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v1.0.0
ICD-10 Guide
ICD-10 CodesH65.11

H65.11

Billable

Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous)

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/12/2025

Code Description

ICD-10 H65.11 is a billable code used to indicate a diagnosis of acute and subacute allergic otitis media (mucoid) (sanguinous) (serous).

Key Diagnostic Point:

Acute and subacute allergic otitis media is characterized by inflammation of the middle ear due to allergic reactions, leading to the accumulation of fluid that can be mucoid, sanguinous, or serous in nature. This condition often presents with symptoms such as ear pain, hearing loss, and a sensation of fullness in the ear. Patients may also experience systemic allergic symptoms such as nasal congestion or sneezing. Diagnosis typically involves a thorough clinical examination, including otoscopic evaluation to assess the presence of fluid in the middle ear and to rule out other causes of otitis media. Management may include antihistamines, corticosteroids, and in some cases, antibiotics if a secondary bacterial infection is suspected. Surgical interventions, such as tympanostomy tube placement, may be indicated for recurrent cases. Accurate coding is essential for proper reimbursement and to reflect the complexity of the patient's condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between types of otitis media (allergic vs. infectious)
  • Variability in clinical presentation and fluid types
  • Need for comprehensive documentation of allergic history
  • Potential for co-existing conditions affecting coding

Audit Risk Factors

  • Inadequate documentation of allergic history
  • Failure to specify fluid type
  • Misclassification of acute vs. subacute
  • Lack of supporting clinical evidence for diagnosis

Specialty Focus

Medical Specialties

Otolaryngology

Documentation Requirements

Detailed history of allergy symptoms, otoscopic findings, and treatment plans.

Common Clinical Scenarios

Patients presenting with recurrent ear infections and a history of allergies.

Billing Considerations

Ensure clear documentation of allergic triggers and response to treatment.

Allergy and Immunology

Documentation Requirements

Comprehensive allergy testing results and management plans.

Common Clinical Scenarios

Patients with chronic otitis media linked to specific allergens.

Billing Considerations

Documenting the correlation between allergy management and otitis media resolution.

Coding Guidelines

Inclusion Criteria

Use H65.11 When
  • Follow official ICD
  • CM guidelines for coding otitis media, ensuring to document the allergic nature and fluid type
  • Include any relevant co
  • morbidities that may affect treatment

Exclusion Criteria

Do NOT use H65.11 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

69436CPT Code

Tympanostomy, general anesthesia

Clinical Scenario

Used for patients with recurrent otitis media requiring drainage.

Documentation Requirements

Document the indication for surgery and previous treatment attempts.

Specialty Considerations

Otolaryngologists should ensure clear justification for surgical intervention.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of allergic conditions, improving the accuracy of patient records and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of allergic conditions, improving the accuracy of patient records and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between acute and subacute allergic otitis media?

Acute allergic otitis media typically presents suddenly and lasts for a shorter duration, while subacute allergic otitis media persists longer but is not chronic. Both require careful documentation to ensure accurate coding.