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v1.0.0
ICD-10 Guide
ICD-10 CodesH72.2

H72.2

Billable

Other marginal perforations of tympanic membrane

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

Code Description

ICD-10 H72.2 is a billable code used to indicate a diagnosis of other marginal perforations of tympanic membrane.

Key Diagnostic Point:

Other marginal perforations of the tympanic membrane refer to non-central perforations located at the edges of the tympanic membrane, which can arise from various causes, including chronic otitis media, trauma, or barotrauma. Clinically, patients may present with symptoms such as hearing loss, otorrhea (ear discharge), and ear pain. The perforation can lead to complications such as recurrent ear infections and further hearing impairment if not managed appropriately. Diagnosis typically involves otoscopic examination, where the perforation's size, location, and associated findings (e.g., fluid in the middle ear) are assessed. Management may include medical treatment with antibiotics for infections, surgical intervention such as tympanoplasty for repair, and audiological assessments to evaluate hearing loss. The prognosis is generally favorable with appropriate treatment, although some patients may experience persistent hearing issues or require further interventions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between types of tympanic membrane perforations
  • Understanding the underlying causes of perforation
  • Documenting associated symptoms and complications
  • Navigating coding for related conditions such as otitis media

Audit Risk Factors

  • Inadequate documentation of the perforation's size and location
  • Failure to document associated symptoms or complications
  • Incorrect linkage of procedures to the diagnosis
  • Misclassification of the type of perforation

Specialty Focus

Medical Specialties

Otolaryngology

Documentation Requirements

Detailed otoscopic findings, treatment plans, and follow-up care notes.

Common Clinical Scenarios

Management of chronic otitis media leading to tympanic membrane perforation, surgical repair of perforations.

Billing Considerations

Ensure clear documentation of the perforation's characteristics and any associated middle ear pathology.

Audiology

Documentation Requirements

Audiometric evaluations, hearing loss assessments, and recommendations for hearing aids or other interventions.

Common Clinical Scenarios

Assessment of hearing loss due to tympanic membrane perforation, fitting of hearing aids.

Billing Considerations

Document the impact of the perforation on hearing and any rehabilitative measures taken.

Coding Guidelines

Inclusion Criteria

Use H72.2 When
  • According to ICD
  • 10 guidelines, H72
  • 2 should be used when the perforation is specifically marginal and not central
  • Coders should ensure that the documentation supports the diagnosis and any associated conditions

Exclusion Criteria

Do NOT use H72.2 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

69631CPT Code

Tympanoplasty

Clinical Scenario

Used for surgical repair of a marginal perforation.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Otolaryngologists should document the type of perforation and any complications encountered during surgery.

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 perforations, improving the accuracy of diagnoses and treatment plans. H72.2 provides a distinct code for marginal perforations, which was less clearly defined in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of tympanic membrane perforations, improving the accuracy of diagnoses and treatment plans. H72.2 provides a distinct code for marginal perforations, which was less clearly defined in ICD-9.

Reimbursement & Billing Impact

reimbursement.

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 are the common causes of marginal perforations of the tympanic membrane?

Common causes include chronic otitis media, trauma, and barotrauma. These conditions can lead to inflammation and damage to the tympanic membrane, resulting in perforation.