Otolaryngology Coding Alert

Question: I’m trying to determine what the correct ICD-10 code would be for 385.83 (Retained foreign body of middle ear). If I do a crosswalk from ICD-9 to ICD-10, it takes me to H74.8X9 (Other specified disorders of middle ear and mastoid, unspecified ear). But, if I look in the index under “Retained,” it says to also see “Retention.” Looking at “Retention foreign body” sends me to “see also Foreign body, retained.” When I go to “Foreign body, retained,” there is no code for in the ear. If I go to “Retained foreign body fragments, plastic” it says Z18.2 (Retained plastic fragments). Our practice places a lot of ear tubes and I want to be sure I am educating our providers correctly. Can you please help me?

Oklahoma Subscriber 

Answer: You have several correct ICD-10 code choices: 

• H74.8X1 – Other specified disorders of right middle ear and mastoid

• H74.8X2 – Other specified disorders of left middle ear and mastoid

• H74.8X3 – Other specified disorders of middle ear and mastoid, bilateral

• H74.8X9 – Other specified disorders of middle ear and mastoid, unspecified.

As you can see, the codes specify the right, left, bilateral, or unspecified ear. You must be careful of crosswalks because they sometimes bring you to just the “unspecified” ear code and you need to check whether there is an expansion defining more specificity. 

All three ICD-9 codes 385.82 (Cholesterin granuloma of middle ear), 385.83 (Retained foreign body of middle ear), and 385.89 (Other disorders of middle ear and mastoid) should crosswalk to these ICD-10 codes.

Interestingly, the GEMs are incorrect and do not crosswalk the right, left, and bilateral ear to 385.83. However, there is no reason that you should not use H748X1 instead of an “unlisted” code if you have documentation of the right ear being affected. The code definition is “other specified disorders of the right ear,” and the retained ear tube is a specified disorder.