Otolaryngology Coding Alert

Look for expanded options for hearing loss, tinnitus, and more.

Just as you’ve been getting accustomed to selecting diagnoses from ICD-10, it’s almost time to implement what will be the first official updates to the code set. The CDC has released a preliminary document with new, revised, and deleted codes, with the final version expected later this summer.

Otolaryngologists won’t have too many updates related to specialty-specific codes. Here’s a quick look at what you can probably expect once the changes are implemented on October 1.

Add These Choices for Hearing Loss and Tinnitus

Ten proposed additions to ICD-10 2017 will help you report some hearing diagnoses with more specificity. The new codes should be:

• H90.A11 – Conductive hearing loss, unilateral, right ear, with restricted hearing on the contralateral side
• H90.A12 – Conductive hearing loss, unilateral, left ear, with restricted hearing on the contralateral side
• H90.A21 – Sensorineural hearing loss, unilateral, right ear, with restricted hearing on the contralateral side
• H90.A22 – Sensorineural hearing loss, unilateral, left ear, with restricted hearing on the contralateral side
• H90.A31 – Mixed conductive and sensorineural hearing loss, unilateral, right ear, with restricted hearing on the contralateral side
• H90.A32 – Mixed conductive and sensorineural hearing loss, unilateral, left ear, with restricted hearing on the contralateral side.

 “Currently, in the 2016 edition of ICD-10, there are only options for unilateral conductive, sensorineural, or mixed conductive hearing loss with unrestricted hearing on the contralateral side,” explains Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, vice president at Stark Coding & Consulting, LLC, in Shrewsbury, N.J. “Unlisted hearing loss codes have been needed to define hearing loss on both sides. With this change in 2017, there will be codes for patients with hearing loss on both sides.”

Refresher: According to the American Academy of Otolaryngology, there are two types of hearing loss. Conductive hearing loss results from what is basically a mechanical problem with sound wave conduction. Sensorineural hearing loss is due to a problem generating or transmitting nerve impulses from the inner ear to the brain. When a patient has a combination of these two types of hearing loss, it’s known as “mixed.”

Another condition affecting a patient’s hearing is tinnitus – the sensation of hearing ringing, buzzing, chirping, whistling, clicking, or other noises when no external sound is present. In pulsatile tinnitus, the patient hears a noise resembling his heartbeat in his ear. It can be caused by noise from blood vessels close to the inner ear.

ICD-10 2017 will introduce four new diagnoses specific to pulsatile tinnitus:

• H93.A1 – Pulsatile tinnitus, right ear
• H93.A2 – Pulsatile tinnitus, left ear
• H93.A3 – Pulsatile tinnitus, bilateral
• H93.A9 – Pulsatile tinnitus, unspecified ear.

“This will force the physicians to diagnose tinnitus with more detail, delineating between regular ringing and buzzing from pulsing,” Cobuzzi says. “Once again, this will require more documentation.”

Make These Changes to Ear Hemorrhage/Hematoma Codes

The original version of ICD-10 has two codes representing postprocedural hemorrhage and hematoma of the ear and mastoid process. Now these codes will be revised and others will be added so that you have separate codes for hemorrhage versus hematoma.

• H95.41 (Postprocedural hemorrhage and hematoma of ear and mastoid process following a procedure on the ear and mastoid process) will delete “and hematoma” so that it only represents hemorrhage
• H95.42 (Postprocedural hemorrhage and hematoma of ear and mastoid process following other procedure) will follow the same process, deleting “and hematoma”
• New codes H95.51 (Postprocedural hematoma of ear and mastoid process following a procedure on the ear and mastoid process) and H95.52 (Postprocedural hematoma of ear and mastoid process following other procedure) will be stand-alone diagnoses for postprocedural hematoma in these situations.

Pay attention: These code updates are another example of how providers will need to be more specific in their documentation regarding what the complications are – hematoma or hemorrhage. Every bit of documentation your physician provides helps you choose the most accurate diagnosis for each patient’s situation.