Oncology & Hematology Coding Alert

Question: The oncologist documented "ringing in head" as a sideeffect of chemotherapy for a patient. What diagnosis code applies?

Oklahoma Subscriber

Answer: Submit the best-fitting choice from 388.3x (Tinnitus). The fifth-digit options describe unspecified, subjective (when only the patient hears the ringing sound), and objective tinnitus (when the physician and patient can both hear the ringing sound).

Explanation: Although your physician documented ringing in the head rather than ringing in the ear, both perceptions apply to tinnitus. The ICD-9 notation with 388.3x states, "Perception of sound in absence of external noise and may affect one or both ears and/or head."

E-code: ICD-9 instructs you to use an additional code to identify the reason for the ear condition, if applicable. In this case, chemotherapy is the documented cause, so consider E933.1 (Drugs, medicinal, and biologicalsubstances causing adverse effects in therapeutic use; antineoplastic and immunosuppressive drugs).

Bonus tip: ICD-10 will replace ICD-9 in 2013. If you were reporting tinnitus using ICD-10 rather than ICD-9, you would need to know which ear was involved or if the problem affects both ears to choose the most specific code. The ICD-10 2011 options are:

• H93.11, Tinnitus, right ear
• H93.12, Tinnitus, left ear
• H93.13, Tinnitus, bilateral
• H93.19, Tinnitus, unspecified ear.

If you need a counterpart for your E-code, look to T45.1x5 (Adverse effect of antineoplastic and immunosuppressive drugs).