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ICD-10 Guide
ICD-10 CodesH72.1

H72.1

Billable

Attic perforation of tympanic membrane

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

Code Description

ICD-10 H72.1 is a billable code used to indicate a diagnosis of attic perforation of tympanic membrane.

Key Diagnostic Point:

Attic perforation of the tympanic membrane refers to a specific type of perforation located in the upper part of the eardrum, known as the attic or pars flaccida. This condition is often associated with chronic otitis media, particularly the cholesteatoma, which can erode the tympanic membrane and lead to hearing loss. Patients may present with symptoms such as ear pain, discharge, and hearing impairment. The perforation can vary in size and may be accompanied by other complications, including infections or further damage to the middle ear structures. Diagnosis typically involves otoscopic examination, where the perforation can be visualized, and audiometric testing to assess hearing loss. Management may include medical treatment for any underlying infections and surgical intervention, such as tympanoplasty, to repair the perforation and restore hearing. The prognosis depends on the size of the perforation and the presence of any associated conditions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of ear anatomy and pathology
  • Differentiation from other types of tympanic membrane perforations
  • Potential for co-existing conditions like cholesteatoma
  • Need for precise documentation of clinical findings

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to document the presence of co-existing conditions
  • Incorrect coding of the type of perforation
  • Lack of supporting audiometric data

Specialty Focus

Medical Specialties

Otolaryngology

Documentation Requirements

Detailed otoscopic findings, audiometric results, and treatment plans.

Common Clinical Scenarios

Management of chronic otitis media, tympanic membrane repair, and cholesteatoma treatment.

Billing Considerations

Ensure clear documentation of the extent of perforation and any associated middle ear pathology.

Audiology

Documentation Requirements

Comprehensive audiometric evaluations and hearing assessments.

Common Clinical Scenarios

Assessment of hearing loss related to tympanic membrane perforations.

Billing Considerations

Document the correlation between audiometric findings and the tympanic membrane condition.

Coding Guidelines

Inclusion Criteria

Use H72.1 When
  • Follow official ICD
  • CM guidelines for coding ear conditions
  • Ensure accurate documentation of the type and location of the perforation, and any associated conditions

Exclusion Criteria

Do NOT use H72.1 When
  • Exclude codes for other types of tympanic membrane perforations unless specified

Related ICD-10 Codes

Related CPT Codes

69631CPT Code

Tympanoplasty

Clinical Scenario

Used for surgical repair of attic perforation.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Otolaryngologists should document the extent of the perforation and any associated conditions.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of tympanic membrane conditions, improving the accuracy of diagnoses and treatment tracking.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of tympanic membrane conditions, improving the accuracy of diagnoses and treatment tracking.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of tympanic membrane conditions, improving the accuracy of diagnoses and treatment tracking.

Resources

Clinical References

  • •
    American Academy of Otolaryngology - Head and Neck Surgery

Coding & Billing References

  • •
    American Academy of Otolaryngology - Head and Neck Surgery

Frequently Asked Questions

What is the primary cause of attic perforation?

The primary cause of attic perforation is chronic otitis media, often complicated by the presence of cholesteatoma, which erodes the tympanic membrane.