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ICD-10 Guide
ICD-10 CodesH72.00

H72.00

Billable

Central perforation of tympanic membrane, unspecified ear

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

Code Description

ICD-10 H72.00 is a billable code used to indicate a diagnosis of central perforation of tympanic membrane, unspecified ear.

Key Diagnostic Point:

Central perforation of the tympanic membrane, commonly known as the eardrum, refers to a hole or tear in the membrane that separates the outer ear from the middle ear. This condition can arise from various causes, including chronic otitis media, trauma, or barotrauma. Clinically, patients may present with symptoms such as hearing loss, ear pain, discharge from the ear, and a sensation of fullness. The perforation can lead to complications such as recurrent ear infections and further hearing impairment. Diagnosis typically involves otoscopic examination, where the physician can visualize the perforation. Audiometric testing may also be performed to assess the degree of hearing loss. Management options vary based on the size and cause of the perforation; small perforations may heal spontaneously, while larger ones may require surgical intervention, such as tympanoplasty. It is crucial for healthcare providers to monitor for signs of infection and to provide appropriate treatment to prevent complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and symptoms
  • Differentiation from other types of tympanic membrane perforations
  • Potential for co-existing conditions such as otitis media
  • Need for precise documentation of the perforation's size and cause

Audit Risk Factors

  • Inadequate documentation of the cause of perforation
  • Failure to document associated symptoms or complications
  • Misclassification of the type of perforation
  • Inconsistent coding of related conditions such as otitis media

Specialty Focus

Medical Specialties

Otolaryngology

Documentation Requirements

Detailed notes on the patient's history, physical examination findings, and treatment plan.

Common Clinical Scenarios

Patients presenting with ear pain, hearing loss, or recurrent ear infections.

Billing Considerations

Ensure clear documentation of the tympanic membrane's condition and any surgical interventions performed.

Audiology

Documentation Requirements

Audiometric test results and their interpretation in relation to tympanic membrane status.

Common Clinical Scenarios

Patients undergoing hearing assessments due to suspected perforation.

Billing Considerations

Document the correlation between hearing loss and tympanic membrane status.

Coding Guidelines

Inclusion Criteria

Use H72.00 When
  • According to ICD
  • 10 coding guidelines, H72
  • 00 should be used when the perforation is not specified as right or left
  • Coders should ensure that the documentation supports the diagnosis and that any associated conditions are also coded appropriately

Exclusion Criteria

Do NOT use H72.00 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

69631CPT Code

Tympanoplasty

Clinical Scenario

Used for surgical repair of the tympanic membrane perforation.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Otolaryngologists should ensure that the indication for surgery is well documented.

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 data collection and reimbursement processes. H72.00 provides a clear designation for central perforations, facilitating better tracking of treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of tympanic membrane conditions, improving the accuracy of data collection and reimbursement processes. H72.00 provides a clear designation for central perforations, facilitating better tracking of treatment outcomes.

Reimbursement & Billing Impact

reimbursement processes. H72.00 provides a clear designation for central perforations, facilitating better tracking of treatment outcomes.

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 causes of central perforation of the tympanic membrane?

Common causes include chronic otitis media, trauma, and barotrauma. Each cause may present with different symptoms and require specific management strategies.

How is a central perforation diagnosed?

Diagnosis is typically made through otoscopic examination, where the physician can visualize the perforation. Audiometric testing may also be performed to assess the degree of hearing loss.

What treatment options are available for tympanic membrane perforation?

Treatment options vary based on the size and cause of the perforation. Small perforations may heal spontaneously, while larger ones may require surgical intervention, such as tympanoplasty.