Otolaryngology Coding Alert

Prep now to hit the ground running on Oct. 1, 2024.

The Centers for Medicare & Medicaid Services (CMS) unveiled the 2025 ICD-10 changes on July 9, 2024. The changes include 252 codes added, 36 existing codes deleted, and 13 code revisions.

Unlike some prior years, the changes for otolaryngologists aren’t so vast that they’ll cause headaches at your ENT practice. However, it’s still important to stay up to date and get all of your systems into place so you won’t face denials by reporting outdated codes.

Here’s an overview of key changes you should be familiar with come October. So, if you’ve been confused about how to report internal nasal valve collapse, or conditions indirectly related to otolaryngology, such as Fanconi anemia or obesity, the latest updates to the ICD-10 code set have you covered. “This is an improvement for reporting patient care, as otolaryngologists have been relegated to using J34.89 (Other specified disorders of nose and nasal sinuses), which is used for so many other nasal and sinus problems as a catchall ICD-10 code. Now, otolaryngology practices will have very specific ICD-10 codes to use for nasal valve collapse, which is an improvement for reporting patient care,” Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, CMCS, of CRN Healthcare Solutions of Tinton Falls, New Jersey believes.

Navigate New Nasal Valve Collapse Options

ICD-10 2025 introduces 10 new codes to identify nasal valve collapses that your otolaryngologist addresses. This describes a narrowing or weakness affecting the patient’s external or internal nasal valve. In some cases, patients will experience collapse both internally and externally.

The new codes are:

• J34.82.- (Nasal valve collapse)
• J34.820.- (Internal nasal valve collapse)
• J34.8200 (Internal nasal valve collapse, unspecified)
• J34.8201 (Internal nasal valve collapse, static)
• J34.8202 (Internal nasal valve collapse, dynamic)
• J34.821.- (External nasal valve collapse)
• J34.8210 (External nasal valve collapse, unspecified)
• J34.8211 (External nasal valve collapse, static)
• J34.8212 (External nasal valve collapse, dynamic)
• J34.829 (Nasal valve collapse, unspecified)

According to notes from the September 2023 ICD-10 Coordination and Maintenance Committee meeting, a static nasal valve collapse occurs due to the narrowing of the nose at rest when the angle between the patient’s lateral cartilage and nasal septum is small, reducing the area of the valve. The consistently narrowed airway causes scarring, inflamed tissue, and a natural deformity.

This is different from a dynamic nasal valve collapse, which occurs if the lateral nasal wall is pulled inward due to pressure when the patient inhales.

These coding updates make it more important than ever to ensure that ENT providers document the type of nasal valve collapse they see, so you and they can select the most accurate code. This means “coders are going to have to educate their otolaryngologists and stress that they include the additional detail in their notes, documenting whether a nasal valve collapse is internal or external and whether it is static or dynamic, so that their coding is not forced into the unspecified ICD-10 codes,” Cobuzzi notes.

Examine New Fanconi Anemia Code

Also joining the ICD-10 code set this year is a new code for Fanconi anemia. This genetic condition is known for causing short stature and bone marrow failure, but patients with it often experience hearing difficulties as well. While Fanconi anemia is rare, it should still be coded accurately, and that will happen effective Oct. 1, 2024, with the addition of new code D61.03 (Fanconi anemia).

During the March 2023 ICD-10 Coordination and Maintenance Committee meeting, stakeholders noted that a new code for this disorder “may facilitate appropriate Fanconi anemia treatment … and may also help in identification of patients for clinical trials evaluating potentially valuable treatment options,” according to the Committee meeting notes.

Zero in on Obesity Code Additions

Although otolaryngologists may not treat obesity specifically, it is common for ENT practices to see obese patients, and the obesity can add a complicating factor in treating the ENT problems. These patients may be more likely to experience ear, nose, and throat issues like sleep apnea, chronic tonsillitis, and sinusitis, one study found.

If you’ve ever looked for an obesity code, you’ve probably visited the E66.- (Overweight and obesity) section of ICD-10. But that section will soon expand, with the addition of the following six new codes for obesity:

• E66.8- (Other obesity)
• E66.81- (Obesity class)
• E66.811 (Obesity, class 1)
• E66.812 (Obesity, class 2)
• E66.813 (Obesity, class 3)
• E66.89 (Other obesity not elsewhere classified)

These new codes refer to “obesity class,” which allows for greater specificity in coding these conditions. The classes are organized using the following BMI parameters:

• Class 1 obesity: 30.0 to 34.9
• Class 2 obesity: 35.0 to 39.9
• Class 3 obesity: 40.0 and above

It’s a good idea to talk to your providers about these changes now, giving them some documentation tips that you can share before the new ICD-10 codes go into effect. For instance, if your ENTs are accustomed to documenting nasal valve collapse or obesity without any details, let them know that beginning Oct. 1, 2024, they and your team will now be able to select more accurate diagnosis codes than ever before, and failure to do so can lead to slowed or halted reimbursement. “If your physicians and advanced practice providers use dictation templates, they may want to change the templates and add the parameters included in the ICD-10 codes, so they can select the appropriate parameters to include in the documentation,” Cobuzzi suggests.

Resource: Visit the CMS website to read the entire list of new, deleted, and revised diagnosis codes.

Torrey Kim, Contributing Writer, Raleigh, N.C.