Total perforations of tympanic membrane, right ear
ICD-10 H72.821 is a billable code used to indicate a diagnosis of total perforations of tympanic membrane, right ear.
Total perforations of the tympanic membrane (TM) in the right ear indicate a complete rupture or tear of the membrane, which can result from various causes, including chronic otitis media, trauma, or barotrauma. Clinically, patients may present with symptoms such as hearing loss, otorrhea (ear discharge), tinnitus, and pain. The perforation can lead to complications such as cholesteatoma or recurrent infections. Diagnosis typically involves otoscopic examination, where the perforation is visualized, and audiometric testing to assess hearing loss. Management may include medical treatment with antibiotics for infections, tympanoplasty for surgical repair, and counseling on ear protection. The condition is significant as it can impact quality of life and may require ongoing monitoring and intervention.
Detailed clinical notes on the patient's history, examination findings, and treatment plan.
Patients presenting with ear pain, hearing loss, or recurrent ear infections.
Ensure documentation reflects the severity and impact of the perforation on hearing and quality of life.
Audiometric evaluations and reports detailing the extent of hearing loss.
Patients undergoing hearing assessments post-perforation or surgery.
Document the relationship between the perforation and hearing loss for accurate coding.
Used when surgical repair of the tympanic membrane is performed.
Surgical notes detailing the procedure and findings.
Otolaryngologists should ensure that the reason for surgery is clearly documented.
Common causes include chronic otitis media, trauma (such as from a blow to the ear), barotrauma from pressure changes, and foreign body insertion.
