381.10.
 
Alternative: If a medical dictionary doesn't give you the information you need to locate an appropriate listed synonym go back to the otolaryngologist for more information. "I ask the physician to explain the unknown term to me so that we can get the right code " Austin says. Slanted Brackets Signal Duel Coding ICD-9's Alphabetic Index sometimes includes additional coding directives. For instance if you find slanted brackets following a code you must use these codes together Bishop says. "You should look up the bracketed [...]