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ICD-10 Guide
ICD-10 CodesH94.80

H94.80

Billable

Other specified disorders of ear in diseases classified elsewhere, unspecified ear

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

Code Description

ICD-10 H94.80 is a billable code used to indicate a diagnosis of other specified disorders of ear in diseases classified elsewhere, unspecified ear.

Key Diagnostic Point:

H94.80 encompasses a range of ear disorders that are not classified under specific categories in the ICD-10 system. This code is often used when patients present with symptoms related to ear diseases that do not fit neatly into established categories such as otitis media, hearing loss, or vestibular disorders. Clinical presentations may include tinnitus, ear pain, or balance issues, which can arise from various underlying conditions such as systemic diseases or infections. Diagnostic criteria typically involve a thorough history, physical examination, and may include audiometric testing or imaging studies to identify the underlying cause. Management strategies vary widely depending on the etiology and may include medical treatment, surgical interventions, or referral to specialists. Accurate coding is essential for proper reimbursement and to reflect the complexity of the patient's condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying conditions that can lead to unspecified ear disorders
  • Need for comprehensive documentation to justify the use of this code
  • Potential overlap with other ear-related codes
  • Variability in clinical presentation and management strategies

Audit Risk Factors

  • Insufficient documentation to support the unspecified nature of the disorder
  • Inconsistent coding practices among different providers
  • Failure to link the diagnosis to the treatment provided
  • Use of this code when a more specific code is available

Specialty Focus

Medical Specialties

Otolaryngology

Documentation Requirements

Detailed clinical notes including history, examination findings, and diagnostic tests performed.

Common Clinical Scenarios

Patients presenting with unexplained ear pain, tinnitus, or balance issues.

Billing Considerations

Ensure that all relevant diagnostic tests and their results are documented to support the use of H94.80.

Audiology

Documentation Requirements

Audiometric evaluations and interpretation of results must be included.

Common Clinical Scenarios

Patients with hearing loss where the cause is not immediately identifiable.

Billing Considerations

Document any referrals to other specialists for comprehensive care.

Coding Guidelines

Inclusion Criteria

Use H94.80 When
  • According to ICD
  • 10 coding guidelines, H94
  • 80 should be used when the ear disorder is specified as 'other' and does not fit into more defined categories
  • Coders should ensure that the documentation clearly indicates the nature of the disorder and any relevant diagnostic findings

Exclusion Criteria

Do NOT use H94.80 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

92557CPT Code

Comprehensive audiometry threshold evaluation and speech recognition

Clinical Scenario

Used when evaluating a patient with hearing loss where the cause is unclear.

Documentation Requirements

Document the results of the audiometric evaluation and any relevant history.

Specialty Considerations

Otolaryngologists and audiologists should ensure that the evaluation aligns with the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more granular coding of ear disorders, but it has also introduced complexity with unspecified codes like H94.80. Coders must be diligent in ensuring that documentation supports the use of this code to avoid denials and audits.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more granular coding of ear disorders, but it has also introduced complexity with unspecified codes like H94.80. Coders must be diligent in ensuring that documentation supports the use of this code to avoid denials and audits.

Reimbursement & Billing Impact

reimbursement.

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

When should I use H94.80?

Use H94.80 when a patient presents with ear disorders that do not fit into more specific categories and when the documentation supports the unspecified nature of the condition.