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Experience. Integrity. Advocacy.

Coding for Nervous System Diagnoses – Chapter 8: Diseases of the Ear and Mastoid Process – PART 4

Chapter 8 is also a new chapter in ICD-10-CM and includes conditions previously found in the Nervous System and Sense Organs chapter of ICD-9-CM.

In Chapter 8 of ICD-10-CM, the classification of diseases and conditions of the ear and mastoid process is organized by anatomic site, starting with diseases of the external ear, followed by diseases of the middle ear, and then the diseases of the inner ear. There is a new block of codes at the end of the chapter devoted to classifying intraoperative and postprocedural complications of treatment by specific body system as opposed to being found throughout the entire chapter.

Current documentation requirements include identifying the acuity of the disease as either acute or chronic, specifying the site, the etiology, and any secondary disease process. ICD-10-CM now includes greater specificity regarding the type and cause of the ear disorder, for instance external, middle, or inner ear, or whether the condition was caused by injury or complication of a surgery. In addition, most codes will require the provider to document right, left, or bilateral in the patients’ medical record. Medical record documentation will need to clearly specify cause-and-effect relationship between medical treatment and an ear disorder and also specify whether the complication occurred in the intraoperative period or the postprocedural period.

Several new instruction notes have been added to this chapter. While there are no chapter-specific guidelines for the ear and mastoid process there are instructional notes throughout the chapter to guide proper code assignment. The note at the beginning of the chapter, for instance, instructs coders to use an external cause code following the code for the ear condition, if applicable, to identify the cause of the ear condition.

Another example is the note that addresses otitis media categories H65, H66: “Use additional code for any associated perforated tympanic membrane (H72.-)” and “Use additional code to identify: Exposure to environmental tobacco smoke (Z77.22), Exposure to tobacco smoke in the perinatal period (P96.81), History of tobacco use (Z87.891), Occupational exposure to environmental tobacco smoke (Z57.31), Tobacco dependence (F17.-), Tobacco use (Z72.0).”

Notes directing the coder to first code the underlying disease also have been added. For example, the category for perforation of the tympanic membrane includes a note instructing coders to code first any associated otitis media. It will be imperative for coders to develop a working knowledge of the anatomy and physiology of the ear and mastoid process in order to achieve correct code assignment.

As we have mentioned throughout this series, ICD-10-CM includes new, updated, and more specific terminology, so understanding the terminology and generating a more detailed documentation of the patient’s condition will be vital. Moving forward into ICD-10-CM, there are specific diseases and disorders–like those for the eye and adnexa and for the ear and mastoid process as we have been discussing–that require greater detail in the medical record to ensure optimal code assignment.

Coding for Nervous System Diagnoses – ICD-10-CM Compared to ICD-9-CM – PART 1, Coding for Nervous System Diagnoses – Chapter 6: Diseases of the Nervous System – PART 2, and Coding for Nervous System Diagnoses – Chapter 7: Diseases of the Eye and Adnexa – PART 3, also are available for your review.

For more ICD-10 articles, please visit our ICD-10 Updates page.

— Compiled by former CIPROMS ICD-10 Coordinator, Angela Hickman, CPC, CEDC, AHIMA-Approved ICD-10 CM/PCS Trainer, AHIMA Ambassador. All rights reserved. For use or reprint in your blog, website, or publication, please contact us at cipromsmarketing@ciproms.com.

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