Pediatric Coding Alert

Question: In the You Be the Coder article “Don’t Exclude This Advice from Your Dx Coding Understanding,” published in Pediatric Coding Alert Volume 23 Number 9, you stated that “per the Excludes1 note that accompanies H65.1- (Other acute nonsuppurative otitis media), you cannot code H66.9- (Otitis media, unspecified) as the two conditions are mutually exclusive.” My question is: if the two diagnoses are reported at the same time, which of the two codes should be reported?

New York Subscriber

Answer: A recent AHA ICD-10-CM Coding Clinic article clarifies that when two conditions are documented, you should “assign only the code referenced in the Excludes1 note” (AHA ICD-10-CM Coding Clinic 2018 Vol. 5, No. 4).

In other words, if both a code from H65.1- and H66.9- are documented, the Excludes1 note under H65.1- tells you that you should only document the code referenced in the Excludes1 note, which would be H66.9-.