ED Coding and Reimbursement Alert

Question: Our ED physician diagnosed a patient with a traumatic central perforation of the right eardrum, but we're having trouble locating the best ICD-10 code. Can you advise?

Codify Subscriber

Answer: Coding this diagnosis can be tricky due to the traumatic specifier. Your first step is to look up Perforation in the ICD-10 index; however, it's at this initial point where coders may find their first hang-up. Next to Perforation, perforated, you will find the two supplementary words (nontraumatic) (of).

Refresher:  According to ICD-10 guidelines, "Parentheses are used in both the Alphabetic Index and Tabular List to enclose supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code number to which it is assigned."

These terms in parentheses, known as nonessential modifiers, may be a clue that you are at the right code, whether you are in the index or the tabular section. But while it may affirm your code choice, don't let a nonessential modifier distract you from using the right code. If the diagnosis you are looking for conflicts with the nonessential modifier, don't worry. After all, it's nonessential. That means it is OK to ignore it.

The nontraumatic supplementary word could easily dissuade a coder from continuing further down the perforation list of diagnosis codes. However, as long as you have a clear understanding that the supplementary words are not necessarily tied in to the underlying term, you may continue to see what coding options are available under Perforation.

Perforation, perforated (nontraumatic) (of) ⇒ ear drum will lead you to see Perforation, tympanum. Under Perforation, perforated (nontraumatic) (of) ⇒ tympanum, tympanic (membrane) (persistent post-traumatic) (postinflammatory), you have the option of selecting central. However, here is another avenue in which you should not let the supplementary words redirect you. As you can see, one of the supplemental words, persistent post-traumatic, might lead a coder to look elsewhere for a more acute injury code. However, since this descriptor may or may not be present, you should continue under central to find the correct diagnosis code.

Under central, you have the option for multiple or total. Since there is no specification as to whether there are multiple or total perforations of the eardrum, you should opt for the default central perforation of the tympanic membrane code, H72.01 (Central perforation of tympanic membrane, right ear).