Otolaryngology Coding Alert

From A codes to Z, we’ve got the ICD-10 answers you need to ensure quick claims payment.

Whether you consider yourself an ICD-10 novice or an expert, it’s always a good idea to brush up on your diagnosis coding skills. Determine whether you can code the following ENT scenarios—then check the answers to find out how you fared.

Can You Report Screenings Accurately?

Question: A patient presented to our ENT practice after he failed a school hearing test, but our otolaryngologist determined that the child’s hearing was actually perfect. Which diagnosis code should we assign to the testing code?

Answer: The correct diagnosis code in this situation is Z01.110 (Encounter for hearing examination following failed hearing screening). The screening code indicates that the ENT evaluated the patient for the hearing exam following a failed test, but does not brand the patient with a hearing problem as a more definitive diagnosis would do.

Do You Know the Post-Procedural Codes?

Question: A patient came to the office with a post-tonsillectomy hemorrhage. Should we apply the tonsillitis diagnosis to it? Or is there an aftercare code that fits more appropriately?

Answer: Neither of those will work in this situation. Instead, since tonsillitis is coded to the respiratory system, the correct code choice is J95.830 (Postprocedural hemorrhage and hematoma of a respiratory system organ or structure following a respiratory system procedure). This is more accurate than using a tonsillitis code, since the patient no longer has tonsillitis.

Understand the Rule Out Rules

Question: We have a new physician who always uses “rule out” diagnoses on his claims when the patient is found not to have anything wrong with them. I know we couldn’t do this under ICD-9, but is this valid under ICD-10?

Answer: You should not code a disease or condition unless the otolaryngologist makes a definitive diagnosis. If the physician performs tests to rule out a diagnosis and the diagnosis is not established when you submit the claim, you should only code the chief complaint, or signs and symptoms related to the ‘rule out’ or ‘possible’ diagnosis.

For instance, suppose a patient presents with a sore throat and swollen glands.  The doctor suspects chronic laryngitis and based on the history and examination the otolaryngologist decides to perform a flexible laryngoscopy confirm the laryngitis and to rule out a laryngeal neoplasm, but the scope shows no abnormalities.

You would report the office visit (99201-99205, Office or other outpatient visit for the evaluation and management of a new patient ...; appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) and the flexible laryngoscopy (31575, Laryngoscopy, flexible fiberoptic; diagnostic). Link both the E/M to the patient’s complaints of sore throat (R07.0) and swollen glands (R59.0) and the procedure to the chief complaint, chronic laryngitis (J37.0), not to the rule out diagnosis of neoplasm (such as D49.1 Neoplasm of unspecified behavior of respiratory system).

Nail Down Tonsillitis Type

Question: A patient presented with acute tonsillitis. How should I report this?

Answer: Although ICD-9 had one common choice for this condition (463, Acute tonsillitis), that’s not the case under ICD-10, and you’ll need to specify a few more details before you can determine the right code. Determine the organism and whether the patient’s condition is acute or recurrent.

The complete range of diagnoses for acute tonsillitis offers the following options:

• J03.0 – Streptococcal tonsillitis

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

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

        o J03.80 – Acute tonsillitis due to other specified organisms
        o 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]).

        o J03.90 – Acute tonsillitis, unspecified
        o J03.91 – Acute recurrent tonsillitis, unspecified.

For example, suppose your ENT sees a patient with acute tonsillitis. The patient had a bout with the same acute condition six months ago, making this the second occurrence in six months. In this situation, you’ll report J03.91 (Acute recurrent tonsillitis, unspecified).