ICD-10 H95.813
Billable / Specific CCPostprocedural stenosis of external ear canal, bilateral
About ICD-10-CM H95.813
ICD-10-CM code H95.813 represents Postprocedural stenosis of external ear canal, bilateral. This is a billable/specific code in the Ear and Mastoid Process chapter (block H95). The 2026 edition of ICD-10-CM H95.813 became effective on October 1, 2025.
Coding Tips for H95.813
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
H95.813 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inpatient DRG Impact, CC
codes Postprocedural stenosis of external ear canal, bilateral. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for H95.813
Local Coverage Determinations (LCDs) from CMS MACs that list H95.813 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing H95.813.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but H95.813 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with H95.813
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert H95.813 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| H95.813 | 99799 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To H95.813
Other codes in section H95 (Intraoperative and postprocedural complications and disorders of ear and mastoid process, not elsewhere classified).
ICD-10 H95.813, Billing FAQ
Is ICD-10 code H95.813 billable? +
Yes, H95.813 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Is H95.813 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does H95.813 map to? +
Per CMS GEMs, H95.813 maps to ICD-9 codes: 99799. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on July 16, 2026.
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