The ear has three main parts – external, middle, and inner. These three parts work together so you can hear and process sounds. The outer ear is called the pinna (or auricle) and is made up of ridged cartilage covered by skin. After sound waves enter the outer ear, they travel through the ear canal and make their way to the middle ear, by vibrating the tympanic membrane. The tympanic membrane separates the outer ear from the middle ear and the ossicles. These are the three smallest bones in the human body. These three bones are named the malleus (hammer), the incus (anvil), and the stapes (stirrup). The vibrations are then conducted to the cochlea, which is part of the inner ear. It transforms sound into nerve impulses that then travel to the brain. The fluid-filled semicircular canals (labyrinth) attach to the cochlea and nerves in the inner ear. They send information on balance and head position to the brain. The eustachian tube drains fluid from the middle ear into the pharynx behind the nose.
In ICD-10-CM, the codes for Diseases of the Ear and Mastoid Process are located in Chapter 8. There are currently no guidelines for this chapter. Diseases of the external ear include codes for otitis externa, swimmer’s ear, and hematoma of the pinna. This is where the codes for cerumen impaction will also be found.
The section for the middle ear includes the codes for otitis media, one of the most common diseases in childhood. The two main types of otitis media are acute otitis media (AOM) and otitis media with effusion (OME). AOM is usually caused by bacteria, usually Streptococcus pneumoniae or Haemophilus influenza; but sometimes by a virus, like respiratory syncytial virus. OME occurs when there is thick or sticky fluid behind the eardrum in the middle ear, but there is no ear infection. Swelling of the lining of the Eustachian tube can be caused by many factors, including allergies, irritants (especially cigarette smoke), and respiratory infections. OME is most common in winter or early spring, but it can occur at any time of year. It can affect people of any age, although it occurs most often in children under age 2, according to the Center for Disease Control. There are many more codes in this section compared to ICD-9-CM due to laterality in the code set. Some examples include:
H65.22 Chronic serous otitis media, left ear
H66.001 Acute nonsuppurative otitis media without spontaneous rupture of ear drum, right ear
H66.23 Chronic atticoantral suppurative otitis media, bilateral
The section for the inner ear includes codes for otosclerosis, vestibular function disorders, and labyrinthitis. Documentation for auditory conditions should include the type of disorder and the ear, or ears, affected in order to assign the codes to the highest level of specificity available in ICD-10-CM.
IN THE NEWS
The ICD-9-CM Coordination and Maintenance Committee Meeting was held on September 19, 2012. The committee is responsible for approving coding changes, developing errata, addenda and other modifications and is comprised of representatives from the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS). The transcripts, handouts, and audio file from the meeting are now available.
DISCHARGE DIAGNOSIS: Right lower extremity methicillin-resistant staphylococcus aureus cellulitis.
ADDITIONAL DISCHARGE DIAGNOSES: Tobacco use. Patient is a 2 pack per day cigarette smoker.
REASON FOR ADMISSION: The patient is a 52-year-old male who has had a very complex course secondary to a right lower extremity complex open wound. He has had prolonged hospitalizations because of this problem. He was recently discharged when he was noted to develop as an outpatient swollen, red tender leg. Examination in the emergency room revealed significant concern for significant cellulitis. Decision was made to admit him to the hospital.
HOSPITAL COURSE: The patient was admitted on 07/26/12 and was started on IV antibiotics elevation, was also counseled to minimizing the cigarette smoking. The patient eventually grew MRSA in a moderate amount. He was treated with IV vancomycin. Local wound care and elevation. The patient had slow progress. He was started on compression, and by 07/31/12 his leg got much improved, minimal redness and swelling was down with compression. The patient was thought safe to discharge home.
DISCHARGE INSTRUCTIONS: The patient was discharged on doxycycline 100 mg p.o. b.i.d. x10 days. He was also given prescription for Percocet and OxyContin, picked up at my office. He is instructed to do daily wound care and also wrap his leg with an Ace wrap. Follow-up was arranged in a couple of weeks.
DISCHARGE CONDITION: Stable.
L03.115 Cellulitis of right lower limb
B95.62 Methicillin resistant Staphylococcus aureus as the cause of diseases classified elsewhere
F17.210 Nicotine dependence, cigarettes, uncomplicated
Rationale: In ICD-10-CM, many codes indicate laterality. In the above scenario, the first-listed code indicated that the right lower limb is affected. An instructional note at the beginning of the section Infections of the skin and subcutaneous tissue (L00-L08) states to use an additional code from B95-B97 to identify the infectious agent. In our scenario, the agent is MRSA. Also, in ICD-10-CM, the type of tobacco product is identified in the chosen code (cigarettes).
In ICD-10-CM, the type of nicotine product a patient is dependent upon is identified in the code. The patient in the above example is dependent on cigarettes.
ICD-10 IMPLEMENTATION STRATEGIES
We will be sharing a number of strategies to help your practice successfully implement ICD-10-CM. Please remember to track your progress in your ICD-10 Implementation Tracker on AAPC's website.
In order to assess the educational needs for providers and staff, you should take a look at your providers' top diagnoses and compare them to their ICD-10-CM counterparts. This will allow you to see how much difference there is between ICD-9-CM and ICD-10-CM for your top used diagnoses. It can help assess how much documentation improvement assistance your providers will need, along with how much education the coding staff will need on the most used codes for your office. You may want to utilize mapping tools to assist with this process to ensure all code possibilities are captured and assessed.
The ICD-10 Implementation Tracker has been revised to reflect the October 2014 final date. This online application is used to track and graphically measure the ICD-10 implementation progress of an individual or organization. The tool lists tasks within key steps of the implementation process and then charts their completion against a recommended timeline/schedule to ensure minimal disruption to your organization. The tool is available exclusively to AAPC members and others participating in AAPC's ICD-10 Training.