In my opinion, it should be counted as two for several reasons. Although the diagnosis is the same, it's two different anatomical sites (left ear/right ear, left breast/right breast). Even if it's the same BA, think about coding for procedures. Certain modifiers exist so that payment can be made for the same procedure on separate sides. The condition may currently exist on each side, but one side may be worse than the other, one may improve or be cured, and so on. Treatment could be given to only one side in a particular visit. A great example of this is cataracts. Also, one of the main improvements with the I-10 is the ability to code so specifically, including laterality. Then you should also consider CPT codes. Some don't allow 50 mods or LT/RT because the side is specified within the code description. In order to append the appropriate DX to such a code, you would need to view them separately. Better yet, think about if a person breaks both of their arms in the exact same place in the exact same way. It's the same general idea; they're both broken, in the same location, in exactly the same way, but that would never be coded as one diagnosis, if that makes sense. Ultimately, it's just by chance that a condition may exist on both the left and right side.