Pediatric Coding Alert

In pediatrics, the most typical otitis diagnosis is related to the middle ear and is called otitis media. That category has many specific types of otitis media; ICD9 Codes has created a strict hierarchy for these codes. To select the correct one, note whether the otitis media is chronic or acute; serous (thin or thick fluid), suppurative (with pus), sanguinous (with blood), mucoid (with mucous), or allergic; and whether the eardrum has ruptured. Then, choose the code that combines the relevant conditions. Always use a fifth digit when required.
 
Acute: The acute otitis media diagnosis codes are:
  381.00 Nonsuppurative otitis media and Eustachian tube disorders; acute nonsuppurative otitis media; unspecified)
  381.01 acute serous otitis media
381.02 acute mucoid otitis media
381.03 acute sanguinous otitis media
381.04 acute allergic serous otitis media
381.05 acute allergic mucoid otitis media
  381.06 acute allergic sanguinous otitis media
382.00 Acute suppurative otitis media without spontaneous rupture of ear drum
382.01 Acute suppurative otitis media with spontaneous rupture of ear drum
382.02 Acute suppurative otitis media in diseases classified elsewhere.
The most common is 382.00.
 
Chronic: The chronic otitis media diagnosis codes are:
  381.10 Chronic serous otitis media, simple or unspecified
  381.19 other
  381.20 Chronic mucoid otitis media, simple or unspecified
  381.29 other
381.3 Other and unspecified chronic nonsuppurative otitis media
  382.1 Chronic tubotympanic suppurative otitis media
  382.2 Chronic atticoantral suppurative otitis media
  382.3 Unspecified chronic suppurative otitis media.
The most common is 381.10.  
Other: For otitis media that is neither acute nor chronic, report 381.4 (Nonsuppurative otitis media, not specified as acute or chronic), 382.4 (Unspecified suppurative otitis media), or 382.9 (Unspecified otitis media). Use this when otitis media without symptoms is diagnosed such as at a routine preventive-medicine services visit.
Five Common Scenarios
Pediatricians often see five kinds of otitis media cases: 1. the baby with no ear discomfort who comes in for a well visit and an ear infection is discovered, 2. the baby with minor discomfort or a low fever who is brought in and the infection is discovered early, 3. the baby with a high fever that is caused by an advanced and painful ear infection, 4. the baby who is recovering or has just recovered from a cold and now has a slight fever or fussiness, and 5. the toddler who has had recurrent otitis media and now needs an evaluation by an otolaryngologist (ENT) for possible surgery.
 
1. Ear infection discovered at a well visit: Code separately for [...]