H95.819 — Postprocedural stenosis of unspecified external ear canal
Is H95.819 billable?
Yes, but H95.819 will trip a Medicare edit. H95.819 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists H95.819 under Medicare Code Editor edit 20, “Unspecified code” — meaning a code specifying laterality (right, left or bilateral) exists in the same family. On an inpatient claim this triggers the edit, because CMS holds that there are very limited circumstances in which laterality cannot be documented.
H95.819 at a glance
| Code | H95.819 |
|---|---|
| Description | Postprocedural stenosis of unspecified external ear canal |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
What Medicare edits apply to H95.819?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name H95.819 directly.
A code specifying laterality (right, left or bilateral) exists in the same family. CMS holds that there are very limited circumstances in which laterality cannot be documented.
Which MS-DRGs does H95.819 group to?
H95.819 sits in MDC 21 and helps define the logic of 3 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 919Complications of Treatment with MCCmedical
- 920Complications of Treatment with CCmedical
- 921Complications of Treatment without CC/MCCmedical
As a secondary diagnosis, H95.819 is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is H95.819 listed in the Alphabetic Index?
The Alphabetic Index lists these routes under H95.81, the nearest indexed parent of H95.819. Use them to find the family, then select the specific code.
- Stenosis, stenotic › external ear canal › postprocedural (cicatricial)
- Complication › ear procedure › postoperative › external ear canal stenosis (s) (from) (of)
- Complication › mastoidprocedure › postoperative › external ear canal stenosis (s) (from) (of)
Excludes2 — not included here — inherited from Chapter 8
The conditions below are not part of H95.819, but a patient may have both at the same time. When documentation supports it, H95.819 and the excluded code may both be reported.
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Excludes2 — not included here — inherited from H95.8
The conditions below are not part of H95.819, but a patient may have both at the same time. When documentation supports it, H95.819 and the excluded code may both be reported.
How long has H95.819 existed?
H95.819 has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.