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The Otolaryngology Coding Coach

KZA consultants discuss two frequently asked spine coding questions every month. Our coding experts are also available for hourly coding consultations and can provide a customized coding and documentation review for your practice.

The Team
Mary LeGrand


October 16, 2014


ICD-10 “X” Placeholder


I recently listened to a webinar on ICD-10. They discussed the x placeholder, but I still don’t understand exactly when to use it. Can you help explain?


Absolutely we can help! The “X” placeholder has two functions in ICD-10-CM. First, it is used with some codes as a placeholder for future code expansion. It holds the data field to be able to place a new alphanumeric character if the definition of the code is expanded in updates to the code set. ICD-10-CM code H66.3X1 (Other chronic suppurative otitis media, right ear) is an example of how the “X” character is used as a placeholder for future code expansion. The “X” has to remain in the code or it becomes invalid.

The second use of the “X” placeholder is to fill data fields to be able to append 7th characters when the code is less than 6 characters in length. 7th character extensions are added to certain codes to further define the condition.

There are three main 7th character extensions: A-initial encounter, D-subsequent encounter, S-sequela. Fractures are the exception and have different 7th characters. The 7th character extensions are noted at the beginning of each code category. The codes otolaryngologists will use that require 7th characters are for injuries (e.g., foreign bodies, fractures, open wounds).

Because not all codes are 6 characters in length, an “X” is put in the empty data fields so the 7th character extension can be placed in the 7th character data field. For example, S02.2 is the code for fracture of nasal bones, but per the instructions at the beginning of the code category, this code will require a 7th character extension to be added to the code to make the code valid. Because this code is only 4 characters in length, “X”s are placed in the 5th and 6th data fields to add the 7th character. Therefore, the valid code for a diagnosis of open fracture of nasal bones, initial encounter is S02.2XXB.



Kick Revenue Into High Gear In 2014

Plan now to attend attend an AAO-HNSF Sponsored Otolaryngology workshop. Click here for 2014 courses dates and locations!

For more information on coding and reimbursement assistance contact the Client Service Team at 312.642.5616 or use the online form found at www.karenzupko.com and click on the “Services” tab.



Webinar: 2014 PQRS Made Easy for Otolaryngologists

Presented by Cheyenne Brinson, MBA, CPA

There is nothing easy about delving through the volumes of information about the PQRS program. At the surface, the program is cumbersome and confusing. KZA consultant Cheyenne Brinson navigates the murky PQRS waters in this focused 25 minute webinar and delivers a roadmap for achieving PQRS tailored specifically for otolaryngology.

Length: 25 minutes

Webinar participants will:

  1. Determine which measures groups or individual measures are applicable for Otolaryngologists to report
  2. Distinguish between a registry method of reporting and claims based reporting
  3. Understand the deadlines for reporting

Cost: $49

Click here to download 2014 PQRS Made Easy for Otolaryngologists.


Webinar: Resolving Cerumen Coding Chaos

Presented by Kim Pollock, RN, MBA, CPC

Confused about 2014 changes to the cerumen impaction removal code, 69210? Getting payor denials? We are getting many questions from clients and course attendees. Here are a few of those questions: Can I really bill 69210 with modifier 50? Is the microscope included in 69210 or can I also report 92504? Can I bill an office visit with 69210? We have the answers in this pre-recorded webinar!

AAPC CEU Credit: 1 hour

Length: 60 minutes

Learning Objectives:

  1. Describe the 2014 change to the CPT code for removal of impacted cerumen.
  2. Discuss the use of modifier 50 (bilateral surgery) with CPT 69210.
  3. Describe the necessary provider documentation to support reporting 69210.
  4. State the difference between the ICD-9-CM and ICD-10-CM codes for cerumen impaction.

Cost: $99

Click here to download Resolving Cerumen Coding Chaos Webinar.



Webinar: ICD-10-CM for ENT

Presented by Joy McKusick, RHIA

You will acquire a solid understanding of ICD-10 structure and specific insight into what that means to ENTs. Joy will share tips on codes for otitis media, sinusitis, tonsils and adenoiditis, nasal fractures and removal of those pesky foreign bodies.





Webinar: Skin In the ICD-10 Game

Presented by Joy McKusick, RHIA

ICD-10 requires significant documentation changes to select and assign diagnosis codes for many skin injuries. This one hour webinar with Joy McKusick will help you learn how to educate providers now on these documentation components and reduce claim submission and payment delays. Learn what documentation elements are required to code for increased specificity supporting medical necessity.




Not the question you’re looking for? Check out our archives for past Coding Coach Q&A's.

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Are You At Risk for an Audit?

Your E&M code usage may flag you as an outlier. KZA's E&M Profile Analyzer for Otolaryngology compares your E&M coding patterns against your specialty's state and national figures using CMS's most recently published database. ASPS has arranged for a special member price of $125.00 for one state's data. Click here to learn more about E&M Profile Analyzer for Otolaryngology.



Coding Resources

Do you have a coding question? KZA experts are available for hourly coding assistance.

Read about how KZA can provide a customized coding evaluation for your practice.

Attend otolaryngology coding courses in a city near you.

Purchase Code-Its! the diagnosis coding helper.

Continue your professional education, access timely information about ENT, and meet colleagues in your specialty across the country. If you aren't a member of AOA, find out the advantages of joining. Go to the AOA web site to request a membership package, or access otolaryngology-specific practice management and coding tips.

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