Ear, Nose and Throat Superbill Template

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

mouth, sublingual, superficial

41005 MOD. Flexible laryngoscopy with

removal of lesion 31578

Level I 99201 99211 I&D, intraoral, tongue, floor of

mouth, sublingual, superficial

41005 Flexible laryngoscopy with

stroboscopy 31579

Level II 99202 99212 I&D, extraoral, floor of mouth,

sublingual 41015 Incision of labial frenulum 40806

Level III 99203 99213 I&D, extraoral, floor of mouth,

submental 41016 Excision lingual frenulum 41115

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 (thermal, cryo) 42160

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 Removal of foreign body,

intranasal 30300

Consultation Level V 99245 Myringotomy 69420 Removal of foreign body, external

auditory canal 69200

Biopsy Tympanostomy 69433 Vestibular Function Tests

Biopsy (Skin) 11100 Tympanostomy with general

anesthesia 69436 Spontaneous nystagmus 92531

each additional skin biopsy 11001 Impacted cerumen removal 69210 Caloric vestibular test 92532

Biopsy, nasal 30100 Control of Nasal Bleed Optokinetic nystagmus test 92534

Biopsy, lip 40490 Simple nasal hemorrhage

control 30901 Basic vestibular evaluation, with

recording 92540

Biopsy, vestibule of mouth 40808 Anterior, complete nasal 30903 Spontaneous nystagmus, with 92541

hemorrhage control recording

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 Caloric vestibular test, with

recording 92543

Biopsy, floor of mouth 41108 Diagnostic nasal endoscopy 31231 Optokinetic nystagmus test, with

recording 92544

Biopsy, palate, uvula 42100 Maxillary sinusoscopy 31232 Oscillating tracking test, with

recording 92545

Biopsy, oropharynx 42800 Sphenoid sinusoscopy 31235 Tympanometry and reflex

threshold measurements 92550

Biopsy, hypopharynx 42802 Nasal endoscopic biopsy,

polypectomy or debridement 31237 Pure tone screening 92551

Biopsy, nasopharynx, visible

lesion 42804 Nasal endoscopic hemorrhage

control 31238 Pure tone audiometry; air only 92552

Biopsy, nasopharynx,

unknown primary 42806 Nasal endoscopy with

dacryocystorhinostomy 31239 Pure tone audiometry: air and

bone 92553

Sialolithotomy Nasal endoscopy with concha

bullosa resection 31240 Speech audiometry threshold 92555

Sialolithotomy,

uncomplicated, intraoral 42330 Endoscopic partial

ethmoidectomy 31254 Speech audiometry threshold with

speech recognition 92556

Sialolithotomy,

submandibular, complicated,

intraoral

42335 Endoscopic total

ethmoidectomy 31255 Comprehensive audiometry 92557

Sialolithotomy, parotid,

extraoral or complicated

intraoral

42340 Endoscopic maxillary

antrostomy 31256 Percutaneous allergy skin test 95004

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

collection 10140 Endoscopic removal of

sphenoid tissue 31288 Single allergy injection (including

extract) 95120

Puncture aspiration of

abscess, cyst, hematoma 10160 Endoscopic maxillary sinus

dilation 31295 Two or more allergy injections

(including extract) 95125

I&D complex, postoperative

wound infection 10180 Endoscopic frontal sinus

dilation 31296 Preparation and provision of

antigens 95165

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 Nasopharyngoscopy 92511

I&D vestibule of mouth,

simple 40800 Flexible diagnostic

laryngoscopy 31575 Single allergy injection (without

extract provision) 95115

I&D vestibule of mouth,

complicated 40801 Flexible laryngoscopy with

biopsy 31576 Venipuncture 36415

I&D, intraoral, tongue, floor of

mouth, lingual 41000 Flexible laryngoscopy with

foreign body removal 31577 Handling 99000

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















S02.42XG 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











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: [email protected].

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Ear, Nose and Throat Superbill Template