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ICD-10 Guide
ICD-10 CodesH66.005

H66.005

Billable

Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left ear

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

Code Description

ICD-10 H66.005 is a billable code used to indicate a diagnosis of acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left ear.

Key Diagnostic Point:

Acute suppurative otitis media (ASOM) is an infection of the middle ear characterized by the presence of pus in the middle ear space. This condition is particularly common in children but can occur in adults as well. The recurrent nature of this diagnosis indicates that the patient has experienced multiple episodes of ASOM, which can lead to complications if not managed appropriately. In cases where there is no spontaneous rupture of the eardrum, the infection may cause significant pain and pressure in the ear, along with potential hearing loss. Symptoms typically include ear pain, fever, irritability in children, and sometimes drainage from the ear if the eardrum is perforated. Diagnosis is primarily clinical, supported by otoscopic examination revealing a bulging, erythematous tympanic membrane. Management often involves antibiotics, analgesics, and in some cases, surgical intervention such as tympanostomy tubes to prevent further episodes. The left ear designation is crucial for accurate coding and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Recurrent nature of the condition complicates treatment and coding.
  • Differentiation from other types of otitis media is necessary.
  • Documentation must specify the absence of spontaneous rupture.
  • Management may involve multiple specialties (ENT, pediatrics).

Audit Risk Factors

  • Inadequate documentation of recurrent episodes.
  • Failure to specify the left ear.
  • Misdiagnosis or misclassification of the type of otitis media.
  • Lack of supporting clinical evidence for antibiotic prescriptions.

Specialty Focus

Medical Specialties

Otolaryngology

Documentation Requirements

Detailed history of recurrent episodes, treatment plans, and outcomes.

Common Clinical Scenarios

Management of recurrent ASOM, surgical interventions like tympanostomy.

Billing Considerations

Ensure clear documentation of the absence of eardrum rupture and specify the ear affected.

Pediatrics

Documentation Requirements

Growth and development assessments, family history of ear infections.

Common Clinical Scenarios

Routine follow-ups for children with recurrent ear infections.

Billing Considerations

Document parental concerns and any previous treatments or interventions.

Coding Guidelines

Inclusion Criteria

Use H66.005 When
  • According to ICD
  • 10 guidelines, this code should be used when the condition is specifically acute, suppurative, recurrent, and without spontaneous rupture
  • Coders must ensure that the documentation supports the recurrent nature and specifies the left ear

Exclusion Criteria

Do NOT use H66.005 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

69436CPT Code

Tympanostomy, surgical

Clinical Scenario

Used when recurrent ASOM necessitates surgical intervention.

Documentation Requirements

Document the recurrent nature of infections and previous treatments.

Specialty Considerations

Otolaryngologists must provide detailed operative reports.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like ASOM, improving the accuracy of patient records and facilitating better management of recurrent cases.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like ASOM, improving the accuracy of patient records and facilitating better management of recurrent cases.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like ASOM, improving the accuracy of patient records and facilitating better management of recurrent cases.

Resources

Clinical References

  • •
    American Academy of Otolaryngology - Head and Neck Surgery

Coding & Billing References

  • •
    American Academy of Otolaryngology - Head and Neck Surgery

Frequently Asked Questions

What is the difference between acute and chronic otitis media?

Acute otitis media is characterized by sudden onset and is often associated with infection, while chronic otitis media is a long-standing condition that may involve persistent fluid in the middle ear without acute infection.