Among the top 25 diagnosis codes worked up in the emergency department and coded by McKesson is Otitis Media (OM) [ICD-9 - 382.9], another very common presentation in the emergency department. OM, Latin for inflammation of the middle ear or tympanitis, is the medical term for middle ear infection.

There are two major types of OM: Acute otitis media and otitis media with effusion. Although acute OM can occur at any age, it is most common in young children, particularly from three months to three years of age. Those very small microorganisms travel through the ear, nose and throat system and can cause cellulitis (swelling and redness of skin) or thrombophlebitis (vein inflammation). Second hand smoke has been implicated as a risk factor.

Signs, symptoms and complications from OM are usually persistent with severe earache. Some hearing loss may occur and fever, nausea, vomiting and diarrhea may also be present in young children. The ear drum or tympanic membrane, which separates the external ear from the middle ear, is typically erythematous or there is abnormal redness of the area due to local congestion, as in inflammation.

Antibiotic therapy is generally indicated to relieve symptoms, hasten resolution of the infection, and reduce the chance of labyrinthine (affecting the internal ear) and potential hearing loss. 

There is a one-to-one crosswalk for OM, not otherwise specified (NOS) or unspecified.  And there are many other types of OM (depending on symptoms, location, etc) as partially outlined in the below table.  The unspecified OM in ICD-10 also includes laterality or which ear is infected or whether the infection is bilateral – see table below.

 Coding Otitis Media

As mentioned above, treatment for OM depends on the patient’s type of OM. The vast majority of OM cases in younger children will be instructed to take antibiotic medications and over the counter medications for pain and fever and drink plenty of fluids. 

As you can see in the above table, there are a number of ICD-10 codes for OM, due to the laterality indications in ICD-10, and this is only a small example of those in both ICD-9 and ICD-10 code books.  The following is a partial list of types of OM that can be found in the ICD-9 and ICD-10 code books:

  • Nonsupporative otitis media
  • Acute supporative otitis media
  • Acute Serous otitis media
  • Chronic serous otitis media
  • Chronic mucoid otitis media

It is imperative that the provider document exactly what the examination and the diagnostic studies’ findings are, if any, to determine the exact course of action for the condition presented or defined after study and to help insure correct coding.

References:
ICD-10-CM, Complete Draft Code Set, Chapter 8, Diseases of the Ear and Mastoid Process (H60 – H95)
ICD-9-CM, Chapter 6, Diseases of the Nervous System and Sense Organs (320 – 389)
Merck Manual, Section 7, Page 674 Ear, Nose and Throat Disorders  

Author - Male

About the author

Robert Bunting, CPC, CPC-H, CHC, CEDC, CEMC, CAC is Compliance Director – Emergency Medicine, McKesson Business Performance Services.