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ICD-10 Guide
ICD-10 CodesH72.13

H72.13

Billable

Attic perforation of tympanic membrane, bilateral

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

Code Description

ICD-10 H72.13 is a billable code used to indicate a diagnosis of attic perforation of tympanic membrane, bilateral.

Key Diagnostic Point:

Attic perforation of the tympanic membrane, also known as the eardrum, refers to a specific type of perforation located in the attic or upper part of the tympanic membrane. This condition is often associated with chronic otitis media, particularly in cases where there is a history of recurrent ear infections. The perforation can lead to various complications, including hearing loss, chronic drainage, and potential spread of infection to surrounding structures. Clinically, patients may present with symptoms such as ear pain, discharge, and hearing impairment. Diagnosis typically involves otoscopic examination, which reveals the perforation and any associated middle ear pathology. Management may include medical treatment with antibiotics for any underlying infection, as well as surgical intervention such as tympanoplasty to repair the perforation and restore hearing. Bilateral attic perforations can complicate the clinical picture, necessitating careful monitoring and management to prevent further complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Bilateral nature of the condition complicates coding.
  • Requires differentiation from other types of tympanic membrane perforations.
  • Potential for co-existing conditions such as chronic otitis media.
  • Documentation must clearly specify the location and nature of the perforation.

Audit Risk Factors

  • Inadequate documentation of bilateral involvement.
  • Failure to document the clinical rationale for surgery.
  • Misclassification of the type of tympanic membrane perforation.
  • Lack of follow-up documentation post-surgery.

Specialty Focus

Medical Specialties

Otolaryngology

Documentation Requirements

Detailed otoscopic findings, history of ear infections, and treatment plans.

Common Clinical Scenarios

Patients presenting with chronic ear infections, hearing loss, or post-operative follow-ups.

Billing Considerations

Ensure clear documentation of the extent of perforation and any surgical interventions performed.

Audiology

Documentation Requirements

Audiometric evaluations and hearing assessments.

Common Clinical Scenarios

Patients with hearing loss secondary to tympanic membrane perforation.

Billing Considerations

Document the impact of the perforation on hearing thresholds and rehabilitation plans.

Coding Guidelines

Inclusion Criteria

Use H72.13 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the bilateral nature of the perforation
  • Include any relevant history of otitis media or other ear conditions
  • Ensure that the code is supported by clinical findings and treatment plans

Exclusion Criteria

Do NOT use H72.13 When
No specific exclusions found.

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

Otolaryngology specialists must document the extent of the perforation and any grafting performed.

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 attic perforation, improving the accuracy of medical records and billing. This specificity aids in better tracking of treatment outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like attic perforation, improving the accuracy of medical records and billing. This specificity aids in better tracking of treatment outcomes and resource allocation.

Reimbursement & Billing Impact

billing. This specificity aids in better tracking of treatment outcomes and resource allocation.

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 is the significance of coding H72.13 accurately?

Accurate coding of H72.13 is crucial for proper reimbursement, tracking of treatment outcomes, and ensuring that patients receive appropriate care for their condition. It also helps in identifying trends in ear health and the effectiveness of interventions.