Otolaryngology Coding Alert

Know when to apply these secondary codes.

Foreign bodies (FBs) entering through one of the three ENT-specific pathways is a relatively common occurrence. While these situations are found primarily with children presenting for service, FBs of the ear, nose, and throat don’t necessarily discriminate when it comes to age. However, when it comes to coding, there are a few general rules to follow regardless of circumstance:

• Include a secondary code from chapter 20 in the ICD-10 to indicate cause of injury. These codes are labeled under “External Causes of Morbidity” and range from accidents to complications of surgical care. It’s important to point out, though, that there is not an external cause code that identifies accidents involving FBs. When looking to apply a secondary code to, say, an accidental swallowing of a foreign object, your best option is to use: X58.- (Accidental exposure to other specified factors …).
• Include a code for the place of occurrence of the external cause (i.e.: park, school, home, etc.): Y92.- (Place of occurrence of external cause …). Exception: Do not report a chapter 20 code if the T code already includes an external cause of injury.
• Use an additional third code to identify any retained FB, if applicable. Document retained FBs using: Z18.-(Other specified retained foreign body …).

Example: A 34-year-old woman comes to the ER from eating in a restaurant, reporting that she has a fish bone stuck in her throat. The surgeon performs a flexible laryngoscopy (31575, Laryngoscopy, flexible; diagnostic) and does not see an FB in the larynx and associated structures. The patient is brought to the operating room where the physician performs a rigid esophagoscopy (43191, Esophagoscopy, rigid, transoral; diagnostic …). The physician removes a fish bone from the esophagus. The diagnoses for this encounter are:

• T18.198A, Other foreign object in esophagus causing other injury, initial encounter
• X58.XXXA, Exposure to other specified factors, initial encounter
• Y92.511, Restaurant or café as the place of occurrence of the external cause

Take note: An FB passing through the digestive tract is not considered a retained FB. However, a retained FB would involve an object lodged in the ear, nose, or throat. This might include situations involving accidents or post-procedural complications.

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