Otolaryngology Coding Alert

ICD-10 will teach you to code based on the specific condition.

An estimate of about 2 million Americans suffer from smell and taste disorders – also called olfactory dysfunctions. When your otolaryngologist diagnoses a patient with a disturbance in her sense of smell or taste, you have a single code to report: 781.1 (Disturbances of sensation of smell and taste). The ICD-9-CM manual defines this diagnosis as:

• absence of the sense of smell
• loss of the sense of smell
• diminished ability to taste
• a bad taste in the mouth
• abnormal appreciation of the taste of foodstuffs, can be related to decreased sense of smell
• diminished ability to smell.

ICD-10 changes: Effective Oct. 1, 2015, ICD-10-CM will become more specific in describing disturbances of sensation of smell and taste by introducing three codes pertaining to definite types of this condition:

• R43.0 – Anosmia
• R43.1 – Parosmia
• R43.2 – Parageusia.

FYI: These codes are found in the “R” chapter because they represent “signs and symptoms” which are found in Chapter 18 – Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00 – R99).

The codes represent the partial or total loss of sense of smell (anosmia), the inability of the brain to correctly identify an odor’s natural smell (parosmia), and a bad taste in the mouth that might make foods taste metallic (parageusia). 

Documentation: Your physician’s goal should be to comprehensively evaluate the functioning of a patient’s smell and taste nerves, and determine what factors may be producing the specific disturbance. Typically, payers require a standardized, quantitative test of olfactory function (such as the University of Pennsylvania Smell Identification Test [UPSIT] or the University of Connecticut Test Battery).

Sometimes, however, the otolaryngologist could examine nasal mucous membranes for abnormal conditions. Biopsy is necessary if intra-nasal or intra-oral neoplasm is suspected to be the cause of the dysfunction. You would code this procedure with 30100 (Biopsy, intranasal). 

Coding tip: Before submitting your claim, contact the payer to learn what exams or services it will cover. Predetermining the diagnostic exams that your carrier will cover, as well as the appropriate paper work that you need to complete can help you avoid you the hassles associated with a possible denial.