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ICD-10 Guide
ICD-10 CodesH66.014

H66.014

Billable

Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, right ear

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

Code Description

ICD-10 H66.014 is a billable code used to indicate a diagnosis of acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, right ear.

Key Diagnostic Point:

Acute suppurative otitis media (ASOM) is an infection of the middle ear characterized by the presence of pus and inflammation. In cases where the ear drum (tympanic membrane) ruptures spontaneously, it often leads to the discharge of purulent material from the ear. This condition is recurrent, indicating that the patient has experienced multiple episodes of ASOM. The right ear is specifically affected, which is crucial for accurate coding. Clinically, patients may present with ear pain, fever, irritability in children, and hearing loss. Diagnosis is typically confirmed through otoscopic examination, revealing a bulging, red tympanic membrane with possible perforation. Management includes antibiotics, analgesics, and sometimes surgical intervention such as tympanostomy tubes for recurrent cases. Understanding the nuances of this condition is essential for proper coding and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between acute and chronic otitis media
  • Identifying recurrent episodes accurately
  • Specifying the affected ear
  • Documenting the presence of spontaneous rupture

Audit Risk Factors

  • Inadequate documentation of recurrent episodes
  • Failure to specify the affected ear
  • Misclassification of acute vs. chronic otitis media
  • Lack of supporting clinical evidence for spontaneous rupture

Specialty Focus

Medical Specialties

Otolaryngology

Documentation Requirements

Detailed history of ear infections, treatment history, and physical examination findings.

Common Clinical Scenarios

Patients presenting with recurrent ear infections, children with persistent otitis media, and adults with complications.

Billing Considerations

Ensure clear documentation of the nature of the infection and any surgical interventions performed.

Pediatrics

Documentation Requirements

Growth and development assessments, vaccination history, and family history of ear infections.

Common Clinical Scenarios

Infants and children with recurrent ear infections and associated symptoms.

Billing Considerations

Document parental observations and any impact on the child's behavior or development.

Coding Guidelines

Inclusion Criteria

Use H66.014 When
  • Follow the official ICD
  • CM guidelines for coding otitis media, ensuring to document the acute nature, recurrent episodes, and specific ear involvement

Exclusion Criteria

Do NOT use H66.014 When
  • Exclude codes for chronic otitis media unless specified

Related ICD-10 Codes

Related CPT Codes

69436CPT Code

Tympanostomy, surgical

Clinical Scenario

Used for recurrent cases requiring drainage and ventilation.

Documentation Requirements

Document the need for surgery due to recurrent infections.

Specialty Considerations

Otolaryngologists should ensure clear indications for surgery are documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of ear conditions, improving the accuracy of diagnoses and treatment plans. H66.014 provides a clear distinction for recurrent cases with complications.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of ear conditions, improving the accuracy of diagnoses and treatment plans. H66.014 provides a clear distinction for recurrent cases with complications.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of ear conditions, improving the accuracy of diagnoses and treatment plans. H66.014 provides a clear distinction for recurrent cases with complications.

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 significance of specifying the ear in H66.014?

Specifying the ear is crucial for treatment planning and understanding the patient's condition, as management may differ based on which ear is affected.