Inpatient Facility Coding & Compliance Alert

Look out for laterality, sequencing and more.

ICD-9 groups diagnosis codes for ear and mastoid conditions in the same chapter (Nervous System and Sense Organs), but that will change in ICD-10. Once Oct. 1, 2015, comes, you’ll find these diagnoses in a separate chapter with several category breakdowns: 

• H60-H62 – Diseases of the external ear
• H65-H75 – Diseases of the middle ear and mastoid
• H80-H83 – Diseases of the inner ear
• H90-H94 – Other disorders of the ear
• H95 – Intraoperative and post procedural complications and disorders of the ear and mastoid process, not otherwise classified.

Keep in mind these tips are for correctly coding ear conditions using ICD-10. 

1. Go by the Correct Code Sequence

Always remember to first report the patient’s underlying disease, then follow it up with the code for manifestation. 

Example: A patient has been diagnosed with otitis externa due to impetigo.  The protocol would be to first code the impetigo (L01.0), and then subsequently follow it up with H62.4 (Otitis externa in other diseases classified elsewhere). 

Plus: In ICD-10’s Alphabetic Index, the codes for these conditions are designated with [] brackets. As an illustration, an Alphabetic Index entry may look like: 

• Otitis
• Externa
• In (due to)
• Parasitic disease NEC B89 [H62.40]. 

You can also quickly glance through the Tabular List, to look for the “use additional code” notation for the etiology and a “code first” note for the manifestation code. 

2. Make Sure Provider Documents Laterality

Many diagnoses in ICD-10 will require you to mention the side or laterality of the pathology (i.e., right, left, or bilateral). Ensure that your provider has given adequate documentation for you to be able to select the most appropriate code. 

For instance, the choices for diffuse otitis externa will include: 

H60.311 (Diffuse otitis externa, right ear)
H60.312 (Diffuse otitis externa, left ear)
H60.313 (Diffuse otitis externa, bilateral)

3. Double check the ‘Includes’ and ‘Excludes’ Notes 

The “excludes” notes of the Tabular List help explain the relationship between multiple diagnoses for a patient.  If one or more conditions are listed as “Excludes 1” under a particular diagnosis, remember never to report the coexistence of those conditions with the primary diagnosis in question. 

Example: Diagnosis H72 (Perforation of tympanic membrane) lists Excludes 1 codes of H66.01- (Acute suppurative otitis media with spontaneous rupture of ear drum) and S09.2- (Traumatic rupture of ear drum). Therefore, you should not report any code from H66.01- or S09.2- with H72. 

Note: When you see “Excludes 2” under a diagnosis, it means that the excludes condition isn’t part of the condition represented by the first-listed diagnosis code, but the patient might have both conditions at the same time and if documented, you can use the “Excludes 2” code(s).

Best bet: Ensuring that you know which side is affected with the pathology will help you select the best diagnosis codes. Otherwise, you’ll be reporting choices such as H60.319 for “unspecified” anatomic sites.  Many practitioners are already putting this into practice for a seamless transition in ICD-10.