Listen to This Ear Condition Coding Advice, Part 1
Anatomic knowledge and a laterality guideline can help pinpoint codes quickly and precisely. From children with otitis media to seniors with presbycusis, your provider sees a wide range of patients with ear conditions in a typical day. But just because the conditions are prevalent doesn’t mean you understand how to code them accurately. That’s why we put together this two-part ear condition coding primer to help you manage many of your ear condition coding conundrums. In this first article, we look at some common ear infections and the coding knowledge you need to correctly document them. Understand Anatomy to Master Ear Infection Reporting The ear is divided into three different sections: the outer ear, which includes the external ear and ear canal; the middle ear, which includes the eardrum, three small bones (ossicles), and the eustachian tube; and finally the inner ear. The eustachian tube’s responsibility is to equalize the air pressure within the middle ear, which allows for fluid to drain from the middle down the throat. Conditions of the ear can vary from mild to severe and affect different areas of the ear. ICD-10-CM navigation tip: Diseases of the ear and mastoid process are coded to H60-H95, with diseases of the external ear being located in the H60-H62 category, diseases of the middle ear and mastoid in the H65-H75 category, and diseases of the inner ear in the H80-H83 category. Extend Your External Ear Condition Coding Choices Here’s a detailed look at some of the more common external ear conditions: This is an infection that can affect the entire outer ear, including the upper part and the earlobe. Antibiotics, pain management, and topical treatments may be used to treat this condition. This is also known as swimmers’ ear and is an infection of the ear canal, the pathway from the outer ear to the middle ear. It can be fungal or bacterial and cause hearing loss if left untreated. The most common form of treatment is ear drops including antibiotic, antifungal, and steroid options. Over-the-counter pain relievers may also be recommended. Then Add These Typical Middle Ear Conditions Here’s a detailed look at some of the more common middle ear conditions: This is considered the typical ear infection and is particularly common among children. It occurs when a virus or bacteria infects the space inside the eardrum. Symptoms in children include ear pain, fussiness, or irritability. Sometimes, this will resolve on its own and in other cases antibiotics, pain-relieving medications, or ear tubes are needed. Remember: Otitis media (OM) is classified as either H65.- (Nonsuppurative otitis media) or H66.- (Suppurative and unspecified otitis media), suppurative meaning that the infection is causing pus to discharge. Other discharge types your provider might document that will help you pinpoint the correct code for the condition include mucus (mucoid), blood (sanguinous), and clear (serous). So, nonsuppurative OM documented with one or more of these discharge types will be coded to H65.11- (Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous)). And don’t forget to follow the Use additional code instruction that accompanies H65.-, which tells you to use an additional code to identify exposure to environmental tobacco smoke (Z77.22), exposure to tobacco smoke in the perinatal period (P96.81), history of tobacco dependence (Z87.891), occupational exposure to environmental tobacco smoke (Z57.31), tobacco dependence (F17.-), and/or tobacco use (Z72.0), when applicable. This occurs when the tubes that connect your middle ears to your throat become clogged, causing pain, hearing loss, and feeling fullness in the ears. This typically goes away within a few days, but if persistent, treatment might be needed. This is an infection of part of the temporal bone, the large bone behind the ear; it occurs when a middle ear infection spreads to the area. Ear pain, drainage, and trouble hearing are common symptoms. Both antibiotics and drainage are used to treat this ear condition and in some serious cases, surgery might be required. This is an infection that can cause blisters on the eardrum that can develop from a cold or ear infection. This is most typically seen in children and young adults and is accompanied by severe ear pain, fever, poor appetite, and trouble sleeping. It is treated with pain medication, decongestants, and antibiotics. Remember: Like many ear conditions, myringitis can be classified as either acute, coded to H73.0- (Acute myringitis); or chronic, coded to H73.1- (Chronic myringitis). However, ICD-10-CM does not provide precise timeframes for any condition defined as acute or chronic. So, whether a condition is defined as acute or chronic comes down to your provider’s judgment. And if your provider documents the presence of blisters, you’ll use H73.01 (Bullous myringitis), as the word “bullous” implies blisters are present. And Know This Guideline to Correctly Assign Laterality Documenting whether the ear condition is in the right or left ear, is bilateral, or is in an unspecified ear is not as easy as simply adding the appropriate 5th or 6th character to the base code. So, it is important to become familiar with ICD-10-CM guideline 1.B.13. On the surface, the guideline is a little confusing, as it tells you to review the entire record before assigning the full code. However, it goes on to say the review should be “to determine the specific reason for the encounter and the conditions treated.” In other words, the diagnosis code assigned should reflect the diagnosis for the condition being treated at the time of the encounter. And “if there is conflicting medical record documentation regarding the affected side, the patient’s attending provider should be queried for clarification,” according to the guideline. Next month, we’ll look at some common hearing loss disorders and the various treatment options your provider may use to evaluate and manage them. Cristin Robinson, CPC, CPMA, CCC, CRC, CEMC, AAPC Approved Instructor,
Education Coding Consultant, Bristol, Tennessee
