Primary Care Coding Alert

ICD-10 will introduce 4 new options.

Otalgia is one of the most common complaints in a family physician’s office, so being prepared for changes under ICD-10 will help you keep submitting painless claims. 

Definition: In everyday terms, otalgia refers to an earache. Younger patients often indicate earache by tugging on their ears; older patients come to your office complaining of ear pain. Physicians often report otalgia diagnoses when patients complain of ear pain but no more definitive diagnosis is found.

ICD-9 to ICD-10: Currently, you should report 388.70 (Otalgia, unspecified) for otalgia. However, that will change when ICD-10 goes into effect in October 2014. At that point, you’ll have four options:

• H92.01 (Otalgia, right ear)
• H92.02 (Otalgia, left ear)
• H92.03 (Otalgia, bilateral)
• H92.09 (Otalgia, unspecified ear).

Anatomical location is what differentiates the diagnoses from each other. 

Documentation: Physicians should already include the affected ear in their documentation. All you need to do as a coder to capture this already present information is to format your superbill to ensure that physicians document the additional anatomical information (i.e. right, left, or both).

Tip: You can organize your superbill in a way that ensures that the physician documents all information applicable for you to submit the most accurate diagnosis code. For instance, you can print it like this:

H92.0x (x=1 for right ear, x=2 for left ear, x=3 for bilateral, and x=9 for unspecified ear)

Or you can simply list “H92.0x” and have the physician circle “left ear,” “right ear,” or “bilateral” on the form.