Pick Other, Unspecified Otosclerosis Codes Confidently
Question: What is the difference between H80.8- and H80.9-? Revenue Cycle Insider Subscriber Answer: Code families that use “unspecified” and “other” codes can be confusing when you’re trying to pick the most accurate code from the medical record; otosclerosis is one of those families. When you turn to the H80.- (Otosclerosis) codes, you see the following code subdivisions: Conditions coded to H80.0- and H80.1- are specific diagnoses of fenestral otosclerosis, with H80.1- referring to the severest form of the condition where the bone has completely covered over the stapes footplate. H80.2- is another specific diagnosis that describes a form of the condition where lesions form in the bony capsule surrounding the cochlear rather than near the oval window. If your provider has documented one of these in the medical record, then that would be the correct code choice. However, if your provider has definitively documented that the patient has a form of otosclerosis that is not described by H80.0-, H80.1-, or H80.2-, such as mixed otosclerosis, you will use the “other” code, H80.8-. Per ICD-10-CM Guideline I.A.9: “Codes titled ‘other’ or ‘other specified’ are for use when the information in the medical record provides detail for which a specific code does not exist.... These Alphabetic Index entries represent specific disease entities for which no specific code exists, so the term is included within an ‘other’ code.” But when your provider does not specify the type of otosclerosis, or the information in the medical record is insufficient to assign a more specific otosclerosis code, you’ll use H80.9-. Again, per ICD-10-CM Guideline I.B.18: “When sufficient clinical information isn’t known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate ‘unspecified’ code (e.g., a diagnosis of pneumonia has been determined, but not the specific type). Unspecified codes should be reported when they are the codes that most accurately reflect what is known about the patient’s condition at the time of that particular encounter.” Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
