ICD-10 Coding for Recurrent Otitis Media(H66.004, H65.114)
Complete ICD-10-CM coding and documentation guide for Recurrent Otitis Media. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Recurrent Otitis Media
H65-H67Primary Range
Diseases of middle ear and mastoid
This range includes all types of otitis media, including recurrent cases.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H66.004 | Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear | Use when there are multiple episodes of acute suppurative otitis media in the right ear without rupture. |
|
| H65.114 | Acute and subacute recurrent otitis media, right ear | Use for recurrent cases of acute or subacute otitis media in the right ear. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for recurrent otitis media
Essential facts and insights about Recurrent Otitis Media
Primary ICD-10-CM Codes for recurrent otitis media
Decision Criteria
clinical Criteria
- Presence of purulent discharge and intact tympanic membrane
documentation Criteria
- Documentation of ≥3 episodes in 6 months
Applicable To
- Recurrent acute suppurative otitis media without rupture
Clinical Validation Requirements
- Purulent discharge on otoscopy
- ≥3 documented episodes in 6 months
- Intact tympanic membrane
Code-Specific Risks
- Misclassification if laterality is not specified
Coding Notes
- Ensure documentation specifies recurrence and laterality to avoid unspecified codes.
H65.114 - Acute and subacute recurrent otitis media, right ear
Use for recurrent cases of acute or subacute otitis media in the right ear.
Applicable To
- Recurrent acute and subacute otitis media
Excludes
- Chronic otitis media (H65.3-H65.4)
Clinical Validation Requirements
- Effusion type specified (serous/mucoid/sanguinous)
- Recurrent in assessment
- Negative bacterial culture (if performed)
Coding Notes
Ensure effusion type and recurrence are documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic)
Z77.22Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Recurrent Otitis Media to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H66.004.
Impact
Clinical: Inaccurate treatment planning, Regulatory: Non-compliance with coding standards, Financial: Potential for denied claims
Mitigation Strategy
Train staff on documentation requirements, Use templates to ensure completeness
Impact
Reimbursement: May lead to lower reimbursement or denial, Compliance: Non-compliance with ICD-10 specificity requirements, Data Quality: Decreases accuracy of clinical data
Mitigation Strategy
Ensure documentation includes laterality and recurrence to use specific codes.
Impact
Failure to document recurrence can lead to audit issues.
Mitigation Strategy
Use structured templates to ensure all elements are documented.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Recurrent Otitis Media, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Recurrent Otitis Media
Use these documentation templates to ensure complete and accurate documentation for Recurrent Otitis Media. These templates include all required elements for proper coding and billing.
Recurrent Otitis Media in Pediatrics
Specialty: PediatricsRequired Elements
- Assessment of recurrence
- Laterality specification
- Effusion type description
- Environmental risk factors
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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