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ICD-10 Coding for Earache(H92.09, H66.009)

Complete ICD-10-CM coding and documentation guide for Earache. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

OtalgiaEar pain

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Related ICD-10 Code Ranges

Complete code families applicable to Earache

H92.0-H92.9Primary Range

Otalgia and related conditions

This range includes codes for earache and related symptoms, which are primary for coding otalgia when no underlying condition is identified.

H65-H67

Otitis media and related conditions

This range includes codes for otitis media, which should be used as primary codes when otalgia is due to an underlying ear infection.

H60-H62

Diseases of external ear

This range includes codes for otitis externa and other external ear conditions that may present with otalgia.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
H92.09Unspecified otalgiaUse when ear pain is present but no specific cause is identified.
  • Patient reports ear pain without a definitive diagnosis.
  • No findings of otitis media or externa on examination.
H66.009Acute suppurative otitis media, unspecified earUse when there is a confirmed diagnosis of acute suppurative otitis media.
  • Otoscopy shows pus in the middle ear.
  • Patient presents with fever and ear pain.

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 earache

Essential facts and insights about Earache

The ICD-10 code for unspecified earache is H92.09, used when no specific cause is identified.

Primary ICD-10-CM Codes for earache

H92.09
Unspecified otalgia
Billable Code

Decision Criteria

clinical Criteria

  • Ear pain without identifiable cause on examination.

coding Criteria

  • No other ear condition codes applicable.

documentation Criteria

  • Documented as 'ear pain' with no further findings.

Applicable To

  • Ear pain, NOS

Excludes

Clinical Validation Requirements

  • Patient reports ear pain without a definitive diagnosis.
  • No findings of otitis media or externa on examination.

Code-Specific Risks

  • Risk of undercoding if an underlying condition is present but not documented.

Coding Notes

  • Ensure laterality is documented when applicable.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Right ear otalgia

H92.01
Use when ear pain is specifically noted in the right ear.

Left ear otalgia

H92.02
Use when ear pain is specifically noted in the left ear.

Unspecified otalgia

H92.09
Use as secondary to indicate associated ear pain.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Acute suppurative otitis media, unspecified ear

H66.009
Use when there is evidence of middle ear infection with pus.

Malignant otitis externa, left ear

H60.322
Use when there is severe infection of the external ear canal.

Recurrent serous otitis media

H65.04
Use for recurrent fluid buildup without infection.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Earache to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H92.09.

Impact

Clinical: Leads to inadequate treatment plans., Regulatory: Non-compliance with documentation standards., Financial: Potential for reduced reimbursement due to unspecified coding.

Mitigation Strategy

Always document the underlying cause if identified., Use specific codes for conditions like otitis media.

Impact

Reimbursement: May lead to incorrect DRG assignment and reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.

Mitigation Strategy

Code the underlying condition first, such as H66.009 for otitis media.

Impact

Frequent use of H92.09 without ruling out other conditions.

Mitigation Strategy

Ensure thorough examination and documentation to identify specific causes.

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 Earache, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Earache

Use these documentation templates to ensure complete and accurate documentation for Earache. These templates include all required elements for proper coding and billing.

Acute otitis media with earache

Specialty: Otolaryngology

Required Elements

  • Onset and duration of symptoms
  • Laterality of ear pain
  • Otoscopy findings

Example Documentation

Patient presents with a 3-day history of right ear pain. Otoscopy reveals erythema and bulging tympanic membrane. Diagnosis: Acute suppurative otitis media, right ear (H66.011).

Examples: Poor vs. Good Documentation

Poor Documentation Example
Ear infection treated with antibiotics.
Good Documentation Example
Acute suppurative otitis media, right ear (H66.011) with moderate otalgia (H92.01). Prescribed amoxicillin 500mg TID for 10 days.
Explanation
The good example provides specific diagnosis, laterality, and treatment plan.

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