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ICD-10 Guide
ICD-10 CodesH66.015

H66.015

Billable

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

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

Code Description

ICD-10 H66.015 is a billable code used to indicate a diagnosis of acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, left ear.

Key Diagnostic Point:

Acute suppurative otitis media (ASOM) is characterized by the presence of pus in the middle ear, leading to inflammation and infection. In cases where the ear drum (tympanic membrane) ruptures spontaneously, it allows for the drainage of pus, which can provide symptomatic relief but also poses risks of further complications. This specific code (H66.015) indicates that the condition is recurrent and affects the left ear. Clinically, patients may present with ear pain, fever, irritability in children, and hearing loss. Diagnosis is typically made through otoscopic examination, revealing a bulging, red tympanic membrane, and possibly purulent drainage. Management often includes antibiotics, analgesics, and in some cases, surgical intervention such as tympanostomy tubes for recurrent cases. The recurrent nature of this condition necessitates careful monitoring and may require referral to an otolaryngologist for further evaluation and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Recurrent nature of the condition complicates coding.
  • Specificity required for left ear involvement.
  • Differentiation from other types of otitis media.
  • Need for accurate documentation of symptoms and treatment.

Audit Risk Factors

  • Inadequate documentation of recurrent episodes.
  • Failure to specify the affected ear.
  • Misclassification of the type of otitis media.
  • Lack of supporting clinical evidence for the diagnosis.

Specialty Focus

Medical Specialties

Otolaryngology

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with recurrent ear infections, requiring surgical intervention.

Billing Considerations

Ensure documentation reflects the severity and frequency of episodes.

Pediatrics

Documentation Requirements

Growth and development assessments, parental reports of symptoms.

Common Clinical Scenarios

Children with recurrent ear infections leading to hearing loss.

Billing Considerations

Consideration of developmental milestones and impact of hearing loss on speech.

Coding Guidelines

Inclusion Criteria

Use H66.015 When
  • Follow ICD
  • CM guidelines for coding otitis media, ensuring to document the recurrent nature and specify the left ear
  • Include any relevant symptoms and treatments provided

Exclusion Criteria

Do NOT use H66.015 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

69436CPT Code

Tympanostomy, surgical

Clinical Scenario

Used for recurrent cases requiring drainage.

Documentation Requirements

Document indication for surgery and previous treatment failures.

Specialty Considerations

Otolaryngologists must provide detailed surgical notes.

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 acute suppurative otitis media, improving the accuracy of patient records and treatment plans.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like acute suppurative otitis media, improving the accuracy of patient records and treatment plans.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like acute suppurative otitis media, improving the accuracy of patient records and treatment plans.

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 left ear?

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