ICD-10 Coding for Hearing Loss Due to Foreign Body in Ear
The appropriate ICD-10 code is H61.2 (Impacted cerumen) if the foreign body is cerumen, or T16.- (Foreign body in ear) for other objects, combined with H90.- or H91.- codes to specify the type and laterality of hearing loss.
Primary Coding Approach
Foreign Body Code (Required)
- Use T16.1 (Foreign body in right ear) or T16.2 (Foreign body in left ear) as the primary diagnosis code when an object is lodged in the external auditory canal 1, 2
- If the foreign body is specifically cerumen impaction, use H61.2 (Impacted cerumen) instead, with laterality specified as H61.21 (right), H61.22 (left), or H61.23 (bilateral) 1, 2
Hearing Loss Code (Secondary)
- Add a secondary code to specify the type of hearing loss caused by the foreign body 1
- Use H90.0 (Conductive hearing loss, bilateral), H90.1 (Conductive hearing loss, unilateral, right ear), or H90.2 (Conductive hearing loss, unilateral, left ear) since foreign bodies in the ear canal cause conductive hearing loss by blocking sound transmission 1, 3
- The conductive hearing loss occurs because the foreign body obstructs the external auditory canal, preventing sound waves from reaching the tympanic membrane 1
Clinical Context for Accurate Coding
Confirming Conductive Hearing Loss
- Physical examination with otoscopy will reveal the foreign body obstructing the ear canal 1
- Tuning fork testing (Weber and Rinne tests) should demonstrate conductive hearing loss patterns: sound lateralizes to the affected ear on Weber test, and bone conduction exceeds air conduction on Rinne test 1, 3
- Foreign bodies causing conductive hearing loss include cotton swabs, hearing aid parts, jewelry, paper products, insects, and cerumen impaction 1, 2
Important Coding Pitfalls to Avoid
- Never code for sensorineural hearing loss (H90.3-H90.5) when a foreign body is present, as foreign bodies cause conductive, not sensorineural hearing loss 1
- The foreign body must be removed before establishing a final diagnosis of any underlying hearing loss, as impacted cerumen alone can reduce hearing by 10-15 dB in mid to high frequencies 1
- If hearing loss persists after foreign body removal, reassess and recode appropriately, as this may indicate tympanic membrane perforation (H72.-) or other complications 1, 4
Special Populations Requiring Attention
High-Risk Groups
- Elderly patients, young children (especially under 5 years), cognitively impaired individuals, and hearing aid users have higher incidence of foreign bodies and cerumen impaction 1, 5, 2
- These patients may be unable to express symptoms, requiring clinicians to examine for foreign bodies during routine healthcare encounters 1
- In hearing aid users, examine for cerumen impaction at least every three months, as hearing aids can stimulate excessive cerumen production through "mechanical milking" 1