ICD-10 Physician Education
ENT
Training Objectives
• ICD-9 to ICD-10 Comparison
• Documentation Tips
• Additional Educational Opportunities
• Questions
2
ICD-9 to ICD-10 Comparison
What Will Change
Code
Structure
What Remains the Same
Up to 7 characters
DRGs
Alpha-numeric codes
CPT, HCPCS, E&M Codes
14,025 to 69,823
Reimbursement methodology
(awaiting finalization)
Diagnosis
Code Volume
Coders can only assign codes based
on provider documentation
Diagnosis Code Structural Change
Reference: CMS
ICD-10-CM
ICD-9
X
X
Category
X
.
X
X
Etiology, anatomic site,
manifestation
X
X
Category
X
.
X
X
X
Etiology, anatomic
site, manifestation
X
Extension
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Otitis
• Site
– Externa
– Media
• Laterality
– Left
– Right
– Bilateral
• Severity
– Acute
– Chronic
• Type
– Actinic
– Diffuse
– Chemical
– Contact
– Eczematoid
– Hemorrhagic
– Infective vs Noninfective
– Malignant
– Reactive
– Serous
– Suppurative vs Nonsuppurative
Perforations & Hearing Loss
Perforations
• Laterality
• Type
– Central perforation
– Attic perforation
– Other marginal
perforations
– Multiple perforations
– Total perforations
Hearing Loss
• Laterality
– Hearing on contralateral
side
• Type
– Conductive
– Sensorineural
– Mixed conductive &
sensorineural
– Ototoxic
– Other
– Unspecified
ENT Trauma
• Type of trauma
– Abrasion
– Dislocation
– Laceration
– Other
• Site & Anatomic
specificity
• Laterality new concept
• Foreign body present
• Episode of Care (from the
patient’s perspective) new concept
– Initial (presentation)
– Subsequent (routine or
delayed healing)
– Sequela (late effect after
initial injury/event has
healed)
Laterality new concept
• Abscess
• Otorrhagia
• Cellulitis
• Swimmer’s ear
• Impacted cerumen
• Tinnitus
• Otalgia
Neoplasms
• Type
– Malignant vs Benign
– In situ
• Detailed location(s)
– Overlapping sites vs
different, distinct
locations
– Laterality (where
applicable) new concept
• Primary
– Still active primary site
– Previously
removed/treated
• Metastatic
– Location
– Symptomatic
– Current treatment
course
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Symptoms
• Cervicalgia
• Dizziness
• Pain in throat
• Swelling, mass, lump
– Head
– Neck
• Hyper-/hypo-nasality
• Cough
• Snoring
• Epistaxis
• Enlarged lymph nodes
• Speech
– Aphonia
– Dysarthria & anarthria
– Dysphonia
– Slurred speech
– Voice and resonance
disorders
• Swallowing
– Dysphagia
•Oral, oropharyngeal,
pharyngeal,
pharyngoesophageal
Additional Common ENT Codes
• Abscess, furuncle,
carbuncle
– Identify location
• Hypertrophy
– Tonsils, adenoids,
both
• Polyps or Nodules
– Identify location
• Sialoadenitis
– Acute, chronic,
recurrent
• Sinusitis
– Identify location
• Tongue Diseases
– Atrophy
– Hypertrophy
– Glossodynia
– Median rhomboid
– Plicated
• Vocal Cord Paralysis
– Unilateral vs bilateral
Additional Common ENT Codes, cont…
• Other postprocedural status
Z96.21
Cochlear implant status
Z96.22
Myringotomy tube(s) status
Z97.4
Presence of external hearing-aid
Z97.8
Presence of other specified devices
• Encounter for
Z488.10 Encounter for surgical aftercare following surgery of sense organs
Z09
Encounter for follow-up examination after completed treatment for conditions
other than malignant neoplasm
Z018.18 Encounter for other preprocedural examination
Additional Educational Opportunities
• Physician/Provider Foundation training
• Specialty/Service Line meetings
• ICD-10 Website
http://iuhicd10.iuhisclinicaleducation.org/
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Questions
[email protected]