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Ear, Nose and Throat Superbill Template
|Date of service: |Insurance: |
|Patient name: | |
| |Subscriber name: |
|Address: |Group #: |Previous balance: |
| |Copay: |Today’s charges: |
|Phone: |Account #: |Today’s payment: check# |
|DOB: Age: Sex: |Physician name: |Balance due: |
|MOD. |Patient E/M |New |Est |MOD. |I&D, intraoral, tongue, floor of |41005 |MOD. |Flexible laryngoscopy with removal of |31578 |
| | | | | |mouth, sublingual, superficial | | |lesion | |
| |Level II |99202 |99212 | |I&D, extraoral, floor of mouth, |41015 | |Incision of labial frenulum |40806 |
| | | | | |sublingual | | | | |
| |Level III |99203 |99213 | |I&D, extraoral, floor of mouth, |41016 | |Excision lingual frenulum |41115 |
| | | | | |submental | | | | |
| |Level IV |99204 |99214 | |I&D, extraoral, submandibular |41017 | |Uvulectomy |42140 |
| |Level V |99205 |99215 | |I&D, peritonsillar |42700 | |Destruction of lesion, palate or uvula |42160 |
| | | | | | | | |(thermal, cryo) | |
| |Consultations | |I&D infected thyroglossal duct cyst|60000 | |Palate Somnoplasty |42145-52|
| |Consultation Level I |99241 | |I&D external ear, simple |69000 | |Turbinate Somnoplasty |30140-52|
| |Consultation Level II |99242 | |I&D external ear, complicated |69005 | |Cautery ablation, any method, superficial|30801 |
| |Consultation Level III |99243 | |I&D, external auditory canal |69020 | |Cautery ablation, intramural |30802 |
| |Consultation Level IV |99244 | |Ear Procedures | |Remova|30300 | |
| | | | | | |l of | | |
| | | | | | |foreig| | |
| | | | | | |n | | |
| | | | | | |body, | | |
| | | | | | |intran| | |
| | | | | | |asal | | |
| |Biopsy | |Tympan|69433 | |Vestib| | |
| | | |ostomy| | |ular | | |
| | | | | | |Functi| | |
| | | | | | |on | | |
| | | | | | |Tests | | |
| |each additional skin biopsy |11001 | |Impacted cerumen removal |69210 | |Caloric vestibular test |92532 |
| |Biopsy, nasal |30100 | |Control of Nasal Bleed | |Optoki|92534 | |
| | | | | | |netic | | |
| | | | | | |nystag| | |
| | | | | | |mus | | |
| | | | | | |test | | |
| |Biopsy, vestibule of mouth |40808 | |Anterior, complete nasal hemorrhage|30903 | |Spontaneous nystagmus, with recording |92541 |
| | | | |control | | | | |
| |Biopsy, tongue (anterior 2/3) |41100 | |Posterior nasal hemorrhage control |30905 | |Positional nystagmus test, with recording|92542 |
| |Biopsy, tongue (posterior 1/3) |41105 | |Nasal Endoscopy | |Calori|92543 | |
| | | | | | |c | | |
| | | | | | |vestib| | |
| | | | | | |ular | | |
| | | | | | |test, | | |
| | | | | | |with | | |
| | | | | | |record| | |
| | | | | | |ing | | |
| |Biopsy, palate, uvula |42100 | |Maxillary sinusoscopy |31232 | |Oscillating tracking test, with recording|92545 |
| |Biopsy, oropharynx |42800 | |Sphenoid sinusoscopy |31235 | |Tympanometry and reflex threshold |92550 |
| | | | | | | |measurements | |
| |Biopsy, hypopharynx |42802 | |Nasal endoscopic biopsy, polypectomy |31237 | |Pure tone screening |92551 |
| | | | |or debridement | | | | |
| |Biopsy, nasopharynx, visible |42804 | |Nasal endoscopic hemorrhage control |31238 | |Pure tone audiometry; air only |92552 |
| |lesion | | | | | | | |
| |Biopsy, nasopharynx, unknown |42806 | |Nasal endoscopy with |31239 | |Pure tone audiometry: air and bone |92553 |
| |primary | | |dacryocystorhinostomy | | | | |
| |Sialolithotomy | |Nasal endoscopy with concha bullosa |31240 | |Speech audiometry threshold |92555 |
| | | |resection | | | | |
| |Sialolithotomy, uncomplicated, |42330 | |Endoscopic partial ethmoidectomy |31254 | |Speech audiometry threshold with speech |92556 |
| |intraoral | | | | | |recognition | |
| |Sialolithotomy, submandibular, |42335 | |Endoscopic total ethmoidectomy |31255 | |Comprehensive audiometry |92557 |
| |complicated, intraoral | | | | | | | |
| |Sialolithotomy, parotid, extraoral|42340 | |Endoscopic maxillary antrostomy |31256 | |Percutaneous allergy skin test |95004 |
| |or complicated intraoral | | | | | | | |
| |Incision and Drainage | |Endoscopic maxillary tissue removal |31267 | |Allergy testing for venoms |95017 |
| |I&D abscess, simple, single |10060 | |Frontal sinus endoscopy |31276 | |Allergy testing for drugs, biological |95018 |
| |I&D, complicated, multiple |10061 | |Endoscopic sphenoidotomy |31287 | |Intradermal allergy tests |95024 |
| |I&D hematoma, seroma, fluid |10140 | |Endoscopic removal of sphenoid tissue|31288 | |Single allergy injection (including |95120 |
| |collection | | | | | |extract) | |
| |Puncture aspiration of abscess, cyst,|10160 | |Endoscopic maxillary sinus dilation |31295 | |Two or more allergy injections (including|95125 |
| |hematoma | | | | | |extract) | |
| |I&D complex, postoperative wound |10180 | |Endoscopic frontal sinus dilation |31296 | |Preparation and provision of antigens |95165 |
| |infection | | | | | | | |
| |I&D nasal abscess or hematoma |30000 | |Endoscopic sphenoid sinus dilation |31297 | |Inhalation bronchial challenge |95070 |
| |I&D nasal septum abscess or hematoma |30020 | |Flexible Laryngoscopy | |Nasoph|92511 | |
| | | | | | |aryngo| | |
| | | | | | |scopy | | |
| |I&D vestibule of mouth, complicated |40801 | |Flexible laryngoscopy with biopsy |31576 | |Venipuncture |36415 |
| |I&D, intraoral, tongue, floor of |41000 | |Flexible laryngoscopy with foreign |31577 | |Handling |99000 |
| |mouth, lingual | | |body removal | | | | |
|ICD-10 Codes |Diagnosis |
|C00.9 |Malignant neoplasm of lip, unspecified |
|C01 |Malignant neoplasm of base of tongue |
|C02.3 |Malignant neoplasm of anterior two-thirds of tongue, part unspecified |
|C04.9 |Malignant neoplasm of floor of mouth, unspecified |
|C05.0 |Malignant neoplasm of hard palate |
|C06.9 |Malignant neoplasm of mouth, unspecified |
|C07 |Malignant neoplasm of parotid gland |
|C08.0 |Malignant neoplasm of submandibular gland |
|C10.9 |Malignant neoplasm of oropharynx, unspecified |
|C11.9 |Malignant neoplasm of nasopharynx, unspecified |
|C13.9 |Malignant neoplasm of hypopharynx, unspecified |
|C30.0 |Malignant neoplasm of nasal cavity |
|C32.0 |Malignant neoplasm of glottis |
|C32.1 |Malignant neoplasm of supraglottis |
|C32.9 |Malignant neoplasm of larynx, unspecified |
|C44.00 |Unspecified malignant neoplasm of skin of lip |
|C44.01 |Basal cell carcinoma of skin of lip |
|C44.02 |Squamous cell carcinoma of skin of lip |
|C44.09 |Other specified malignant neoplasm of skin of lip |
|C44.202 |Unspecified malignant neoplasm of skin of right ear and external auricular canal |
|C44.209 |Unspecified malignant neoplasm of skin of left ear and external auricular canal |
|C44.212 |Basal cell carcinoma of skin of right ear and external auricular canal |
|C44.219 |Basal cell carcinoma of skin of left ear and external auricular canal |
|C44.222 |Squamous cell carcinoma of skin of right ear and external auricular canal |
|C44.229 |Squamous cell carcinoma of skin of left ear and external auricular canal |
|C44.301 |Unspecified malignant neoplasm of skin of nose |
|C44.309 |Unspecified malignant neoplasm of other parts of face |
|C44.311 |Basal cell carcinoma of skin of nose |
|C44.319 |Basal cell carcinoma of skin of other parts of face |
|C44.321 |Squamous cell carcinoma of skin of nose |
|C44.329 |Squamous cell carcinoma of skin of other parts of face |
|C44.40 |Unspecified malignant neoplasm of skin of scalp and neck |
|C44.41 |Basal cell carcinoma of skin of scalp and neck |
|C44.42 |Squamous cell carcinoma of skin of scalp and neck |
|C44.49 |Other specified malignant neoplasm of skin of scalp and neck |
|C73 |Malignant neoplasm of thyroid gland |
|C77.0 |Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck |
|D00.01 |Carcinoma in situ of labial mucosa and vermilion border |
|D00.02 |Carcinoma in situ of buccal mucosa |
|D00.03 |Carcinoma in situ of gingiva and edentulous alveolar ridge |
|D00.04 |Carcinoma in situ of soft palate |
|D00.05 |Carcinoma in situ of hard palate |
|D00.06 |Carcinoma in situ of floor of mouth |
|D00.07 |Carcinoma in situ of tongue |
|D00.08 |Carcinoma in situ of pharynx |
|D10.30 |Benign neoplasm of unspecified part of mouth |
|D10.39 |Benign neoplasm of other parts of mouth |
|D11.0 |Benign neoplasm of parotid gland |
|D11.7 |Benign neoplasm of other major salivary gland |
|D14.0 |Benign neoplasm of middle ear, nasal cavity and accessory sinuses |
|D14.1 |Benign neoplasm of larynx |
|D22.11 |Melanocytic nevi of right eyelid, including canthus |
|D22.12 |Melanocytic nevi of left eyelid, including canthus |
|D23.11 |Other benign neoplasm of skin of right eyelid, including canthus |
|D23.12 |Other benign neoplasm of skin of left eyelid, including canthus |
|D33.3 |Benign neoplasm of cranial nerves |
|D35.2 |Benign neoplasm of pituitary gland |
|D37.01 |Neoplasm of uncertain behavior of lip |
|D37.02 |Neoplasm of uncertain behavior of tongue |
|D37.030 |Neoplasm of uncertain behavior of the parotid salivary glands |
|D37.031 |Neoplasm of uncertain behavior of the sublingual salivary glands |
|D37.032 |Neoplasm of uncertain behavior of the submandibular salivary glands |
|D37.04 |Neoplasm of uncertain behavior of the minor salivary glands |
|D37.05 |Neoplasm of uncertain behavior of pharynx |
|D37.09 |Neoplasm of uncertain behavior of other specified sites of the oral cavity |
|D38.0 |Neoplasm of uncertain behavior of larynx |
|D48.5 |Neoplasm of uncertain behavior of skin |
|D49.0 |Neoplasm of unspecified behavior of digestive system |
|D49.1 |Neoplasm of uncertain behavior of respiratory system |
|D49.2 |Neoplasm of uncertain behavior of bone, soft tissue, and skin |
|D49.7 |Neoplasm of uncertain behavior of endocrine glands and other parts of nervous system |
|E04.1 |Nontoxic single thyroid nodule |
|E04.2 |Nontoxic multinodular goiter |
|E05.90 |Thyrotoxicosis, unspecified without thyrotoxic crisis or storm |
|E06.9 |Thyroiditis, unspecified |
|E21.0 |Primary hyperparathyroidism |
|E21.1 |Secondary hyperparathyroidism, not elsewhere classified |
|E21.2 |Other hyperparathyroidism |
|E84.9 |Cystic fibrosis |
|F45.8 |Other somatoform disorders |
|F80.4 |Speech and language development delay due to hearing loss |
|G47.09 |Other insomnia |
|G47.19 |Other hypersomnia |
|G47.30 |Sleep apnea, unspecified |
|G47.33 |Obstructive sleep apnea (adult) (pediatric) |
|G50.1 |Atypical facial pain |
|G51.0 |Bell’s palsy |
|H6.301 |Acquired stenosis of right external ear canal, unspecified |
|H60.331 |Swimmer’s ear, right ear |
|H60.332 |Swimmer’s ear, left ear |
|H60.333 |Swimmer’s ear, bilateral |
|H60.391 |Other infective otitis externa, right ear |
|H60.392 |Other infective otitis externa, left ear |
|H60.393 |Other infective otitis externa, bilateral |
|H60.511 |Acute actinic otitis externa, right ear |
|H60.512 |Acute actinic otitis externa, left ear |
|H60.513 |Acute actinic otitis externa, bilateral |
|H60.521 |Acute chemical otitis externa, right ear |
|H60.522 |Acute chemical otitis externa, left ear |
|H60.523 |Acute chemical otitis externa, bilateral |
|H60.531 |Acute contact otitis externa, right ear |
|H60.532 |Acute contact otitis externa, left ear |
|H60.533 |Acute contact otitis externa, bilateral |
|H60.541 |Acute eczematoid otitis externa, right ear |
|H60.542 |Acute eczematoid otitis externa, left ear |
|H60.543 |Acute eczematoid otitis externa, bilateral |
|H60.551 |Acute reactive otitis externa, right ear |
|H60.552 |Acute reactive otitis externa, left ear |
|H60.553 |Acute reactive otitis externa, bilateral |
|H60.591 |Other noninfective acute otitis externa, right ear |
|H60.592 |Other noninfective acute otitis externa, left ear |
|H60.593 |Other noninfective acute otitis externa, bilateral |
|H60.61 |Unspecified chronic otitis externa, right ear |
|H60.62 |Unspecified chronic otitis externa, left ear |
|H60.63 |Unspecified chronic otitis externa, bilateral |
|H61.011 |Acute perichondritis of right external ear |
|H61.012 |Acute perichondritis of left external ear |
|H61.013 |Acute perichondritis of external ear, bilateral |
|H61.021 |Chronic perichondritis of right external ear |
|H61.022 |Chronic perichondritis of left external ear |
|H61.023 |Chronic perichondritis of external ear, bilateral |
|H61.121 |Hematoma of pinna, right ear |
|H61.122 |Hematoma of pinna, left ear |
|H61.123 |Hematoma of pinna, bilateral |
|H61.21 |Impacted cerumen, right ear |
|H61.22 |Impacted cerumen, left ear |
|H61.23 |Impacted cerumen, bilateral |
|H61.302 |Acquired stenosis of left external ear canal, unspecified |
|H61.303 |Acquired stenosis of external ear canal, unspecified, bilateral |
|H61.391 |Other acquired stenosis of right external ear canal |
|H61.392 |Other acquired stenosis of left external ear canal |
|H61.393 |Other acquired stenosis of external ear canal, bilateral |
|H61.811 |Exostosis of right external ear canal |
|H61.812 |Exostosis of left external ear canal |
|H61.813 |Exostosis of external ear canal, bilateral |
|H65.01 |Acute serous otitis media, right ear |
|H65.02 |Acute serous otitis media, left ear |
|H65.03 |Acute serous otitis media, bilateral |
|H65.04 |Acute serous otitis media, recurrent, right ear |
|H65.05 |Acute serous otitis media, recurrent, left ear |
|H65.06 |Acute serous otitis media, recurrent, bilateral |
|H65.91 |Unspecified nonsuppurative otitis media, right ear |
|H65.92 |Unspecified nonsuppurative otitis media, left ear |
|H65.93 |Unspecified nonsuppurative otitis media, bilateral |
|H66.001 |Acute suppurative otitis media without spontaneous rupture of ear drum, right ear |
|H66.002 |Acute suppurative otitis media without spontaneous rupture of ear drum, left ear |
|H66.003 |Acute suppurative otitis media without spontaneous rupture of ear drum, bilateral |
|H66.004 |Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear |
|H66.005 |Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left ear |
|H66.006 |Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, bilateral |
|H66.011 |Acute suppurative otitis media with spontaneous rupture of ear drum, right ear |
|H66.012 |Acute suppurative otitis media with spontaneous rupture or ear drum, left ear |
|H66.013 |Acute suppurative otitis media with spontaneous rupture of ear drum, bilateral |
|H66.014 |Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, right ear |
|H66.015 |Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, left ear |
|H66.016 |Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, bilateral |
|H66.11 |Chronic tubotympanic suppurative otitis media, right ear |
|H66.12 |Chronic tubotympanic suppurative otitis media, left ear |
|H66.13 |Chronic tubotympanic suppurative otitis media, bilateral |
|H66.21 |Chronic atticoantral suppurative otitis media, right ear |
|H66.22 |Chronic atticoantral suppurative otitis media, left ear |
|H66.23 |Chronic atticoantral suppurative otitis media, bilateral |
|H66.3X1 |Other chronic suppurative otitis media, right ear |
|H66.3X2 |Other chronic suppurative otitis media, left ear |
|H66.3X3 |Other chronic suppurative otitis media, bilateral |
|H66.91 |Otitis media, unspecified, right ear |
|H66.92 |Otitis media, unspecified, left ear |
|H66.93 |Otitis media, unspecified, bilateral |
|H69.81 |Other specified disorder of Eustachian tube, right ear |
|H69.82 |Other specified disorder of Eustachian tube, left ear |
|H69.83 |Other specified disorder of Eustachian tube, bilateral |
|H70.11 |Chronic mastoiditis, right ear |
|H70.12 |Chronic mastoiditis, left ear |
|H70.13 |Chronic mastoiditis, bilateral |
|H71.01 |Cholesteatoma of attic, right ear |
|H71.02 |Cholesteatoma of attic, left ear |
|H71.03 |Cholesteatoma of attic, bilateral |
|H71.11 |Cholesteatoma of tympanum, right ear |
|H71.12 |Cholesteatoma of tympanum, left ear |
|H71.13 |Cholesteatoma of tympanum, bilateral |
|H71.21 |Cholesteatoma of mastoid, right ear |
|H71.22 |Cholesteatoma of mastoid, left ear |
|H71.23 |Cholesteatoma of mastoid, bilateral |
|H71.91 |Unspecified cholesteatoma, right ear |
|H71.92 |Unspecified cholesteatoma, left ear |
|H71.93 |Unspecified cholesteatoma, bilateral |
|H72.01 |Central perforation of tympanic membrane, right ear |
|H72.01 |Central perforation of tympanic membrane, right ear |
|H72.02 |Central perforation of tympanic membrane, left ear |
|H72.02 |Central perforation of tympanic membrane, left ear |
|H72.03 |Central perforation of tympanic membrane, bilateral |
|H72.03 |Central perforation of tympanic membrane, bilateral |
|H72.11 |Attic perforation of tympanic membrane, right ear |
|H72.12 |Attic perforation of tympanic membrane, left ear |
|H72.13 |Attic perforation of tympanic membrane, bilateral |
|H72.2X1 |Other marginal perforations of tympanic membrane, right ear |
|H72.2X2 |Other marginal perforations of tympanic membrane, left ear |
|H72.2X3 |Other marginal perorations of tympanic membrane, bilateral |
|H72.811 |Multiple perforations of tympanic membrane, right ear |
|H72.812 |Multiple perforations of tympanic membrane, left ear |
|H72.813 |Multiple perforations of tympanic membrane, bilateral |
|H72.91 |Unspecified perforation of tympanic membrane, right ear |
|H72.92 |Unspecified perforation of tympanic membrane, left ear |
|H72.93 |Unspecified perforation of tympanic membrane, bilateral |
|H73.11 |Chronic myringitis, right ear |
|H73.12 |Chronic myringitis, left ear |
|H73.13 |Chronic myringitis, bilateral |
|H74.11 |Adhesive right middle ear disease |
|H74.12 |Adhesive left middle ear disease |
|H74.13 |Adhesive middle ear disease, bilateral |
|H80.91 |Unspecified otosclerosis, right ear |
|H80.92 |Unspecified otosclerosis, left ear |
|H80.93 |Unspecified otosclerosis, bilateral |
|H81.01 |Meniere’s disease, right ear |
|H81.02 |Meniere’s disease, left ear |
|H81.03 |Meniere’s disease, bilateral |
|H81.11 |Benign paroxysmal vertigo, right ear |
|H81.12 |Benign paroxysmal vertigo, left ear |
|H81.13 |Benign paroxysmal vertigo, bilateral |
|H81.41 |Vertigo of central origin, right ear |
|H81.42 |Vertigo of central origin, left ear |
|H81.43 |Vertigo of central origin, bilateral |
|H83.2X1 |Labyrinthine dysfunction, right ear |
|H83.2X2 |Labyrinthine dysfunction, left ear |
|H83.2X3 |Labyrinthine dysfunction, bilateral |
|H83.3X1 |Noise effects on right inner ear |
|H83.3X2 |Noise effect on left inner ear |
|H83.3X3 |Noise effects on inner ear, bilateral |
|H90.0 |Conductive hearing loss, bilateral |
|H90.11 |Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side |
|H90.12 |Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side |
|H90.2 |Conductive hearing loss, unspecified |
|H90.3 |Sensorineural hearing loss, bilateral |
|H90.41 |Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side |
|H90.42 |Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side |
|H90.5 |Unspecified sensorineural hearing loss |
|H90.6 |Mixed conductive and sensorineural hearing loss, bilateral |
|H90.71 |Mixed conductive and sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side |
|H90.72 |Mixed conductive and sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side |
|H90.8 |Mixed conductive and sensorineural hearing loss, unspecified |
|H91.11 |Presbycusis, right ear |
|H91.12 |Presbycusis, left ear |
|H91.13 |Presbycusis, bilateral |
|H91.91 |Unspecified hearing loss, right ear |
|H91.92 |Unspecified hearing loss, left ear |
|H91.93 |Unspecified hearing loss, bilateral |
|H92.01 |Otalgia, right ear |
|H92.02 |Otalgia, left ear |
|H92.03 |Otalgia, bilateral |
|H93.11 |Tinnitus, right ear |
|H93.12 |Tinnitus, left ear |
|H93.13 |Tinnitus, bilateral |
|H93.291 |Other abnormal auditory perceptions, right ear |
|H93.292 |Other abnormal auditory perceptions, left ear |
|H93.293 |Other abnormal auditory perceptions, bilateral |
|J01.80 |Other acute sinusitis |
|J01.81 |Other acute recurrent sinusitis |
|J01.90 |Acute sinusitis, unspecified |
|J01.91 |Acute recurrent sinusitis, unspecified |
|J02.8 |Acute pharyngitis due to other specified organism |
|J02.9 |Acute pharyngitis, unspecified |
|J04.0 |Acute laryngitis |
|J30.0 |Vasomotor rhinitis |
|J30.1 |Allergic rhinitis due to pollen |
|J30.2 |Other seasonal allergic rhinitis |
|J30.89 |Other allergic rhinitis |
|J30.9 |Allergic rhinitis, unspecified |
|J31.0 |Chronic rhinitis |
|J31.2 |Chronic pharyngitis |
|J32.0 |Chronic maxillary sinusitis |
|J32.1 |Chronic frontal sinusitis |
|J32.2 |Chronic ethmoidal sinusitis |
|J32.3 |Chronic sphenoidal sinusitis |
|J32.4 |Chronic pansinusitis |
|J32.8 |Other chronic sinusitis |
|J33.0 |Polyp of nasal cavity |
|J33.1 |Polypoid sinus degeneration |
|J33.8 |Other poly of sinus |
|J34.2 |Deviated nasal septum |
|J34.3 |Hypertrophy of nasal turbinates |
|J34.81 |Nasal mucositis (ulcerative) |
|J34.89 |Other specified disorder of nose and nasal sinuses |
|J35.01 |Chronic tonsillitis |
|J35.02 |Chronic adenoiditis |
|J35.03 |Chronic tonsillitis and adenoiditis |
|J35.1 |Hypertrophy of tonsils |
|J35.2 |Hypertrophy of adenoids |
|J35.3 |Hypertrophy of tonsils with hypertrophy of adenoids |
|J36 |Peritonsillar abscess |
|J37.0 |Chronic laryngitis |
|J38.01 |Paralysis of vocal cords and larynx, unilateral |
|J38.02 |Paralysis of vocal cords and larynx, bilateral |
|J38.1 |Polyp of vocal cord and larynx |
|J38.2 |Nodules of vocal cords |
|J38.3 |Other diseases of vocal cords |
|J38.4 |Edema of larynx |
|J38.5 |Laryngeal spasm |
|J38.6 |Stenosis of larynx |
|J38.7 |Other disease of larynx |
|J96.01 |Acute respiratory failure with hypoxia |
|J96.02 |Acute respiratory failure with hypercapnia |
|J96.11 |Chronic respiratory failure with hypoxia |
|J96.12 |Chronic respiratory failure with hypercapnia |
|J96.21 |Acute and chronic respiratory failure with hypoxia |
|J96.22 |Acute and chronic respiratory failure with hypercapnia |
|K09.8 |Other cysts of oral region, not elsewhere classified |
|K09.9 |Cyst of oral region, unspecified |
|K11.21 |Acute sialoadenitis |
|K11.22 |Acute recurrent sialoadenitis |
|K11.23 |Chronic sialoadenitis |
|K11.5 |Sialolithiasis |
|K11.6 |Mucocele of salivary gland |
|K12.30 |Oral mucositis (ulcerative), unspecified |
|K13.0 |Disease of lips |
|K13.4 |Granuloma and granuloma-like lesions of oral mucosa |
|K13.6 |Irritative hyperplasia of oral mucosa |
|K13.70 |Unspecified lesions of oral mucosa |
|K13.79 |Other lesions of oral mucosa |
|K14.0 |Glossitis |
|K21.0 |Gastro-esophageal reflux disease with esophagitis |
|K21.9 |Gastro-esophageal reflux disease without esophagitis |
|K22.5 |Diverticulum of esophagus, acquired |
|L03.211 |Cellulitis of face |
|L03.221 |Cellulitis of neck |
|L72.0 |Epidermal cyst |
|L72.11 |Pilar cyst |
|L72.12 |Trichodermal cyst |
|L72.2 |Steatocystoma multiplex |
|L72.3 |Sebaceous cyst |
|L72.8 |Other follicular cysts of the skin and subcutaneous tissue |
|L91.0 |Hypertrophic scar |
|M26.60 |Temporomandibular joint disorders, unspecified |
|M26.69 |Other specified disorders of temporomandibular joint |
|M54.2 |Cervicalgia |
|M95.0 |Acquired deformity of nose |
|Q16.1 |Congenital absence, atresia and stricture of auditory canal (external) |
|Q18.0 |Sinus, fistula and cyst of branchial cleft |
|Q31.0 |Web of larynx |
|Q31.1 |Congenital subglottic stenosis |
|Q31.2 |Laryngeal hypoplasia |
|Q31.3 |Laryngocele |
|Q31.5 |Congenital laryngomalacia |
|Q31.8 |Other congenital malformation of larynx |
|Q32.0 |Congenital tracheomalacia |
|Q32.1 |Other congenital malformations of trachea |
|Q32.2 |Congenital bronchomalacia |
|Q32.3 |Congenital stenosis of bronchus |
|Q32.4 |Other congenital malformations of bronchus |
|Q38.1 |Ankyloglossia |
|Q89.2 |Congenital malformations of other endocrine glands |
|R04.0 |Epistaxis |
|R04.2 |Hemoptysis |
|R04.89 |Hemorrhage from other sites in respiratory passages |
|R04.9 |Hemorrhage from respiratory passages, unspecified |
|R05 |Cough |
|R06.00 |Dyspnea, unspecified |
|R06.09 |Other forms of dyspnea |
|R06.1 |Stridor |
|R06.89 |Other abnormalities of breathing |
|R13.10 |Dysphagia, unspecified |
|R22.0 |Localized swelling, mass and lump, head |
|R22.1 |Localized swelling, mass and lump, neck |
|R42 |Dizziness and giddiness |
|R43.0 |Anosmia |
|R43.1 |Parosmia |
|R43.2 |Parageusia |
|R43.8 |Other disturbance of smell and taste |
|R49.0 |Dysphonia |
|R51 |Headache |
|R59.0 |Localized enlarged lymph nodes |
|R59.1 |Generalized enlarged lymph nodes |
|R59.9 |Enlarged lymph nodes, unspecified |
|S02.10XA |Unspecified fracture of base of skull, initial encounter for closed fracture |
|S02.10XB |Unspecified fracture of base of skull, initial encounter for open fracture |
|S02.10XD |Unspecified fracture of base of skull, subsequent encounter for fracture with routine healing |
|S02.10XG |Unspecified fracture of base of skull, subsequent encounter for fracture with delayed healing |
|S02.10XK |Unspecified fracture of base of skull, subsequent encounter for fracture with nonunion |
|S02.10XS |Unspecified fracture of base of skull, sequela |
|S02.2XXA |Fracture of nasal bones, initial encounter for closed fracture |
|S02.2XXB |Fracture of nasal bones, initial encounter for open fracture |
|S02.2XXD |Fracture of nasal bones, subsequent encounter for fracture with routine healing |
|S02.2XXG |Fracture of nasal bones, subsequent encounter for fracture with delayed healing |
|S02.2XXK |Fracture of nasal bones, subsequent encounter for fracture with nonunion |
|S02.2XXS |Fracture of nasal bones, sequela |
|S02.3XXA |Fracture of orbital floor, initial encounter for closed fracture |
|S02.3XXB |Fracture of orbital floor, initial encounter for open fracture |
|S02.3XXD |Fracture of orbital floor, subsequent encounter for fracture with routine healing |
|S02.3XXG |Fracture of orbital floor, subsequent encounter for fracture with delayed healing |
|S02.3XXK |Fracture of orbital floor, subsequent encounter for fracture with nonunion |
|S02.3XXS |Fracture of orbital floor, sequela |
|S02.401A |Maxillary fracture, unspecified, initial encounter for closed fracture |
|S02.401B |Maxillary fracture, unspecified, initial encounter for open fracture |
|S02.401D |Maxillary fracture, unspecified, subsequent encounter for fracture with routine healing |
|S02.401G |Maxillary fracture, unspecified, subsequent encounter for fracture with delayed healing |
|S02.401K |Maxillary fracture, unspecified, subsequent encounter for fracture with nonunion |
|S02.401S |Maxillary fracture, unspecified, sequela |
|S02.402A |Zygomatic fracture, unspecified, initial encounter for closed fracture |
|S02.402B |Zygomatic fracture, unspecified, initial encounter for open fracture |
|S02.402D |Zygomatic fracture, unspecified, subsequent encounter for fracture with routine healing |
|S02.402G |Zygomatic fracture, unspecified, subsequent encounter for fracture with delayed healing |
|S02.402K |Zygomatic fracture, unspecified, subsequent encounter for fracture with nonunion |
|S02.402S |Zygomatic fracture, unspecified, sequela |
|S02.411A |LeFort I fracture, initial encounter for closed fracture |
|S02.411B |LeFort I fracture, initial encounter for open fracture |
|S02.411D |LeFort I fracture, subsequent encounter for fracture with routine healing |
|S02.411G |LeFort I fracture, subsequent encounter for fracture with delayed healing |
|S02.411K |LeFort I fracture, subsequent encounter for fracture with nonunion |
|S02.411S |LeFort I fracture, sequela |
|S02.413A |LeFort III fracture, initial encounter for closed fracture |
|S02.413B |LeFort III fracture, initial encounter for open fracture |
|S02.413D |LeFort III fracture, subsequent encounter for fracture with routine healing |
|S02.413G |LeFort III fracture, subsequent encounter for fracture with delayed healing |
|S02.413K |LeFort III fracture, subsequent encounter for fracture with nonunion |
|S02.413S |LeFort III fracture, sequela |
|S02.42XA |Fracture of alveolus maxilla, initial encounter for closed fracture |
|S02.42XB |Fracture of alveolus maxilla, initial encounter for open fracture |
|S02.42XD |Fracture of alveolus maxilla, subsequent encounter for fracture with routine healing |
|S02.402G |Zygomatic fracture, unspecified, subsequent encounter for fracture with delayed healing |
|S02.402K |Zygomatic fracture, unspecified, subsequent encounter for fracture with nonunion |
|S02.402S |Zygomatic fracture, unspecified, sequela |
|S02.411A |LeFort I fracture, initial encounter for closed fracture |
|S02.411B |LeFort I fracture, initial encounter for open fracture |
|S02.411D |LeFort I fracture, subsequent encounter for fracture with routine healing |
|S02.411G |LeFort I fracture, subsequent encounter for fracture with delayed healing |
|S02.411K |LeFort I fracture, subsequent encounter for fracture with nonunion |
|S02.411S |LeFort I fracture, sequela |
|S02.413A |LeFort III fracture, initial encounter for closed fracture |
|S02.413B |LeFort III fracture, initial encounter for open fracture |
|S02.413D |LeFort III fracture, subsequent encounter for fracture with routine healing |
|S02.413G |LeFort III fracture, subsequent encounter for fracture with delayed healing |
|S02.413K |LeFort III fracture, subsequent encounter for fracture with nonunion |
|S02.413S |LeFort III fracture, sequela |
|S02.42XA |Fracture of alveolus maxilla, initial encounter for closed fracture |
|S02.42XB |Fracture of alveolus maxilla, initial encounter for open fracture |
|S02.42XD |Fracture of alveolus maxilla, subsequent encounter for fracture with routine healing |
|S02.413D |LeFort III fracture, subsequent encounter for fracture with routine healing |
|S02.413G |LeFort III fracture, subsequent encounter for fracture with delayed healing |
|S02.413K |LeFort III fracture, subsequent encounter for fracture with nonunion |
|S02.413S |LeFort III fracture, sequela |
|S02.42XA |Fracture of alveolus maxilla, initial encounter for closed fracture |
|S02.42XB |Fracture of alveolus maxilla, initial encounter for open fracture |
|S02.42XD |Fracture of alveolus maxilla, subsequent encounter for fracture with routine healing |
|S02.42XG |Fracture of alveolus maxilla, subsequent encounter for fracture with delayed healing |
|S02.42XK |Fracture of alveolus maxilla, subsequent encounter for fracture with nonunion |
|S02.42XS |Fracture of alveolus maxilla, sequela |
|S09.21XA |Traumatic rupture of right ear drum, initial encounter |
|S09.21XD |Traumatic rupture of right ear drum, subsequent encounter |
|S09.21XS |Traumatic rupture of right ear drum, sequela |
|S09.22XA |Traumatic rupture of left ear drum, initial encounter |
|S09.22XD |Traumatic rupture of left ear drum, subsequent encounter |
|S09.22XS |Traumatic rupture of left ear drum, sequela |
|S09.92XA |Unspecified injury of nose, initial encounter |
|S09.92XD |Unspecified injury of nose, subsequent encounter |
|S09.92XS |Unspecified injury of nose, sequela |
|S09.93XA |Unspecified injury of face, initial encounter |
|S09.93XD |Unspecified injury of face, subsequent encounter |
|S09.93XS |Unspecified injury of face, sequela |
|S16.8XXA |Other specified injury of muscle, fascia and tendon at neck level, initial encounter |
|S16.8XXD |Other specified injury of muscle, fascia and tendon at neck level, subsequent encounter |
|S16.8XXS |Other specified injury of muscle, fascia and tendon at neck level, sequela |
|S19.81XA |Other specified injuries of larynx, initial encounter |
|S19.81XD |Other specified injuries of larynx, subsequent encounter |
|S19.81XS |Other specified injuries of larynx, sequela |
|S19.82XA |Other specified injuries of cervical trachea, initial encounter |
|S19.82XD |Other specified injuries of cervical trachea, subsequent encounter |
|S19.82XS |Other specified injuries of cervical trachea, sequela |
|S19.83XA |Other specified injuries of vocal cord, initial encounter |
|S19.83XD |Other specified injuries of vocal cord, subsequent encounter |
|S19.83XS |Other specified injuries of vocal cord, sequela |
|S19.84XA |Other specified injuries of thyroid gland, initial encounter |
|S19.84XD |Other specified injuries of thyroid gland, subsequent encounter |
|S19.84XS |Other specified injuries of thyroid gland, sequela |
|S19.85XA |Other specified injuries of pharynx and cervical esophagus, initial encounter |
|S19.85XD |Other specified injuries of pharynx and cervical esophagus, subsequent encounter |
|S19.85XS |Other specified injuries of pharynx and cervical esophagus, sequela |
|S19.9XXA |Unspecified injury of neck, initial encounter |
|S19.9XXD |Unspecified injury of neck, subsequent encounter |
|S19.9XXS |Unspecified injury of neck, sequela |
|T16.1XXA |Foreign body in right ear, initial encounter |
|T16.1XXD |Foreign body in right ear, subsequent encounter |
|T16.1XXS |Foreign body in right ear, sequela |
|T16.2XXA |Foreign body in left ear, initial encounter |
|T16.2XXD |Foreign body in left ear, subsequent encounter |
|T16.2XXS |Foreign body in left ear, sequela |
|T17.0XXA |Foreign body in nasal sinus, initial encounter |
|T17.0XXD |Foreign body in nasal sinus, subsequent encounter |
|T17.0XXS |Foreign body in nasal sinus, sequela |
|T17.1XXA |Foreign body in nostril, initial encounter |
|T17.1XXD |Foreign body in nostril, subsequent encounter |
|T17.1XXS |Foreign body in nostril, sequela |
|Z01.10 |Encounter for examination of ears and hearing without abnormal findings |
|Z01.110 |Encounter for hearing examination following failed hearing screening |
|Z01.118 |Encounter for examination of ears and hearing with other abnormal findings |
|Z08 |Encounter for follow-up examination after completed treatment for malignant neoplasm |
|Z09 |Encounter for follow-up examination after completed treatment for condition other than malignant neoplasm |
|Z43.0 |Encounter for attention to tracheostomy |
|Z44.8 |Encounter for fitting and adjustment of other external prosthetic devices |
|Z71.1 |Person with feared health complaint in whom no diagnosis is made |
|Z79.899 |Other long term (current) drug therapy |
|Z09 |Encounter for follow-up examination after completed treatment for condition other than malignant neoplasm |
|Z43.0 |Encounter for attention to tracheostomy |
|Z44.8 |Encounter for fitting and adjustment of other external prosthetic devices |
|Z71.1 |Person with feared health complaint in whom no diagnosis is made |
|Z79.899 |Other long term (current) drug therapy |
|Z09 |Encounter for follow-up examination after completed treatment for condition other than malignant neoplasm |
|Z43.0 |Encounter for attention to tracheostomy |
|Z44.8 |Encounter for fitting and adjustment of other external prosthetic devices |
|Z71.1 |Person with feared health complaint in whom no diagnosis is made |
|Z79.899 |Other long term (current) drug therapy |
Disclaimer: This sample ICD-10 superbill is designed to assist otolaryngology practices in quickly completing and submitting procedure(s) and diagnosis(s) codes from a patient visit for reimbursement. It is generally customized for an otolaryngology office and contains fields for patient information, the most common CPT (procedure) and ICD-10-CM (diagnostic) codes used by Otolaryngologists. Members should note that this superbill is designed solely as an exercise in demonstrating the process of transitioning to the new ICD-10-CM coding system, and does not represent an endorsement by the Academy of the use of superbills or this particular superbill format.
For more information on the transition to ICD-10 please contact the health policy team at: healthpolicy@.
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