ICD-10 Coding for Otitis Externa

Otitis externa is commonly known as “swimmer’s ear” and usually is caused by bacteria invading the skin inside the ear canal. Symptoms are usually mild, at first, but may worsen without treatment. Doctors often classify swimmer’s ear according to mild, moderate, and advanced stages of progression.
Mild signs and symptoms:

  • Itching in the ear canal
  • Slight redness inside the ear
  • Mild discomfort made worse by pulling on the outer ear
  • Some drainage of clear, odorless fluid

Moderate progression signs and symptoms include:

  • More intense itching
  • Increasing pain
  • More extensive redness in the ear
  • Excessive fluid drainage
  • Discharge of pus
  • Feeling of fullness inside the ear and partial blockage of ear canal by swelling, fluid, and debris
  • Decreased or muffled hearing

Advanced progression signs and symptoms include:

  • Severe pain that may radiate to face, neck, or side of the head
  • Complete blockage of ear canal
  • Redness or swelling of outer ear
  • Swelling in the lymph nodes of the neck
  • Fever

Clinically, otitis externa may be classified into several types:
Acute diffuse Otitis Externa – The most common form of Otitis Externa, typically seen in swimmers; it is characterized by rapid onset (generally within 48 hours) and symptoms of external auditory canal (EAC) inflammation (e.g. otalgia, itching, or fullness, with or without hearing loss or jaw pain), as well as tenderness of the tragus or pinna, diffuse ear edema or erythema, or both, with or without otorrhea, regional lymphadenitis, tympanic membrane erythema, or cellulitis of the pinna.
Acute localized Otitis Externa – Also known as furunculosis, it is associated with infection of a hair follicle.
Chronic Otitis Externa – The same as acute diffuse OE, but of greater than six weeks’ duration.
Eczematous (eczematoid) Otitis Externa – Encompasses a variety of dermatologic conditions (e.g., atopic dermatitis, psoriasis, systemic lupus erythematosus, and eczema) that may infect the EAC.
Necrotizing (malignant) Otitis Externa – An infection that extends into the deeper tissues adjacent to the EAC. It primarily occurs in adult patients who are immunocompromised (e.g., as a result of diabetes mellitus or AIDS), and is rarely described in children. May result in cases of cellulitis and osteomyelitis.
Otomycosis – Infection of the ear canal secondary to fungus species such as Candida or Aspergillus.
Complete clinical documentation should indicate the type of otitis externa, such as noninfective, actinic, chemical, contact, eczematoid, infective, reactive, or malignant, as well as the laterality (right, left, bilateral)
In ICD-10-CM, Otitis externa is coded to H60 and H62. Example codes include:
H60.2- Malignant otitis externa
H60.3- Other infective otitis externa
H60.5- Acute noninfective otitis externa
H60.6- Unspecified chronic otitis externa
H62.4- Otitis externa in other diseases classified elsewhere (Code first underlying disease, such as: erysipelas (A46), impetigo (L01.0))
Note that these codes require a 5th character.
Example: A 38-year-old man presents with painful, “wet” right ear, preceded by several days of itching. Patient inserted cotton swabs into the ear canal, and used an over-the-counter cerumen removal kit to try to relieve the symptoms. Examination revealed an erythematous canal with normal tympanic membrane. He was given strict instructions regarding water precautions and ear trauma. He was prescribed a steroid and antibiotic topical therapy. Based on the available documentation, the correct code is H60.91 Unspecified otitis externa, right ear.

John Verhovshek
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John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

One Response to “ICD-10 Coding for Otitis Externa”

  1. Teresa McClure RN says:

    I am an Auditor of EM/CPT codes. My ENT providers are using the unlisted CPT code 69339 when removing pus and fungal debris during OE.
    They state that the pus and fungal debris are foreign bodies
    I do not believe there is a code to bill for pus/fungal debris, as these are not foreign to the body. Also, if they are removing this debris to see the inner ear, it is not billable (as will Cerumen removal 69210), if removing wax just to see the inner ear, we cannot bill for that procedure as well