Otolaryngology Coding Alert

Hint: The H61.2- family will have all your code choices.

With coding for impacted cerumen being such a hot topic in 2014, be sure you’re aware of associated diagnoses and how you should report them when ICD-10 goes into effect. The key to correct diagnosis choice? Your physician’s documentation.

Keep It Simple With 380.4 Under ICD-9

ICD-9 currently provides a single diagnosis code for impacted cerumen: 380.4 (Impacted cerumen). Coding guidelines instruct you to report an additional external cause code, if applicable, to identify the cause of the ear condition.

“Typically, when ICD-9 refers to an ‘external cause code,’ it’s referring to an E code,” says Kent J. Moore, manager of healthcare delivery and finance systems for the American Academy of Family Practice (AAFP) in Leawood, Kan. “In general, most external cause codes aren’t applicable to impacted cerumen. The only one that might be applicable is E013.8 (Activities involving personal hygiene and household maintenance; other personal hygiene activity).”

Possibility: “If the impacted cerumen was the result of someone trying to clean his or her ear out with a Q-tip, you might be able to list E013.8 as an external cause,” Moore adds. “That said, most times an external cause code won’t be needed or applicable.”

Choose From 4 ICD-10 Options

Documentation and your resulting diagnosis coding will need to be more specific under ICD-10. You’ll find your choices in the H61.2- (Impacted cerumen) series of codes. The fourth digit will specify the affected ear:

• H61.20, Impacted cerumen, unspecified ear
• H61.21, Impacted cerumen, right ear
• H61.22, Impacted cerumen, left ear
• H61.23, Impacted cerumen, bilateral.

Result: Physicians will need to be more detailed in their documentation of impacted cerumen by noting which ear is affected and how they treated the problem. Let your physicians know that they need to include details regarding which ear has impacted cerumen, so you don’t have to report the “unspecified” diagnosis.