Ear, Nose and Throat Superbill TemplateDate 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 hemorrhage control

30903

Spontaneous nystagmus, with recording

92541

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 DiagnosisC00.9 Malignant neoplasm of lip, unspecifiedC01 Malignant neoplasm of base of tongueC02.3 Malignant neoplasm of anterior two-thirds of tongue, part unspecifiedC04.9 Malignant neoplasm of floor of mouth, unspecifiedC05.0 Malignant neoplasm of hard palateC06.9 Malignant neoplasm of mouth, unspecifiedC07 Malignant neoplasm of parotid glandC08.0 Malignant neoplasm of submandibular glandC10.9 Malignant neoplasm of oropharynx, unspecifiedC11.9 Malignant neoplasm of nasopharynx, unspecifiedC13.9 Malignant neoplasm of hypopharynx, unspecifiedC30.0 Malignant neoplasm of nasal cavityC32.0 Malignant neoplasm of glottisC32.1 Malignant neoplasm of supraglottisC32.9 Malignant neoplasm of larynx, unspecifiedC44.00 Unspecified malignant neoplasm of skin of lipC44.01 Basal cell carcinoma of skin of lipC44.02 Squamous cell carcinoma of skin of lipC44.09 Other specified malignant neoplasm of skin of lipC44.202 Unspecified malignant neoplasm of skin of right ear and external auricular canalC44.209 Unspecified malignant neoplasm of skin of left ear and external auricular canalC44.212 Basal cell carcinoma of skin of right ear and external auricular canalC44.219 Basal cell carcinoma of skin of left ear and external auricular canalC44.222 Squamous cell carcinoma of skin of right ear and external auricular canalC44.229 Squamous cell carcinoma of skin of left ear and external auricular canalC44.301 Unspecified malignant neoplasm of skin of noseC44.309 Unspecified malignant neoplasm of other parts of faceC44.311 Basal cell carcinoma of skin of noseC44.319 Basal cell carcinoma of skin of other parts of faceC44.321 Squamous cell carcinoma of skin of noseC44.329 Squamous cell carcinoma of skin of other parts of faceC44.40 Unspecified malignant neoplasm of skin of scalp and neckC44.41 Basal cell carcinoma of skin of scalp and neckC44.42 Squamous cell carcinoma of skin of scalp and neckC44.49 Other specified malignant neoplasm of skin of scalp and neckC73 Malignant neoplasm of thyroid glandC77.0 Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neckD00.01 Carcinoma in situ of labial mucosa and vermilion borderD00.02 Carcinoma in situ of buccal mucosaD00.03 Carcinoma in situ of gingiva and edentulous alveolar ridgeD00.04 Carcinoma in situ of soft palateD00.05 Carcinoma in situ of hard palateD00.06 Carcinoma in situ of floor of mouthD00.07 Carcinoma in situ of tongueD00.08 Carcinoma in situ of pharynxD10.30 Benign neoplasm of unspecified part of mouthD10.39 Benign neoplasm of other parts of mouthD11.0 Benign neoplasm of parotid glandD11.7 Benign neoplasm of other major salivary gland

D14.0 Benign neoplasm of middle ear, nasal cavity and accessory sinusesD14.1 Benign neoplasm of larynxD22.11 Melanocytic nevi of right eyelid, including canthusD22.12 Melanocytic nevi of left eyelid, including canthusD23.11 Other benign neoplasm of skin of right eyelid, including canthusD23.12 Other benign neoplasm of skin of left eyelid, including canthusD33.3 Benign neoplasm of cranial nervesD35.2 Benign neoplasm of pituitary glandD37.01 Neoplasm of uncertain behavior of lipD37.02 Neoplasm of uncertain behavior of tongueD37.030 Neoplasm of uncertain behavior of the parotid salivary glandsD37.031 Neoplasm of uncertain behavior of the sublingual salivary glandsD37.032 Neoplasm of uncertain behavior of the submandibular salivary glandsD37.04 Neoplasm of uncertain behavior of the minor salivary glandsD37.05 Neoplasm of uncertain behavior of pharynxD37.09 Neoplasm of uncertain behavior of other specified sites of the oral cavityD38.0 Neoplasm of uncertain behavior of larynxD48.5 Neoplasm of uncertain behavior of skinD49.0 Neoplasm of unspecified behavior of digestive systemD49.1 Neoplasm of uncertain behavior of respiratory systemD49.2 Neoplasm of uncertain behavior of bone, soft tissue, and skinD49.7 Neoplasm of uncertain behavior of endocrine glands and other parts of nervous systemE04.1 Nontoxic single thyroid noduleE04.2 Nontoxic multinodular goiterE05.90 Thyrotoxicosis, unspecified without thyrotoxic crisis or stormE06.9 Thyroiditis, unspecifiedE21.0 Primary hyperparathyroidismE21.1 Secondary hyperparathyroidism, not elsewhere classifiedE21.2 Other hyperparathyroidismE84.9 Cystic fibrosisF45.8 Other somatoform disordersF80.4 Speech and language development delay due to hearing lossG47.09 Other insomniaG47.19 Other hypersomniaG47.30 Sleep apnea, unspecifiedG47.33 Obstructive sleep apnea (adult) (pediatric)G50.1 Atypical facial painG51.0 Bell’s palsyH6.301 Acquired stenosis of right external ear canal, unspecified H60.331 Swimmer’s ear, right earH60.332 Swimmer’s ear, left earH60.333 Swimmer’s ear, bilateralH60.391 Other infective otitis externa, right earH60.392 Other infective otitis externa, left earH60.393 Other infective otitis externa, bilateralH60.511 Acute actinic otitis externa, right earH60.512 Acute actinic otitis externa, left earH60.513 Acute actinic otitis externa, bilateralH60.521 Acute chemical otitis externa, right earH60.522 Acute chemical otitis externa, left earH60.523 Acute chemical otitis externa, bilateralH60.531 Acute contact otitis externa, right earH60.532 Acute contact otitis externa, left earH60.533 Acute contact otitis externa, bilateralH60.541 Acute eczematoid otitis externa, right earH60.542 Acute eczematoid otitis externa, left earH60.543 Acute eczematoid otitis externa, bilateralH60.551 Acute reactive otitis externa, right earH60.552 Acute reactive otitis externa, left earH60.553 Acute reactive otitis externa, bilateralH60.591 Other noninfective acute otitis externa, right earH60.592 Other noninfective acute otitis externa, left earH60.593 Other noninfective acute otitis externa, bilateral

H60.61 Unspecified chronic otitis externa, right earH60.62 Unspecified chronic otitis externa, left earH60.63 Unspecified chronic otitis externa, bilateralH61.011 Acute perichondritis of right external earH61.012 Acute perichondritis of left external earH61.013 Acute perichondritis of external ear, bilateralH61.021 Chronic perichondritis of right external earH61.022 Chronic perichondritis of left external earH61.023 Chronic perichondritis of external ear, bilateralH61.121 Hematoma of pinna, right earH61.122 Hematoma of pinna, left earH61.123 Hematoma of pinna, bilateralH61.21 Impacted cerumen, right earH61.22 Impacted cerumen, left earH61.23 Impacted cerumen, bilateralH61.302 Acquired stenosis of left external ear canal, unspecifiedH61.303 Acquired stenosis of external ear canal, unspecified, bilateralH61.391 Other acquired stenosis of right external ear canalH61.392 Other acquired stenosis of left external ear canalH61.393 Other acquired stenosis of external ear canal, bilateralH61.811 Exostosis of right external ear canalH61.812 Exostosis of left external ear canalH61.813 Exostosis of external ear canal, bilateralH65.01 Acute serous otitis media, right earH65.02 Acute serous otitis media, left earH65.03 Acute serous otitis media, bilateralH65.04 Acute serous otitis media, recurrent, right earH65.05 Acute serous otitis media, recurrent, left earH65.06 Acute serous otitis media, recurrent, bilateralH65.91 Unspecified nonsuppurative otitis media, right earH65.92 Unspecified nonsuppurative otitis media, left earH65.93 Unspecified nonsuppurative otitis media, bilateralH66.001 Acute suppurative otitis media without spontaneous rupture of ear drum, right earH66.002 Acute suppurative otitis media without spontaneous rupture of ear drum, left earH66.003 Acute suppurative otitis media without spontaneous rupture of ear drum, bilateralH66.004 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right

earH66.005 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left

earH66.006 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent,

bilateralH66.011 Acute suppurative otitis media with spontaneous rupture of ear drum, right earH66.012 Acute suppurative otitis media with spontaneous rupture or ear drum, left earH66.013 Acute suppurative otitis media with spontaneous rupture of ear drum, bilateralH66.014 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, right earH66.015 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, left earH66.016 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, bilateralH66.11 Chronic tubotympanic suppurative otitis media, right earH66.12 Chronic tubotympanic suppurative otitis media, left earH66.13 Chronic tubotympanic suppurative otitis media, bilateralH66.21 Chronic atticoantral suppurative otitis media, right earH66.22 Chronic atticoantral suppurative otitis media, left earH66.23 Chronic atticoantral suppurative otitis media, bilateralH66.3X1 Other chronic suppurative otitis media, right earH66.3X2 Other chronic suppurative otitis media, left earH66.3X3 Other chronic suppurative otitis media, bilateralH66.91 Otitis media, unspecified, right earH66.92 Otitis media, unspecified, left earH66.93 Otitis media, unspecified, bilateralH69.81 Other specified disorder of Eustachian tube, right earH69.82 Other specified disorder of Eustachian tube, left earH69.83 Other specified disorder of Eustachian tube, bilateralH70.11 Chronic mastoiditis, right ear

H70.12 Chronic mastoiditis, left earH70.13 Chronic mastoiditis, bilateralH71.01 Cholesteatoma of attic, right earH71.02 Cholesteatoma of attic, left earH71.03 Cholesteatoma of attic, bilateralH71.11 Cholesteatoma of tympanum, right earH71.12 Cholesteatoma of tympanum, left earH71.13 Cholesteatoma of tympanum, bilateralH71.21 Cholesteatoma of mastoid, right earH71.22 Cholesteatoma of mastoid, left earH71.23 Cholesteatoma of mastoid, bilateralH71.91 Unspecified cholesteatoma, right earH71.92 Unspecified cholesteatoma, left earH71.93 Unspecified cholesteatoma, bilateralH72.01 Central perforation of tympanic membrane, right earH72.01 Central perforation of tympanic membrane, right earH72.02 Central perforation of tympanic membrane, left earH72.02 Central perforation of tympanic membrane, left earH72.03 Central perforation of tympanic membrane, bilateralH72.03 Central perforation of tympanic membrane, bilateralH72.11 Attic perforation of tympanic membrane, right earH72.12 Attic perforation of tympanic membrane, left earH72.13 Attic perforation of tympanic membrane, bilateralH72.2X1 Other marginal perforations of tympanic membrane, right earH72.2X2 Other marginal perforations of tympanic membrane, left earH72.2X3 Other marginal perorations of tympanic membrane, bilateralH72.811 Multiple perforations of tympanic membrane, right earH72.812 Multiple perforations of tympanic membrane, left earH72.813 Multiple perforations of tympanic membrane, bilateralH72.91 Unspecified perforation of tympanic membrane, right earH72.92 Unspecified perforation of tympanic membrane, left earH72.93 Unspecified perforation of tympanic membrane, bilateralH73.11 Chronic myringitis, right earH73.12 Chronic myringitis, left earH73.13 Chronic myringitis, bilateralH74.11 Adhesive right middle ear diseaseH74.12 Adhesive left middle ear diseaseH74.13 Adhesive middle ear disease, bilateralH80.91 Unspecified otosclerosis, right earH80.92 Unspecified otosclerosis, left earH80.93 Unspecified otosclerosis, bilateralH81.01 Meniere’s disease, right earH81.02 Meniere’s disease, left earH81.03 Meniere’s disease, bilateralH81.11 Benign paroxysmal vertigo, right earH81.12 Benign paroxysmal vertigo, left earH81.13 Benign paroxysmal vertigo, bilateralH81.41 Vertigo of central origin, right earH81.42 Vertigo of central origin, left earH81.43 Vertigo of central origin, bilateralH83.2X1 Labyrinthine dysfunction, right earH83.2X2 Labyrinthine dysfunction, left earH83.2X3 Labyrinthine dysfunction, bilateralH83.3X1 Noise effects on right inner earH83.3X2 Noise effect on left inner earH83.3X3 Noise effects on inner ear, bilateralH90.0 Conductive hearing loss, bilateralH90.11 Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral

sideH90.12 Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral

sideH90.2 Conductive hearing loss, unspecifiedH90.3 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 lossH90.6 Mixed conductive and sensorineural hearing loss, bilateralH90.71 Mixed conductive and sensorineural hearing loss, unilateral, right ear, with

unrestricted hearing on the contralateral sideH90.72 Mixed conductive and sensorineural hearing loss, unilateral, left ear, with unrestricted

hearing on the contralateral sideH90.8 Mixed conductive and sensorineural hearing loss, unspecifiedH91.11 Presbycusis, right earH91.12 Presbycusis, left earH91.13 Presbycusis, bilateralH91.91 Unspecified hearing loss, right earH91.92 Unspecified hearing loss, left earH91.93 Unspecified hearing loss, bilateralH92.01 Otalgia, right earH92.02 Otalgia, left earH92.03 Otalgia, bilateralH93.11 Tinnitus, right earH93.12 Tinnitus, left earH93.13 Tinnitus, bilateralH93.291 Other abnormal auditory perceptions, right earH93.292 Other abnormal auditory perceptions, left earH93.293 Other abnormal auditory perceptions, bilateralJ01.80 Other acute sinusitisJ01.81 Other acute recurrent sinusitisJ01.90 Acute sinusitis, unspecifiedJ01.91 Acute recurrent sinusitis, unspecifiedJ02.8 Acute pharyngitis due to other specified organismJ02.9 Acute pharyngitis, unspecifiedJ04.0 Acute laryngitisJ30.0 Vasomotor rhinitisJ30.1 Allergic rhinitis due to pollenJ30.2 Other seasonal allergic rhinitisJ30.89 Other allergic rhinitisJ30.9 Allergic rhinitis, unspecifiedJ31.0 Chronic rhinitisJ31.2 Chronic pharyngitisJ32.0 Chronic maxillary sinusitisJ32.1 Chronic frontal sinusitisJ32.2 Chronic ethmoidal sinusitisJ32.3 Chronic sphenoidal sinusitisJ32.4 Chronic pansinusitisJ32.8 Other chronic sinusitisJ33.0 Polyp of nasal cavityJ33.1 Polypoid sinus degenerationJ33.8 Other poly of sinusJ34.2 Deviated nasal septumJ34.3 Hypertrophy of nasal turbinatesJ34.81 Nasal mucositis (ulcerative)J34.89 Other specified disorder of nose and nasal sinusesJ35.01 Chronic tonsillitisJ35.02 Chronic adenoiditisJ35.03 Chronic tonsillitis and adenoiditisJ35.1 Hypertrophy of tonsilsJ35.2 Hypertrophy of adenoidsJ35.3 Hypertrophy of tonsils with hypertrophy of adenoidsJ36 Peritonsillar abscessJ37.0 Chronic laryngitisJ38.01 Paralysis of vocal cords and larynx, unilateralJ38.02 Paralysis of vocal cords and larynx, bilateral

J38.1 Polyp of vocal cord and larynxJ38.2 Nodules of vocal cordsJ38.3 Other diseases of vocal cordsJ38.4 Edema of larynxJ38.5 Laryngeal spasmJ38.6 Stenosis of larynxJ38.7 Other disease of larynxJ96.01 Acute respiratory failure with hypoxiaJ96.02 Acute respiratory failure with hypercapniaJ96.11 Chronic respiratory failure with hypoxiaJ96.12 Chronic respiratory failure with hypercapniaJ96.21 Acute and chronic respiratory failure with hypoxiaJ96.22 Acute and chronic respiratory failure with hypercapniaK09.8 Other cysts of oral region, not elsewhere classifiedK09.9 Cyst of oral region, unspecifiedK11.21 Acute sialoadenitisK11.22 Acute recurrent sialoadenitisK11.23 Chronic sialoadenitisK11.5 SialolithiasisK11.6 Mucocele of salivary glandK12.30 Oral mucositis (ulcerative), unspecifiedK13.0 Disease of lipsK13.4 Granuloma and granuloma-like lesions of oral mucosaK13.6 Irritative hyperplasia of oral mucosaK13.70 Unspecified lesions of oral mucosaK13.79 Other lesions of oral mucosaK14.0 GlossitisK21.0 Gastro-esophageal reflux disease with esophagitisK21.9 Gastro-esophageal reflux disease without esophagitisK22.5 Diverticulum of esophagus, acquiredL03.211 Cellulitis of faceL03.221 Cellulitis of neckL72.0 Epidermal cystL72.11 Pilar cystL72.12 Trichodermal cystL72.2 Steatocystoma multiplexL72.3 Sebaceous cystL72.8 Other follicular cysts of the skin and subcutaneous tissueL91.0 Hypertrophic scarM26.60 Temporomandibular joint disorders, unspecifiedM26.69 Other specified disorders of temporomandibular jointM54.2 CervicalgiaM95.0 Acquired deformity of noseQ16.1 Congenital absence, atresia and stricture of auditory canal (external)Q18.0 Sinus, fistula and cyst of branchial cleftQ31.0 Web of larynxQ31.1 Congenital subglottic stenosisQ31.2 Laryngeal hypoplasiaQ31.3 LaryngoceleQ31.5 Congenital laryngomalaciaQ31.8 Other congenital malformation of larynxQ32.0 Congenital tracheomalaciaQ32.1 Other congenital malformations of tracheaQ32.2 Congenital bronchomalaciaQ32.3 Congenital stenosis of bronchusQ32.4 Other congenital malformations of bronchusQ38.1 AnkyloglossiaQ89.2 Congenital malformations of other endocrine glandsR04.0 EpistaxisR04.2 HemoptysisR04.89 Hemorrhage from other sites in respiratory passagesR04.9 Hemorrhage from respiratory passages, unspecifiedR05 Cough

R06.00 Dyspnea, unspecifiedR06.09 Other forms of dyspneaR06.1 StridorR06.89 Other abnormalities of breathingR13.10 Dysphagia, unspecifiedR22.0 Localized swelling, mass and lump, headR22.1 Localized swelling, mass and lump, neckR42 Dizziness and giddinessR43.0 AnosmiaR43.1 ParosmiaR43.2 ParageusiaR43.8 Other disturbance of smell and tasteR49.0 DysphoniaR51 HeadacheR59.0 Localized enlarged lymph nodesR59.1 Generalized enlarged lymph nodesR59.9 Enlarged lymph nodes, unspecifiedS02.10XA Unspecified fracture of base of skull, initial encounter for closed fractureS02.10XB Unspecified fracture of base of skull, initial encounter for open fractureS02.10XD Unspecified fracture of base of skull, subsequent encounter for fracture with routine

healingS02.10XG Unspecified fracture of base of skull, subsequent encounter for fracture with delayed

healingS02.10XK Unspecified fracture of base of skull, subsequent encounter for fracture with nonunionS02.10XS Unspecified fracture of base of skull, sequelaS02.2XXA Fracture of nasal bones, initial encounter for closed fractureS02.2XXB Fracture of nasal bones, initial encounter for open fractureS02.2XXD Fracture of nasal bones, subsequent encounter for fracture with routine healingS02.2XXG Fracture of nasal bones, subsequent encounter for fracture with delayed healingS02.2XXK Fracture of nasal bones, subsequent encounter for fracture with nonunionS02.2XXS Fracture of nasal bones, sequelaS02.3XXA Fracture of orbital floor, initial encounter for closed fractureS02.3XXB Fracture of orbital floor, initial encounter for open fractureS02.3XXD Fracture of orbital floor, subsequent encounter for fracture with routine healingS02.3XXG Fracture of orbital floor, subsequent encounter for fracture with delayed healingS02.3XXK Fracture of orbital floor, subsequent encounter for fracture with nonunionS02.3XXS Fracture of orbital floor, sequelaS02.401A Maxillary fracture, unspecified, initial encounter for closed fractureS02.401B Maxillary fracture, unspecified, initial encounter for open fractureS02.401D Maxillary fracture, unspecified, subsequent encounter for fracture with routine healingS02.401G Maxillary fracture, unspecified, subsequent encounter for fracture with delayed healingS02.401K Maxillary fracture, unspecified, subsequent encounter for fracture with nonunionS02.401S Maxillary fracture, unspecified, sequelaS02.402A Zygomatic fracture, unspecified, initial encounter for closed fractureS02.402B Zygomatic fracture, unspecified, initial encounter for open fractureS02.402D Zygomatic fracture, unspecified, subsequent encounter for fracture with routine healingS02.402G Zygomatic fracture, unspecified, subsequent encounter for fracture with delayed healingS02.402K Zygomatic fracture, unspecified, subsequent encounter for fracture with nonunionS02.402S Zygomatic fracture, unspecified, sequelaS02.411A LeFort I fracture, initial encounter for closed fractureS02.411B LeFort I fracture, initial encounter for open fractureS02.411D LeFort I fracture, subsequent encounter for fracture with routine healingS02.411G LeFort I fracture, subsequent encounter for fracture with delayed healingS02.411K LeFort I fracture, subsequent encounter for fracture with nonunionS02.411S LeFort I fracture, sequelaS02.413A LeFort III fracture, initial encounter for closed fractureS02.413B LeFort III fracture, initial encounter for open fractureS02.413D LeFort III fracture, subsequent encounter for fracture with routine healingS02.413G LeFort III fracture, subsequent encounter for fracture with delayed healingS02.413K LeFort III fracture, subsequent encounter for fracture with nonunionS02.413S LeFort III fracture, sequelaS02.42XA Fracture of alveolus maxilla, initial encounter for closed fractureS02.42XB Fracture of alveolus maxilla, initial encounter for open fracture

S02.42XD Fracture of alveolus maxilla, subsequent encounter for fracture with routine healingS02.402G Zygomatic fracture, unspecified, subsequent encounter for fracture with delayed healingS02.402K Zygomatic fracture, unspecified, subsequent encounter for fracture with nonunionS02.402S Zygomatic fracture, unspecified, sequelaS02.411A LeFort I fracture, initial encounter for closed fractureS02.411B LeFort I fracture, initial encounter for open fractureS02.411D LeFort I fracture, subsequent encounter for fracture with routine healingS02.411G LeFort I fracture, subsequent encounter for fracture with delayed healingS02.411K LeFort I fracture, subsequent encounter for fracture with nonunionS02.411S LeFort I fracture, sequelaS02.413A LeFort III fracture, initial encounter for closed fractureS02.413B LeFort III fracture, initial encounter for open fractureS02.413D LeFort III fracture, subsequent encounter for fracture with routine healingS02.413G LeFort III fracture, subsequent encounter for fracture with delayed healingS02.413K LeFort III fracture, subsequent encounter for fracture with nonunionS02.413S LeFort III fracture, sequelaS02.42XA Fracture of alveolus maxilla, initial encounter for closed fractureS02.42XB Fracture of alveolus maxilla, initial encounter for open fractureS02.42XD Fracture of alveolus maxilla, subsequent encounter for fracture with routine healingS02.413D LeFort III fracture, subsequent encounter for fracture with routine healingS02.413G LeFort III fracture, subsequent encounter for fracture with delayed healingS02.413K LeFort III fracture, subsequent encounter for fracture with nonunionS02.413S LeFort III fracture, sequelaS02.42XA Fracture of alveolus maxilla, initial encounter for closed fractureS02.42XB Fracture of alveolus maxilla, initial encounter for open fractureS02.42XD Fracture of alveolus maxilla, subsequent encounter for fracture with routine healingS02.42XG Fracture of alveolus maxilla, subsequent encounter for fracture with delayed healingS02.42XK Fracture of alveolus maxilla, subsequent encounter for fracture with nonunionS02.42XS Fracture of alveolus maxilla, sequelaS09.21XA Traumatic rupture of right ear drum, initial encounter S09.21XD Traumatic rupture of right ear drum, subsequent encounterS09.21XS Traumatic rupture of right ear drum, sequelaS09.22XA Traumatic rupture of left ear drum, initial encounterS09.22XD Traumatic rupture of left ear drum, subsequent encounterS09.22XS Traumatic rupture of left ear drum, sequelaS09.92XA Unspecified injury of nose, initial encounterS09.92XD Unspecified injury of nose, subsequent encounterS09.92XS Unspecified injury of nose, sequelaS09.93XA Unspecified injury of face, initial encounterS09.93XD Unspecified injury of face, subsequent encounterS09.93XS Unspecified injury of face, sequelaS16.8XXA Other specified injury of muscle, fascia and tendon at neck level, initial encounterS16.8XXD Other specified injury of muscle, fascia and tendon at neck level, subsequent encounterS16.8XXS Other specified injury of muscle, fascia and tendon at neck level, sequelaS19.81XA Other specified injuries of larynx, initial encounterS19.81XD Other specified injuries of larynx, subsequent encounterS19.81XS Other specified injuries of larynx, sequelaS19.82XA Other specified injuries of cervical trachea, initial encounterS19.82XD Other specified injuries of cervical trachea, subsequent encounterS19.82XS Other specified injuries of cervical trachea, sequelaS19.83XA Other specified injuries of vocal cord, initial encounterS19.83XD Other specified injuries of vocal cord, subsequent encounterS19.83XS Other specified injuries of vocal cord, sequelaS19.84XA Other specified injuries of thyroid gland, initial encounterS19.84XD Other specified injuries of thyroid gland, subsequent encounterS19.84XS Other specified injuries of thyroid gland, sequelaS19.85XA Other specified injuries of pharynx and cervical esophagus, initial encounterS19.85XD Other specified injuries of pharynx and cervical esophagus, subsequent encounterS19.85XS Other specified injuries of pharynx and cervical esophagus, sequelaS19.9XXA Unspecified injury of neck, initial encounterS19.9XXD Unspecified injury of neck, subsequent encounterS19.9XXS Unspecified injury of neck, sequelaT16.1XXA Foreign body in right ear, initial encounter

T16.1XXD Foreign body in right ear, subsequent encounterT16.1XXS Foreign body in right ear, sequelaT16.2XXA Foreign body in left ear, initial encounterT16.2XXD Foreign body in left ear, subsequent encounterT16.2XXS Foreign body in left ear, sequelaT17.0XXA Foreign body in nasal sinus, initial encounterT17.0XXD Foreign body in nasal sinus, subsequent encounterT17.0XXS Foreign body in nasal sinus, sequelaT17.1XXA Foreign body in nostril, initial encounterT17.1XXD Foreign body in nostril, subsequent encounterT17.1XXS Foreign body in nostril, sequelaZ01.10 Encounter for examination of ears and hearing without abnormal findingsZ01.110 Encounter for hearing examination following failed hearing screeningZ01.118 Encounter for examination of ears and hearing with other abnormal findingsZ08 Encounter for follow-up examination after completed treatment for malignant

neoplasmZ09 Encounter for follow-up examination after completed treatment for condition other

than malignant neoplasmZ43.0 Encounter for attention to tracheostomyZ44.8 Encounter for fitting and adjustment of other external prosthetic devicesZ71.1 Person with feared health complaint in whom no diagnosis is madeZ79.899 Other long term (current) drug therapyZ09 Encounter for follow-up examination after completed treatment for condition other

than malignant neoplasmZ43.0 Encounter for attention to tracheostomyZ44.8 Encounter for fitting and adjustment of other external prosthetic devicesZ71.1 Person with feared health complaint in whom no diagnosis is madeZ79.899 Other long term (current) drug therapyZ09 Encounter for follow-up examination after completed treatment for condition other

than malignant neoplasmZ43.0 Encounter for attention to tracheostomyZ44.8 Encounter for fitting and adjustment of other external prosthetic devicesZ71.1 Person with feared health complaint in whom no diagnosis is madeZ79.899 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@entnet.org.