Otolaryngology Coding Alert

These ENT-specific scenarios will help you gauge your knowledge.

You’ve been reporting ICD-10 codes for over a year now, and your success rate probably grows with each claim. To ensure that you’ve got a handle on the correct diagnosis codes to report, take this short quiz, and then check your answers to ensure you’ve coded properly.

Get the Scoop on Tonsillitis Coding

Question: Which diagnosis code should you report for acute tonsillitis?

Answer: Acute tonsillitis might be one of the most common diagnoses your otolaryngologist assigns, and one of the easiest for you to code. Although you only had one code to consider under ICD-10, you’ve had to expand your horizons since ICD-10 wants to know the type of the patient’s tonsillitis.

The fourth character in your tonsillitis code will identify the organism and the fifth will indicate whether the patient’s condition is acute or recurrent, as follows:

• J03.0 –  Streptococcal tonsillitis

             J03.00 – Acute streptococcal tonsillitis, unspecified
             J03.01 – Acute recurrent streptococcal tonsillitis

•  J03.8 – Acute tonsillitis due to other specified organisms

             J03.80 – Acute tonsillitis due to other specified organisms
             J03.81 – Acute recurrent tonsillitis due to other specified organisms

• J03.9 – Acute tonsillitis, unspecified (which includes follicular tonsillitis [acute], gangrenous tonsillitis [acute], infective tonsillitis [acute], tonsillitis [acute] NOS, and ulcerative tonsillitis [acute])•J03.90 – Acute tonsillitis, unspecified

             J03.91 – Acute recurrent tonsillitis, unspecified.

A patient that has acute tonsillitis that is not recurrent is assigned an “unspecified” diagnosis. This does not mean that the diagnosis is truly unspecified in these cases. This “unspecified” diagnosis actually means that the patient’s acute tonsillitis is not mentioned as recurrent. Payers should not penalize providers for using these “unspecified” diagnoses since there are no other alternatives available.

Extract Appropriate Cerumen Impaction Dx

Question: How do you report impacted cerumen?

Answer: 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.

You’ll want to report the “unspecified ear” code H61.20 as seldom as possible. The reality is that your physician should be documenting the affected ear for every patient and the “unspecified ear” diagnosis should not ever be used.

Evaluate the Hearing Loss Options

Question: Which code should you report for mixed hearing loss?

Answer: Last year, ICD-10 debuted new codes for mixed hearing loss, as the original iteration of ICD-10 did not include them, and coders were forced to report unspecified codes.

The correct codes for mixed hearing loss are in the H90.A3 category (Mixed conductive and sensorineural hearing loss, unilateral with restricted hearing on the contralateral side). To identify the affected ear, you’ll select a sixth character as follows:

• 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.