ICD-10 Challenge

In this forum thread feel free to post your comments and areas for discussion that you may have based on the weekly auditing and compliance tips from NAMAS.

Moderators: Shannon DeConda, NAMAS Moderator

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Vonnie
Posts: 3
Joined: Wed Nov 05, 2014 10:05 am

Fri Mar 27, 2015 9:24 am

I would use H90.5 for hearing loss, as documented, and H66.90 for the ear infection, as documented.
maryanne
Posts: 11
Joined: Fri Mar 20, 2015 10:49 am

Mon Mar 30, 2015 12:28 pm

Hi there,

There is really not enough documentation and I would query the provider, however, given the information that is provided:

1) H90.12 is for conductive hearing loss of the left ear. We don't know that the hearing loss is conductive, or sensorineural, or mixed, nor do we know which ear - right, left, bilateral??? Unspecified hearing loss is coded as H91.9-- and in this case you would have to use H91.90 for unspecified ear.

2) H66.9 for the infection is missing a digit - again in this case we would have to use 0 = H66.90 unspecified ear. When you look up straight "otitis" in the alpha index (because we don't know if it is media, externa, or inner) this is the code that you are directed to.

I would definitely query the provider and ask that he/she work on documenting with more specificity (and laterality) because I think there are better codes that could be used rather than the unspecified.

Hope I got this right!!! :D
Shannon DeConda
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Location: Melbourne, FL
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Wed Apr 08, 2015 12:13 pm

From the 3-27-2015 ICD-Challenge in the Members Only Weekly TIp

Audit the following scenario for proper ICD-10 coding:
Ginger came in to see the audiologist for an updated hearing test due to her hearing loss. While here, she also noted ear discomfort and was treated for ear infection by the physician.
The practice used the following ICD-10 diagnoses on the claim, and based on ONLY the information noted above, are these codes supported?
Hearing loss H90.12
Ear Infection H66.9
Audit these codes and post your thoughts/comments to the forum. Come back to the forum next week for the rationale.

RATIONALE:
H90.12 is an ICD-10 code for hearing loss, however, this code specifically identifies the type of hearing loss demonstrated by the patient as well as the affected ear and effect on the other ear. The scenario did not represent these specifics. So the correct code would be H91.90.
H66.9 does not include the additional 5th character required to identify the ear(s) involved

While we did not provide the entire encounter for auditing purposes which have better demonstrated these additional points, we do note that this scenario is indicative of how many records are currently being created. As noted, these codes would not be supported during the audit process as we do not have the documentation to adequately support each.
Thank you,
Shannon O. DeConda, CPC, CPC-I, CEMC, CMSCS, CPMA, CMPM, CPMN
Founder & President of NAMAS

Disclaimer: NAMAS cannot be held liable for any advice given that could have had a variable answer based on additional information.
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