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v1.0.0
ICD-10 Guide
ICD-10 CodesH92.03

H92.03

Billable

Otalgia, bilateral

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

Code Description

ICD-10 H92.03 is a billable code used to indicate a diagnosis of otalgia, bilateral.

Key Diagnostic Point:

Otalgia, or ear pain, can occur due to various underlying conditions affecting the ear and surrounding structures. Bilateral otalgia indicates that the pain is present in both ears. Common causes include otitis media (middle ear infection), otitis externa (outer ear infection), and referred pain from dental issues or throat infections. Patients may present with symptoms such as sharp or dull pain, a feeling of fullness in the ears, hearing loss, or associated symptoms like fever and drainage. Diagnosis typically involves a thorough history and physical examination, including otoscopic evaluation to assess for signs of infection or other abnormalities. Management may include analgesics for pain relief, antibiotics for bacterial infections, or referral to an ENT specialist for persistent or complicated cases. Understanding the etiology of bilateral otalgia is crucial for effective treatment and coding, as it may be linked to systemic conditions or require surgical interventions such as tympanostomy or myringotomy in severe cases.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between primary and secondary causes of ear pain.
  • Potential overlap with other ear-related diagnoses.
  • Need for detailed documentation of symptoms and history.
  • Variability in treatment approaches based on underlying causes.

Audit Risk Factors

  • Inadequate documentation of bilateral involvement.
  • Failure to specify the underlying cause of otalgia.
  • Misuse of codes for unilateral conditions.
  • Lack of supporting clinical evidence for the diagnosis.

Specialty Focus

Medical Specialties

Otolaryngology

Documentation Requirements

Detailed history of symptoms, physical examination findings, and any imaging or lab results.

Common Clinical Scenarios

Patients presenting with ear pain, hearing loss, or recurrent ear infections.

Billing Considerations

Ensure documentation reflects the bilateral nature of the condition and any interventions performed.

Primary Care

Documentation Requirements

Comprehensive patient history, including duration and severity of pain, and any associated symptoms.

Common Clinical Scenarios

Initial evaluation of ear pain, management of uncomplicated otitis media or externa.

Billing Considerations

Document any referrals to specialists and follow-up care provided.

Coding Guidelines

Inclusion Criteria

Use H92.03 When
  • Follow official ICD
  • CM guidelines for coding otalgia, ensuring to document bilateral involvement and any underlying conditions
  • Include additional codes for associated symptoms or complications as necessary

Exclusion Criteria

Do NOT use H92.03 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

69210CPT Code

Removal of impacted cerumen

Clinical Scenario

When cerumen impaction is contributing to bilateral ear pain.

Documentation Requirements

Document the need for cerumen removal and any associated symptoms.

Specialty Considerations

Otolaryngologists may perform this procedure in conjunction with other evaluations.

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 bilateral otalgia, improving the accuracy of diagnoses and treatment tracking.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like bilateral otalgia, improving the accuracy of diagnoses and treatment tracking.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like bilateral otalgia, improving the accuracy of diagnoses and treatment tracking.

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 H92.03 and H92.00?

H92.03 specifies bilateral otalgia, while H92.00 is used for unspecified ear pain without indicating laterality.