BeCOME Familiar With Otitis Media Codes
Question: How can I distinguish the difference between and correctly code the conditions of otitis media with effusion and chronic otitis media with effusion, as documented by my physician for two different patients? Colorado Subscriber Answer: Otitis media with effusion (OME), also referred to as serous OM, is characterized by inflammation and fluid accumulation in the middle ear without any indications of an active bacterial or viral infection. This condition can develop after an episode of acute otitis media (AOM). The ICD-10-CM Alphabetic Index directs you to reference “otitis, media, nonsuppurative” to locate the code for otitis (acute) with effusion, which corresponds to H65.9- (Unspecified nonsuppurative otitis media). Chronic otitis media with effusion (COME) is a condition where fluid persistently remains in the middle ear or repeatedly accumulates despite the absence of an infection. To correctly code this condition, the index directs you to “otitis, media, nonsuppurative, chronic,” which corresponds to the code H65.49- (Other chronic nonsuppurative otitis media). The term “chronic otitis media with effusion (nonpurulent)” is listed as a synonym, which verifies the accuracy of the selected code for this condition. Keep in mind: The major difference between these two conditions is the duration of the effusion. For future claims: If your physician notes that a patient’s ear is discharging pus, you should consider using a code from the H66.- (Suppurative and unspecified otitis media) series. The term “suppurative” is synonymous with “purulent.” If your physician uses this term in their documentation, you can turn to H66.4- (Suppurative otitis media, unspecified), as purulent otitis media NOS is synonymous with this code. On the other hand, for noninfected ear conditions, you should use a code from the H65.- series (Nonsuppurative otitis media). Nonsuppurative ear conditions also have secretions, which can be serous, mucoid, or sanguinous. Serous fluid is thin, clear, or yellowish; mucoid fluid is thicker and resembles mucus; and sanguinous fluid is reddish, indicating the presence of blood. For ICD-10-CM coding purposes, these terms are secondary to your provider’s documentation of the severity of the otitis media (OM). For acute serous OM, use H65.0- (Acute serous otitis media), and for acute mucoid and sanguinous OM, use H65.19- (Other acute nonsuppurative otitis media). Lindsey Bush, BA, MA, CPC, Production Editor, AAPC
