Primary Care Coding Alert

With more than 24 codes to choose from (381.00-382.9), coding an otitis media diagnoses can be a real earful. To select the correct code, you'll need to note whether the otitis media is chronic or acute; serous (thin or thick fluid), suppurative (with pus), sanguinous (with blood), mucoid (with mucous) or allergic; and whether the eardrum has ruptured. Then, choose the code that combines the relevant conditions. Always use a fifth digit when required. Typical Otitis Scenarios FPs often see five kinds of otitis media cases: 1. Ear infection discovered at a well visit: A baby with no ear discomfort comes in for a well visit, and an ear infection is discovered. Code separately for the ear infection, using an office visit (99211-99215) with modifier -25 (Significant, separately identifiable E/M services by the same physician on the same day of the procedure or other service) appended only if you perform a significant and separately identifiable service over and above what you did for the preventive medicine service. Link the otitis media diagnosis, usually 381.01 (Nonsup-purative otitis media and Eustachian tube disorders; acute serous otitis media) or 382.00 (Acute suppurative otitis media without spontaneous rupture of ear drum), to the office visit, and link V20.2 (Routine infant or child health check) to the preventive medicine service. Usually, the child gets an antibiotic. "It is impossible to tell if the infection is bacteria or a virus without getting a sample of the fluid behind the eardrum," says Daniel S. Fick, MD, medical director for the Joint Office of Compliance at the University of Iowa Health Care in Iowa City. "Obviously docs are not going to poke holes in the tympanic membrane (eardrum) to find out, so most kids get antibiotics." 2. Minor discomfort or low fever: A baby with minor discomfort or a low fever is brought in, and the infection is discovered early. The ear infection discovered early on by an FP is most likely 382.00. Code an office visit (99211-99215). "All new infections are called acute, and then if it lasts more than a couple weeks it's called chronic," Fick says. "It is often a subjective call by the physician when to call it chronic." 3. High fever and advanced infection: A baby presents with a high fever that is caused by an advanced and painful ear infection. Use the otitis media diagnosis code (382.00) as the primary diagnosis, and the fever (780.6) as the secondary diagnosis. "Technically, you do not have to list the signs and symptoms at all if you have the definitive diagnosis," says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C. "But if you use both, list the definitive diagnosis [...]