ICD-10-CM Coding Chapter 8: Diseases of the Ear and Mastoid Process

1. Basic ICD-10-CM/PCS Coding2013 Edition Chapter 11: Diseases of the Ear and Mastoid Process (H60–H95)

2. Learning Objectives • Review the chapter’s learning objectives and key terms • At the conclusion of this chapter, what must you know about the coding of diseases of the ear and mastoid process?

3. ICD-10-CM Chapter 8: Diseases of Ear and Mastoid Process (H60–H95) Chapter 8 of ICD-10-CM includes categories arranged in the following blocks: H60–H62 Diseases of external ear H65–H75 Diseases of middle ear and mastoid H80–H83 Diseases of inner ear H90–H94 Other disorders of ear H95 Intraoperative and postprocedural complications and disorders of ear and mastoid process NEC

4. ICD-10-CM Chapter 8: Diseases of Ear and Mastoid Process (H60-H95) Codes have greater specificity at the 4th, 5th, and 6th character level Includes laterality for the right, left, bilateral and unspecified sides of the body Includes notes to “code first underlying disease”

5. Coding Guidelines for ICD-10-CM Chapter 8 NCHS has not published chapter-specific guidelines for Chapter 8 in the 2013 version of the ICD-10-CM Official Guidelines for Coding and Reporting

6. Coding Instructional Notes for ICD-10-CM Chapter 8 At start of Chapter 8, there is a note to use an external cause code following the code for the ear condition, if applicable, to identify the cause of the ear condition.

7. Coding Instructional Notes for ICD-10-CM Chapter 8 An Excludes2 note includes a series of excluded conditions that are applicable to all conditions classified to Chapter 8. For example, certain conditions originating in the perinatal period of the first 28 days of life is coded to Chapter 16 of ICD-10-CM and certain infectious and parasitic diseases are coded to Chapter 1 instead of using Chapter 8 codes for diseases of the ear and mastoid process.

8. Coding Instructional Notes for ICD-10-CM Chapter 8 An instructional note appears at category H72, Perforation of tympanic membrane, to recognize the importance of coding first the associated otitis media with the diagnosis of perforation of the tympanic membrane. The Excludes1 note explains that other conditions are not to be coded to category H72 as these excluded conditions cannot occur together.

9. Coding Instructional Notes for ICD-10-CM Chapter 8 Category H72, Perforation of tympanic membrane includes a “code first any associated otitis media” (H65-H67) Other notes state to use additional code to identify Exposure to environmental smoke or smoke in perinatal period, history of tobacco use, occupational exposure to environment tobacco smoke, tobacco dependence or tobacco use

10. Coding Instructional Notes for ICD-10-CM Chapter 8 There is an instructional note in categories H65, H66 and H67 to use an additional code for any associated perforated tympanic membrane (H72.-). The note reminds coders that two codes are required when a patient has both otitis media and perforated tympanic membrane.

11. Coding Instructional Notes for ICD-10-CM Chapter 8 Another instructional note is found under the category for suppurative and unspecified otitis media (H66.) The note states to use an additional code to identify: Exposure to environmental tobacco smoke Exposure to tobacco smoke in the perinatal period History of tobacco use Occupational exposure to environmental tobacco smoke Tobacco dependence Tobacco use

12. Coding Diseases of the Ear and Mastoid Process in Chapter 8 Diseases of External Ear External ear is the part of the ear consisting of the auricle and the auditory canal or the passage leading to the ear drum. Also known as the outer ear. Otitis externa, external otitis or swimmer’s ear is an infection of the external auditory canal Acute otitis externa: moderate to severe pain, fever, regional cellulitis and partial hearing loss Chronic otitis externa: pruritus, scaling and thickening of skin

13. Coding Diseases of the Ear and Mastoid Process in Chapter 8 Diseases of External Ear Codes exist for abscess, cellulitis and malignant otitis externa Other codes include diffuse otitis externa, hemorrhagic otitis externa, swimmer’s ear and other infective otitis with specific codes for unspecified, right, left and bilateral ears There are codes for otitis externa and other disorders of the external ear in diseases classified externa. These codes require the reporting of the underlying disease that has caused the external ear condition A code first note appears under each subcategory

14. Coding Diseases of the Ear and Mastoid Process in Chapter 8 Diseases of Middle Ear Otitis media is an inflammation of the middle ear The variations of these conditions include Acute suppurative otitis media Acute secretory or serous otitis media Chronic serous and mucoid otitis media Nonsuppurative otitis media Suppurative and unspecified otitis media Codes exist for the right, left, bilateral and unspecified ear

15. Coding Diseases of the Ear and Mastoid Process in Chapter 8 Diseases of Middle Ear Instructional notes appear with categories H65, H66, and H67 to use an additional code for any associated perforated tympanic membrane Another instructional note states to use an additional code to identify the use of or exposure to tobacco products

16. Coding Diseases of the Ear and Mastoid Process in Chapter 8 Eustachian Salpingitis and Obstruction Acute and chronic infection of the Eustachian tube as well as obstruction of the Eustachian tube Salpingitis is the inflammation of a tubular site, such as a fallopian tube in the female reproductive tract as well as the Eustachian tube in the middle ear

17. Coding Diseases of the Ear and Mastoid Process in Chapter 8 Mastoiditis and Related Conditions Code identifies acute and chronic mastoiditis, petrositis and other related conditions Codes for right, left, bilateral and unspecified ears included Mastoiditis includes all inflammatory processes of the mastoid air cells of the temporal bone The mastoid bone is an extension of the middle ear cleft

18. Coding Diseases of the Ear and Mastoid Process in Chapter 8 Mastoiditis and Related Conditions Acute mastoiditis is present with acute otitis media and in some patients the infection spread and patients develop osteitis or periosteitis of the mastoid process. Chronic mastoiditis occurs with chronic suppurative otitis media and with cholesteatoma formation. Cholesteatomas are growths in the lining of the middle ear that invades and changes the normal structure and function of surrounding soft tissue and bone.

19. Coding Diseases of the Ear and Mastoid Process in Chapter 8 Mastoiditis and Related Conditions The most common organisms causing surgical mastoiditis is Streptococcus pneumoniae, Haemophilus influenzae and group A Streptococcus pyogenes. Gram negative organisms and Staphylococcus aureus are the organisms that develop more frequently in patients with chronic mastoiditis In children, Streptococcus pneumoniae and Pseudomonas aeruginosa causes acute mastoiditis

20. Coding Diseases of the Ear and Mastoid Process in Chapter 8 Perforation of Tympanic Membrane A perforated or ruptured tympanic membrane can occur at the same time as acute and chronic middle ear infections. Includes note states persistent posttraumatic perforation and postinflammatory perforation of the ear drum are included in these codes. There is a code first any associated otitis media with codes for perforation of tympanic membrane to acknowledge that the otitis media is the cause of the perforation in many patients.

21. Coding Diseases of the Ear and Mastoid Process in Chapter 8 Diseases of the inner ear include Otosclerosis Disorders of vestibular function such as Meniere’s disease Different types of vertigo

22. Coding Diseases of the Ear and Mastoid Process in Chapter 8 Otosclerosis is the growth of spongy bone in the inner ear where it causes obstruction. It causes slowly progressive conductive hearing loss. Condition affects 10 percent of the white population and is more likely to occur in women Frequency is decreasing due to measles vaccination Pregnancy and estrogen therapy is suspected to increase the progression of otosclerosis

23. Coding Diseases of the Ear and Mastoid Process in Chapter 8 Meniere’s disease is a disorder of the inner ear also known as idiopathic endolymphatic and labyrinthine hydrops. Hydrops increases pressure within the inner ear lymphatic system. Excess pressure causes fluctuating hearing loss, vertigo, tinnitus, and pressure or fullness sensation in the ears. Cause of Meniere’s disease is unknown. Codes include right, left, bilateral, or unspecified ears.

24. Coding Diseases of the Ear and Mastoid Process in Chapter 8 Benign paroxysmal vertigo (BPV) is a common type of vertigo Vertigo is a feeling of a person’s surroundings that seem to whirl around them. Dizziness is not the same as vertigo as dizziness is a sensation of unsteadiness accompanied by a feeling of movement within the head.

25. Coding Diseases of the Ear and Mastoid Process in Chapter 8 Classic BPV is usually triggered by sitting up quickly from a supine position with a sudden onset. The symptoms resolve quickly but can occur again when the patient moves to a sitting position. It occurs more commonly in women over the age 60. Persons at risk for BPV are persons who are inactive due to illness and who have central nervous system and ear diseases. It is also common in patients with acute alcoholism.

26. Coding Diseases of the Ear and Mastoid Process in Chapter 8 Conductive hearing loss is the decreased ability to hear sounds because of a defect of the sound-conducting apparatus of the ear. The condition can occur in one ear or it can be a bilateral hearing loss. Sensorineural hearing loss is the decreased ability to hear sounds due to a defect in the sensory mechanisms within the ear or the nerves in the ear. It may be described as sensory, neural or central hearing loss.

27. Coding Diseases of the Ear and Mastoid Process in Chapter 8 Specific codes exist for unilateral mixed conductive and sensorineural hearing loss and bilateral mixed hearing loss. Deaf nonspeaking or deafmutism is a condition when a patient has the absence of both hearing and the faculties of speech.

28. Coding Diseases of the Ear and Mastoid Process in Chapter 8 Intraoperative and postprocedural complications and disorders of the ear and mastoid process include Recurrent cholesteatoma of postmastoidectomy cavity Intraoperative hemorrhage and hematoma of ear and mastoid process complicating the ear and mastoid process Accidental puncture and laceration or postprocedural hemorrhage and hematoma of ear and mastoid process during a procedure on the ear and mastoid process Postprocedural stenosis of external ear canal

29. ICD-10-PCS Procedure Coding for Chapter 8 Procedures on the ear, nose, and sinus ICD-10-PCS codes in the table 090–09W with root operations Alteration, Bypass, Change Destruction, Dilation, Division, Drainage Excision, Extirpation, Extraction, Insertion, Inspection Reattachment, Release, Removal, Repair, Replacement Reposition, Resection, Supplement and Revision Coder must apply the definition of the ICD-10-PCS root operations to code the procedures according to the primary objective of the procedure

30. ICD-10-PCS Procedure Coding for Chapter 8 Rhinoplasty is performed for a variety of objectives Alteration Repair Replacement Supplement

31. ICD-10-PCS Procedure Coding for Chapter 8 Ethmoidectomy, myringectomy, sinusotomy, stapedectomy and turbinectomy is performed for two objectives Excision for cutting out or off a portion of the body part Resection for cutting out or off all of a body part

32. ICD-10-PCS Procedure Coding for Chapter 8 Otoplasty, septoplasty and turbinoplasty is performed for a variety of objectives Repair Replacement Reposition Supplement

33. ICD-10-PCS Procedure Coding for Chapter 8 Otoscopy, rhinoscopy and sinusoscopy may be performed without an accompanying surgical procedure through the scope. When the procedure is strictly an examination it is coded with the root operation of “inspection”

34. ICD-10-PCS Procedure Coding for Chapter 8 Myringotomy or turbinotomy are procedures performed to drain or destroy a lesion with the root operations of Drainage Destruction Removal of a foreign body is a common procedure performed on the ear with the root operation of extirpation

35. Exercises Practice coding the conditions included in Chapter 8 of ICD-10-CM for diseases of the ear and mastoid as well as the procedures used to treat these conditions by completing the review exercises for Chapter 11.