ICD-10 Coding for Recurrent Ear Infection(H65.04, H66.1-)
Complete ICD-10-CM coding and documentation guide for Recurrent Ear Infection. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Recurrent Ear Infection
H65-H67Primary Range
Diseases of middle ear and mastoid
This range includes codes for various forms of otitis media, which are relevant for coding recurrent ear infections.
Perforation of tympanic membrane
This range is used when there is a documented perforation of the tympanic membrane associated with otitis media.
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 | Acute serous otitis media, recurrent, right ear | Use for recurrent acute serous otitis media in the right ear with documented recurrence criteria. |
|
| H66.1- | Chronic suppurative otitis media | Use for chronic cases with persistent suppurative effusion. |
|
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 ear infections
Essential facts and insights about Recurrent Ear Infection
Primary ICD-10-CM Codes for recurrent ear infection
Decision Criteria
clinical Criteria
- Recurrent episodes with documented effusion
documentation Criteria
- Detailed description of symptoms and recurrence
Applicable To
- Recurrent acute serous otitis media
Excludes
- Chronic serous otitis media (H65.2-)
Clinical Validation Requirements
- Documented recurrent episodes (≥3 in 6 months or ≥4 in 12 months)
- Tympanic membrane bulging
- Confirmed middle ear effusion
Code-Specific Risks
- Risk of using without documented recurrence criteria
- Incorrect laterality documentation
Coding Notes
- Ensure documentation specifies recurrence and laterality.
H66.1- - Chronic suppurative otitis media
Use for chronic cases with persistent suppurative effusion.
Applicable To
- Chronic tubotympanic suppurative otitis media
Excludes
- Acute suppurative otitis media (H66.0-)
Clinical Validation Requirements
- Persistent suppurative effusion
- Chronicity documented over months
Coding Notes
Chronicity must be clearly documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Tobacco smoke exposure
Z77.22Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Recurrent Ear Infection to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H65.04.
Impact
Clinical: Leads to inappropriate treatment plans., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.
Mitigation Strategy
Use specific terms like 'acute', 'chronic', 'serous', 'suppurative'.
Impact
Reimbursement: May lead to reduced reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of patient records.
Mitigation Strategy
Always document and code the specific ear affected.
Impact
Failure to document recurrence criteria can lead to audit findings.
Mitigation Strategy
Ensure all recurrence criteria are documented in patient records.
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 Ear Infection, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Recurrent Ear Infection
Use these documentation templates to ensure complete and accurate documentation for Recurrent Ear Infection. These templates include all required elements for proper coding and billing.
Initial encounter for recurrent OM
Specialty: PediatricsRequired Elements
- History of recurrent episodes
- Tympanic membrane findings
- Effusion documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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