Awareness : Did You Know? 2015-2016

Did You Know? Weekly Educational Series 37

For the Week of June 13, 2016

Question: Patient was diagnosed with recurrent otitis media and chronic otitis media with effusion. This could be confusing because you may not be sure which condition is meant. Could it be coded it as H65.196?

Answer: The patient actually might have different types of otitis media in each ear, which could be why the physician documented both conditions. Select diagnosis code H65.197 (Other acute non-suppurative otitis media recurrent, unspecified ear) for recurrent otitis media if the documentation does not specify the affected ear. Diagnosis H65.499 (Other chronic non-suppurative otitis media, unspecified ear) is an appropriate code for chronic otitis media with effusion when the affected ear is not noted.

New tactic: Many ICD-10 diagnosis code families include choices for laterality – right, left, bilateral, or unspecified location. Stress to all providers the importance of including these details in their documentation so you they can be coded more accurately.

For example, the full range of choices for recurrent otitis media include:

  • H65.194 – Other acute non-suppurative otitis media, recurrent, right ear
  • H65.195 – … left ear
  • H65.196 – … bilateral
  • H65.197 – … unspecified.

The laterality must be checked with the provider before filing the claim. If the provider updates their documentation to include the affected ears for each type of otitis media, then one can be sure that the correct diagnoses were assigned.