Otolaryngology Coding Alert

‘Bilateral’ addition will be only difference in new codes.  

“Otosclerosis” is the term for an abnormal bone growth in the middle ear that causes hearing loss because the eardrum can’t vibrate in response to sound waves. 

ICD-9 has several diagnosis codes for otosclerosis, all in code family 387.x (Otosclerosis). The complete codes are: 

• 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. 

Coding guidelines direct you to also report a diagnosis for the cause of the ear condition, if applicable. 

ICD-10 changes: When ICD-10 becomes effective on Oct. 1, 2015, you’ll have the same descriptors, except for one change. Each new diagnosis includes “bilateral” to denote the presence of otosclerosis in both ears. 

• H80.00 - Otosclerosis involving oval window, nonobliterative, unspecified ear
• H80.01 - Otosclerosis involving oval window, nonobliterative, right ear
• H80.02 - Otosclerosis involving oval window, nonobliterative, left ear
• H80.03 – Otosclerosis involving oval window, nonobliterative, bilateral 
• H80.10 - Otosclerosis involving oval window, obliterative, unspecified ear
• H80.11 - Otosclerosis involving oval window, obliterative, right ear
• H80.12 - Otosclerosis involving oval window, obliterative, left ear
• H80.13 – Otosclerosis involving oval window, obliterative, bilateral 
• H80.20 - Cochlear otosclerosis, unspecified ear
• H20.21 - Cochlear otosclerosis, right ear
• H20.22 - Cochlear otosclerosis, left ear
• H80.23 – Cochlear otosclerosis, bilateral 
• H80.80 - Other otosclerosis, unspecified ear
• H80.81 - Other otosclerosis, right ear
• H80.82 - Other otosclerosis, left ear
• H80.83 – Other otosclerosis, bilateral 
• H80.90 - Unspecified otosclerosis, unspecified ear
• H80.91 - Unspecified otosclerosis, right ear
• H80.92 - Unspecified otosclerosis, left ear
• H80.93 – Unspecified otosclerosis, bilateral.

Documentation: ENTs typically perform audiometry testing to diagnose otosclerosis since it reveals the extent of hearing loss and identifies conductive hearing loss. Nevertheless, variable degrees of hearing loss may require thorough testing. For instance, patients reporting balance disturbances may require vestibular testing. A CT scan could help in assessing the condition of the ossicles, cochlea, and vestibular organs and in distinguishing otosclerosis from other causes of hearing loss. 

Important: Make sure your physicians and audiologists document the specific ear effected so that you’re able to select the right correct codes. Once ICD-10 is in effect, payers might reject coding which represent “unspecified ear” since it is not difficult to determine the diseased ear(s)

Coder tips: Medicare and some other insurers pay for certain prosthetic devices that produce the perception of sound by replacing the functions of the middle ear, cochlea, or auditory nerve. However, your documentation should indicate that using hearing aids are medically inappropriate, or cannot be utilized because of congenital malformations, chronic disease, severe sensorineural hearing loss or surgery. The following are considered prosthetic devices:

• cochlear implants
• auditory brainstem implants
• osseointegrated implants.