Otolaryngology Coding Alert

You’ll need better documentation of anatomic location to choose the correct diagnosis.

Otosclerosis is a condition characterized by an abnormal, sponge-like bone growth in the middle ear that causes hearing loss. Your current diagnosis code choices are based on a few details regarding where the growth is found, but ICD-10 will bring many more options in October 2014.

ICD-9 Coding Choices

The base code for otosclerosis (387.x) is extended to a fourth digit, but the descriptors are still rather basic:

• 387.0 — Otosclerosis involving oval window, nonobliterative
• 387.1 — Otosclerosis involving oval window, obliterative
• 387.2 — Cochlear otosclerosis
• 387.8 — Other otosclerosis
• 387.9 — Otosclerosis unspecified.

ICD-10 Changes

You’ll have more choices for each code under ICD-10, which means your diagnosis assignment will be more accurate. The parent diagnoses for each type of condition will be:

• H80.0x — Otosclerosis involving oval window, nonobliterative
• H80.1x — Otosclerosis involving oval window, obliterative
• H80.2x — Cochlear otosclerosis
• H80.8x — Other otosclerosis
• H80.9x — Otosclerosis unspecified.

Each parent code will have four associated fifth-digit extensions (represented by the x above):

0 = unspecified ear

1 = right ear

2 = left ear

3 = bilateral.

Example: The entire code family for cochlear otosclerosis will be as follows:

• H80.20 — Cochlear otosclerosis, unspecified ear
• H80.21 — Cochlear otosclerosis, right ear
• H80.22 — Cochlear otosclerosis, left ear
• H80.23 — Cochlear otosclerosis, bilateral.

Providers will need to be much more detailed with their documentation of otosclerosis under ICD-10 because of the code designations for the exact anatomic site and which ear(s) is affected. Otherwise, you’ll resort to assigning H80.90 (Otosclerosis, unspecified; unspecified) on a regular basis. The more information your claim can include, however, the easier it will be to justify services to the payer.

Example: Medicare and some other payers reimburse for certain prosthetic devices that produce the perception of sound by replacing the functions of the middle ear, cochlea, or auditory nerve. Before your physician can hope to gain payer approval for any of these devices (such as cochlear implants, auditory brainstem implants, or osseointegrated implants), he must show that using hearing aids won’t help the patient’s condition. Having clear documentation of conditions such as otosclerosis can help show that hearing aids are medically inappropriate for the patient – and that more extensive treatment is the patient’s best alternative.