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v1.0.0
ICD-10 Guide
ICD-10 CodesH94.81

H94.81

Billable

Other specified disorders of right ear in diseases classified elsewhere

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

Code Description

ICD-10 H94.81 is a billable code used to indicate a diagnosis of other specified disorders of right ear in diseases classified elsewhere.

Key Diagnostic Point:

H94.81 is used to classify other specified disorders of the right ear that are not specifically categorized under other codes in the ICD-10 system. This code encompasses a variety of conditions affecting the right ear, which may arise from diseases classified elsewhere, such as systemic diseases, infections, or trauma. Clinical presentations can include symptoms like hearing loss, tinnitus, vertigo, or ear pain. Diagnostic criteria often involve a thorough patient history, physical examination, audiometric testing, and imaging studies when necessary. Management may include medical treatment, surgical interventions, or referral to specialists, depending on the underlying cause. 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 ear disorders
  • Need for precise documentation of the primary disease causing the ear disorder
  • Potential for overlapping symptoms with other ear codes
  • Variability in treatment approaches based on the underlying cause

Audit Risk Factors

  • Inadequate documentation of the underlying disease
  • Failure to specify the right ear in documentation
  • Misuse of the code for more common ear disorders
  • Lack of supporting diagnostic tests in the medical record

Specialty Focus

Medical Specialties

Otolaryngology

Documentation Requirements

Detailed history of ear symptoms, results of audiometric tests, and any imaging studies performed.

Common Clinical Scenarios

Patients presenting with unilateral hearing loss, tinnitus, or vertigo associated with systemic diseases.

Billing Considerations

Ensure that the primary disease is well documented to justify the use of H94.81.

Primary Care

Documentation Requirements

Comprehensive patient history and physical examination findings related to ear symptoms.

Common Clinical Scenarios

Patients with ear complaints referred to specialists for further evaluation.

Billing Considerations

Document any referrals and the rationale for using H94.81.

Coding Guidelines

Inclusion Criteria

Use H94.81 When
  • According to ICD
  • 10 guidelines, H94
  • 81 should be used when the ear disorder is a secondary condition resulting from a primary disease
  • Coders must ensure that the primary disease is documented and that the ear disorder is specified as affecting the right ear

Exclusion Criteria

Do NOT use H94.81 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 suspected hearing loss related to H94.81.

Documentation Requirements

Audiometric test results must be documented.

Specialty Considerations

Otolaryngologists should ensure that the evaluation correlates with the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specificity in coding ear disorders, enabling better tracking of conditions like those classified under H94.81. This specificity aids in research and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specificity in coding ear disorders, enabling better tracking of conditions like those classified under H94.81. This specificity aids in research and treatment outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specificity in coding ear disorders, enabling better tracking of conditions like those classified under H94.81. This specificity aids in research and 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

When should I use H94.81?

Use H94.81 when documenting other specified disorders of the right ear that are secondary to diseases classified elsewhere, ensuring that the primary disease is well documented.