ICD-10 Coding for Recurrent Acute Otitis Media(H65.04, H66.14)
Complete ICD-10-CM coding and documentation guide for Recurrent Acute 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 Acute Otitis Media
H65.04-H65.07Primary Range
Recurrent acute nonsuppurative otitis media
This range covers recurrent acute otitis media without suppuration, specifying laterality.
H66.14-H66.17Primary Range
Recurrent acute suppurative otitis media
This range covers recurrent acute otitis media with suppuration, specifying laterality.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H65.04 | Recurrent acute nonsuppurative otitis media, right ear | Use when the patient has recurrent nonsuppurative otitis media affecting the right ear. |
|
| H66.14 | Recurrent acute suppurative otitis media, right ear | Use when the patient has recurrent suppurative otitis media affecting 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 acute otitis media
Essential facts and insights about Recurrent Acute Otitis Media
Primary ICD-10-CM Codes for recurrent acute otitis media
Decision Criteria
clinical Criteria
- Documented episodes and tympanometry results
Applicable To
- Recurrent serous otitis media
- Recurrent mucoid otitis media
Excludes
- Suppurative otitis media (H66.-)
Clinical Validation Requirements
- ≥3 episodes in 6 months or ≥4 in 12 months
- Documented tympanometry showing Type B curve
Code-Specific Risks
- Incorrectly coding as suppurative when no pus is present
Coding Notes
- Ensure documentation specifies laterality and type of fluid.
H66.14 - Recurrent acute suppurative otitis media, right ear
Use when the patient has recurrent suppurative otitis media affecting the right ear.
Applicable To
- Recurrent purulent otitis media
Excludes
- Nonsuppurative otitis media (H65.-)
Clinical Validation Requirements
- ≥3 episodes in 6 months or ≥4 in 12 months
- Presence of purulent discharge
Coding Notes
Ensure documentation specifies purulence and laterality.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Recurrent Acute Otitis Media to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H65.04.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Could result in non-compliance with coding guidelines., Financial: Potential for denied claims or reduced reimbursement.
Mitigation Strategy
Train staff on documentation requirements, Use templates that prompt for episode count
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Increases risk of audit failures., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Query the provider for specific details such as laterality and suppuration.
Impact
Risk of audits due to unspecified coding of otitis media.
Mitigation Strategy
Ensure complete documentation of all relevant clinical details.
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 Acute Otitis Media, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Recurrent Acute Otitis Media
Use these documentation templates to ensure complete and accurate documentation for Recurrent Acute Otitis Media. These templates include all required elements for proper coding and billing.
Recurrent AOM in pediatric patient
Specialty: PediatricsRequired Elements
- History of present illness
- Physical exam findings
- Type of fluid
- Laterality
- Number of episodes
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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