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v1.0.0
ICD-10 Guide
ICD-10 CodesH67.1

H67.1

Billable

Otitis media in diseases classified elsewhere, right ear

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

Code Description

ICD-10 H67.1 is a billable code used to indicate a diagnosis of otitis media in diseases classified elsewhere, right ear.

Key Diagnostic Point:

Otitis media in diseases classified elsewhere, right ear (H67.1) refers to the inflammation or infection of the middle ear that occurs as a complication of other underlying diseases. This condition can arise from various etiologies, including systemic infections, autoimmune disorders, or neoplastic processes affecting the ear. Clinically, patients may present with ear pain, hearing loss, and sometimes fever. The right ear designation is crucial for accurate coding and treatment planning. Diagnosis typically involves a thorough history, physical examination, and possibly imaging studies to assess the extent of the disease. Management may include antibiotics for bacterial infections, analgesics for pain relief, and in some cases, surgical interventions such as tympanostomy or mastoidectomy. 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

  • Requires understanding of underlying diseases causing otitis media.
  • Differentiation from other types of otitis media.
  • Specificity in coding for the right ear.
  • Potential for multiple co-existing conditions.

Audit Risk Factors

  • Inadequate documentation of underlying conditions.
  • 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 ear symptoms, physical examination findings, and any imaging results.

Common Clinical Scenarios

Patients presenting with ear pain, drainage, or hearing loss secondary to systemic diseases.

Billing Considerations

Ensure documentation reflects the relationship between the underlying disease and otitis media.

Primary Care

Documentation Requirements

Comprehensive patient history, including any systemic illnesses and their management.

Common Clinical Scenarios

Initial evaluation of ear symptoms in patients with known systemic diseases.

Billing Considerations

Document any referrals to specialists and follow-up care.

Coding Guidelines

Inclusion Criteria

Use H67.1 When
  • According to ICD
  • 10 guidelines, H67
  • 1 should be used when otitis media is a complication of another disease
  • Coders must ensure that the underlying condition is documented and coded appropriately

Exclusion Criteria

Do NOT use H67.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

69436CPT Code

Tympanostomy, bilateral

Clinical Scenario

Used when surgical intervention is required for chronic otitis media.

Documentation Requirements

Document the indication for surgery and any prior treatments attempted.

Specialty Considerations

Otolaryngologists should ensure that the underlying disease is well-documented.

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 H67.1, improving the accuracy of diagnoses and treatment plans. This specificity aids in better tracking of disease patterns and outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like H67.1, improving the accuracy of diagnoses and treatment plans. This specificity aids in better tracking of disease patterns and outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like H67.1, improving the accuracy of diagnoses and treatment plans. This specificity aids in better tracking of disease patterns and outcomes.

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 importance of specifying the right ear in H67.1?

Specifying the right ear is crucial for accurate treatment planning and coding, as it impacts the management and potential surgical interventions.