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ICD-10 Guide
ICD-10 CodesH70.811

H70.811

Billable

Postauricular fistula, right ear

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/12/2025

Code Description

ICD-10 H70.811 is a billable code used to indicate a diagnosis of postauricular fistula, right ear.

Key Diagnostic Point:

A postauricular fistula is an abnormal connection or passageway that forms behind the ear, typically resulting from developmental anomalies during embryogenesis. This condition can manifest as a small pit or opening in the skin, which may become infected or lead to the accumulation of fluid. In the right ear, the fistula may be associated with congenital conditions such as preauricular sinuses or other ear malformations. Clinically, patients may present with recurrent infections, drainage, or discomfort in the area. Diagnosis is often made through physical examination, and imaging studies such as ultrasound or CT scans may be utilized to assess the extent of the fistula and any associated complications. Management typically involves surgical intervention to excise the fistula and prevent recurrence, especially if recurrent infections are present. Postoperative care is crucial to monitor for complications and ensure proper healing. Accurate coding of this condition is essential for appropriate reimbursement and tracking of healthcare outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and symptoms
  • Potential for associated congenital anomalies
  • Need for imaging studies for accurate diagnosis
  • Surgical intervention may vary based on individual anatomy

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to document associated conditions or complications
  • Misclassification of the fistula type
  • Lack of preoperative and postoperative notes

Specialty Focus

Medical Specialties

Otolaryngology

Documentation Requirements

Detailed notes on the fistula's characteristics, associated symptoms, and surgical interventions performed.

Common Clinical Scenarios

Patients presenting with recurrent infections, drainage from the fistula, or preoperative assessments for surgical repair.

Billing Considerations

Ensure thorough documentation of any imaging studies and the rationale for surgical intervention.

Pediatrics

Documentation Requirements

Documentation of developmental history, any congenital anomalies, and family history of ear conditions.

Common Clinical Scenarios

Children with recurrent ear infections or developmental delays related to ear structure.

Billing Considerations

Consideration of growth and development milestones in relation to the condition.

Coding Guidelines

Inclusion Criteria

Use H70.811 When
  • According to ICD
  • 10 guidelines, H70
  • 811 should be used when there is a confirmed diagnosis of a postauricular fistula in the right ear
  • It is important to document any associated conditions or complications, as these may affect treatment and coding

Exclusion Criteria

Do NOT use H70.811 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

69436CPT Code

Tympanostomy, bilateral

Clinical Scenario

Often performed in conjunction with the repair of a postauricular fistula if there is associated otitis media.

Documentation Requirements

Document the indication for tympanostomy and any findings during the procedure.

Specialty Considerations

Otolaryngologists should ensure that the surgical notes clearly outline the relationship between the fistula and any middle ear conditions.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like postauricular fistula, improving the accuracy of patient records and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like postauricular fistula, improving the accuracy of patient records and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the common symptoms of a postauricular fistula?

Common symptoms include drainage from the fistula, recurrent infections, and discomfort in the area behind the ear.

How is a postauricular fistula diagnosed?

Diagnosis is typically made through physical examination, and imaging studies may be used to assess the fistula's extent.

What is the typical management for a postauricular fistula?

Management often involves surgical excision of the fistula, especially if recurrent infections are present.