Otolaryngology Coding Alert

Your diagnosis choices will expand in October. 

Congenital midline nasal masses are rare malformations, but ENT coders should still know what they are and how to report them. 

These masses can include nasal gliomas, nasal dermoid cysts, and nasal encephaloceles. Gliomas in the nasal region generally present at birth as nasal masses. They are usually firm, noncompressible masses, purple or gray in color, and are sometimes covered with telangiectasias. 

ICD-9 coding rules: Under ICD-9, you currently report 748.1 (Other congenital anomalies of nose) for patients diagnosed with nasal gliomas. Other applicable terms for the diagnosis include:

• Absent nose
• Accessory nose
• Cleft nose
• Deformity of wall of nasal sinus
• Congenital (deformity of nose, notching of tip of nose, perforation of wall of nasal sinus).

ICD-10 changes: Effective Oct. 1, 2015, you’ll refrain from using an “umbrella” code for other congenital anomalies of nose such as nasal glioma. Instead, when reporting this condition under ICD-10-CM, you’ll choose from three expanded codes:

• Q30.1 – Agenesis and underdevelopment of nose
• Q30.2 – Fissured, notched and cleft nose
• Q30.8 – Other congenital malformations of nose.

Documentation: Your physician’s documentation should include the duration and degree of symptoms related to nasal obstruction (e.g., chronic rhinosinusitis and mouth breathing). The physician should also note the results of conservative management of these symptoms. Additionally, your documentation should contain results of imaging tests, such as nasal endoscopy and CT, verifying the degree of nasal obstruction. 

Coder tips: When coding for nasal deformities or anomalies, make sure the medical record notes if the deformity is acquired or congenital. Look at M95.0 (Acquired deformity of nose) when the deformity is acquired, or if the note indicates an overdevelopment of nasal bones. On the other hand, code Q30.1, Q30.2 or Q30.8 for congenital deformity.