Pediatric Coding Alert

And know what to do when the condition has been resolved.

As a peds coder, your ICD-10 manual probably falls open to H65-H67 whenever you open it.

That's because otitis media (OM) is "the second most common disease of childhood" and "the most common cause for childhood visits to a physician's office" according to Medscape (Source: https://emedicine.medscape.com/article/994656-overview#a2).

But there's a lot more to coding OM than you think. So, we've prepared this handy guide to help you zero in on the most common OM diagnoses that your pediatrician makes, and to add the correct code once the patient's condition has been resolved.

Know Vocabulary for Quick Identification

Accurate OM coding, like most disease coding, hinges on your ability to recognize a number of key words. Fortunately, OM coding only requires you to know a handful of medical terms, all of which are related to the kind of fluid the ear is discharging:

This immediately enables you to determine whether to code H65.- (Nonsuppurative otitis media) or H66.- (Suppurative and unspecified otitis media).

The division is particularly useful to coders, as it enables you to code any kind of OM that involves a discharge of fluid other than pus as nonsupperative. So, for chronic serous otitis media you would code H65.2-, while you would code H65.3- for chronic mucoid otitis media. And you would code H65.11- (Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous)) for acute and subacute exacerbations that involve the discharge of any of these fluids.

Code for Infectious Agent When Appropriate

If your provider documents the cause of the OM, ICD-10 directs you to code H66.9- (Otitis media, unspecified) for cases of OM that are caused by the staphylococcal or streptococcal virus, while you would code OM due to other causes using H67.- (Otitis media in diseases classified elsewhere). The exceptions to this are B05.3 (Measles complicated by otitis media) or A38.0 (Scarlet fever with otitis media), which are both Excludes1 codes for H67.-.

Add Severity, Laterality When Documented

The usual ICD-10 definitions of acute, subacute, chronic, and recurrent all exist in some form throughout the H65-H67 codes. As always, though, you should not code for severity based on previous provider notes. If your pediatrician has not documented chronic serous OM, for example, but you see in the medical record that the patient has been seen for serous OM in the past, you cannot make the decision to code H65.2-.

Additionally, Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico, reminds coders that it is important to indicate laterality in documenting OM. "Coders need to stipulate which ear - left, right or bilateral - has the infection, Witt goes on, noting that "to do less would not be coding to the highest level of specificity."

JoAnne M. Wolf, RHIT, CPC, CEMC, AAPC Fellow, coding manager at Children'sHealth Network in Minneapolis, Minnesota, agrees, adding that "Coders should avoid the unspecified ear codes such as H65.00 [Acute serous otitis media, unspecified ear] whenever possible. Specificity," Wolf tells coders, "especiallylaterality," is key when reporting codes for OM.

But even though the codes do feature fifth or sixth characters to specify laterality, coders need to be careful when assigning them. Some code sets include two different codes for left and right depending on whether the OM is recurrent or not. So, you can code a diagnosis of acute serous OM in the right ear as either H65.01 (Acute serous otitis media, right ear) or H65.04 (Acute serous otitis media, recurrent, right ear) depending on whether or not the OM is recurrent.

Add Perforation and Tobacco Smoke Codes When Appropriate

Lastly, you should also pay close attention to the ICD-10 guidelines that appear just before the H65-H67 codes where you are asked to code for "any associated perforated tympanic membrane (H72.-)." And, Wolf adds, "coders shouldn't forget to encouragetheir providers to also include any diagnosis of tobacco use, dependence, or exposure when coding pediatric ear infections."

Coding alert: Once the patient's OM has been resolved, coders face one more problem, according to Witt. "If the patient had OM and has returned for a recheck and the condition has still not resolved at the time of the subsequent encounter, you would code only the OM."

However, Witt goes on, if the condition is resolved, you would code Z09 (Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm) even though "some insurances are now denying Z09 for the visit."

As always, knowing payer guidelines is the key to coding this kind of scenario. Some carriers may want a secondary diagnosis, for example, to explain why this is a recheck visit. Even so, "if the payer considers Z09 to mean that the visit was not medically indicated," Witt advises, "you cannot use another inaccurate diagnosis to get it paid."