ICD-10 Primer for Pediatrics

ICD 10 codes for asthma, otitis media and all things pediatricContinuing our series on ICD-10 basics we are offering high-level primers to illustrate the differences on specific documentation requirements for various specialties. We will also give some samples of how ICD-9-CM codes common for those specialties compare to ICD-10-CM codes. Again, much of the material in these speciality-specific blog posts is based on guidelines and material published by CMS in its Road to 10 Series. There is a lot of questionable information and advice out there and we want to help improve the consistency and reduce the uncertainty by going to the source of regulations. We will summarize and consolidate to enhance readability and brevity. The application of ICD-10 documentation requirements and the common codes for Pediatrics is the focus of this post. In ICD-10-CM, there are three main categories of changes:

  • Definition Changes
  • Terminology differences
  • Increased specificity

Specifying anatomical location and laterality is often required by ICD-10. More than 1/3 of the expansion of ICD-10 codes is due to the addition of laterality (left, right, bilateral). Physicians and other clinicians likely already note the side when evaluating the clinically pertinent anatomical site(s). Asthma Terminology Difference ICD-10 terminology used to describe asthma has been updated to reflect the current clinical classification system. ICD-10-CM uses the National Heart, Lung, and Blood Institute (NHLBI)’s asthma severity classification in the terminology. This information in the context of the NHLBI guidelines can be accessed here. ICD-10-CM has another change in reporting respiratory diagnoses such as asthma and requires an additional code, where applicable, to identify whether the patient had exposure to second-hand smoke, a history of tobacco use, or current use or dependence of tobacco. The assignment of this code for exposure to second-hand smoke is dependent upon the physician’s documentation. The code should not be assigned as a first-listed diagnosis but may be assigned as an additional code when the physician has stated that second-hand smoke or environmental tobacco smoke is the cause of the patient’s condition. The code should not assigned in the absence of a condition or symptom. When documenting asthma, include the following:

  • Cause
    • Exercise induced
    • Cough variant,
    • Related to smoking, chemical or particulate cause,
    • Occupational
  • Severity: (Choose one of the three options below for persistent asthma patients)
    • Mild persistent
    • Moderate persistent
    • Severe persistent
  • Temporal factors
    • Acute
    • Chronic
    • Intermittent
    • Persistent
    • Status asthmaticus
    • Acute exacerbation

ICD-10 Code Examples

J45.30 Mild persistent asthma, uncomplicated
J45.991 Cough variant asthma

Otitis Media Increased Specificity When documenting otitis media, include the following:

  • Type
    • Serous
    • Sanguinous
    • Suppurative
    • Allergic
    • Mucoid
  • Infectious agent
    • Strep
    • Staph
    • Scarlett Fever
    • Influenza
    • Measles
    • Mumps
  • Temporal factors
    • Acute
    • Subacute
    • Chronic
    • Recurrent
  • Side
    • Left, right or both ears
  • Tympanic membrane rupture (Note whether this is present)
  • Secondary causes
    • Tobacco smoke, etc.

ICD-10 Code Examples

H66.001 Acute suppurative otitis media without spontaneous rupture of ear drum, right ear
H66.004 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear
H65.03 Acute serous otitis media, bilateral
H72.821 Total perforations of the tympanic membrane, right ear

Comparison of ICD-9 CM Codes to ICD-10 Codes for Otitis Media

Acute Serous Otitis Media ICD-9-CM

381.01 Acute serous Otitis Media

ICD-10-CM Codes

H65.00* Acute serous otitis media, unspecified ear
H65.01 Acute serous otitis media, right ear
H65.02 Acute serous otitis media, left ear
H65.03 Acute serous otitis media, bilateral
H65.04 Acute serous otitis media, recurrent, right ear
H65.05 Acute serous otitis media, recurrent, left ear
H65.06 Acute serous otitis media, recurrent, bilateral
H65.07* Acute serous otitis media, recurrent, unspecified ear

Other Acute Nonsuppurative Otitis Media ICD-9-CM

381.00 Acute nonsuppurative Otitis Media
381.02 Acute mucoid Otitis Media
381.03 Acute sanguineous Otitis Media
381.04 Acute allergic serous Otitis Media
381.05 Acute allergic mucoid Otitis Media
381.06 Acute allergic saguinous Otitis Media

ICD-10-CM Codes

H65.111 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear
H65.112 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), left ear
H65.113 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), bilateral
H65.114 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, right ear
H65.115 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, left ear
H65.116 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, bilateral
H65.117* Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, unspecified ear
H65.119* Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), unspecified ear
H65.191 Other acute nonsuppurative otitis media, right ear
H65.192 Other acute nonsuppurative otitis media, left ear
H65.193 Other acute nonsuppurative otitis media, bilateral
H65.194 Other acute nonsuppurative otitis media, recurrent, right ear
H65.195 Other acute nonsuppurative otitis media, recurrent, left ear
H65.196 Other acute nonsuppurative otitis media, recurrent, bilateral
H65.197* Other acute nonsuppurative otitis media recurrent, unspecified ear
H65.199* Other acute nonsuppurative otitis media, unspecified ear

Chronic Serous Otitis Media ICD-9-CM

381.10 Chronic serous Otitis Media, simple or unspecified
381.19 Other chronic serous Otitis Media

ICD-10-CM Codes

H65.20* Chronic serous otitis media, unspecified ear
H65.21 Chronic serous otitis media, right ear
H65.22 Chronic serous otitis media, left ear
H65.23 Chronic serous otitis media, bilateral

Chronic Mucoid Otitis Media ICD-9-CM

381.20 Chronic mucoid Otitis Media, simple or unspecified
381.29 Other chronic mucoid Otitis Media

ICD-10-CM Codes

H65.30* Chronic mucoid otitis media, unspecified ear
H65.31 Chronic mucoid otitis media, right ear
H65.32 Chronic mucoid otitis media, left ear
H65.33 Chronic mucoid otitis media, bilateral

Other Chronic Nonsuppurative Otitis Media ICD-9-CM

381.3 Other and unspecified nonsuppurative Otitis Media

ICD-10-CM Codes

H65.411 Chronic allergic otitis media, right ear
H65.412 Chronic allergic otitis media, left ear
H65.413 Chronic allergic otitis media, bilateral
H65.419* Chronic allergic otitis media, unspecified ear
H65.491 Other chronic nonsuppurative otitis media, right ear
H65.492 Other chronic nonsuppurative otitis media, left ear
H65.493 Other chronic nonsuppurative otitis media, bilateral
H65.499* Other chronic nonsuppurative otitis media, unspecified ear

Unspecified Nonsuppurative Otitis Media ICD-9-CM

381.4 Nonsuppurative Otitis Media not specified as acute or chronic

ICD-10-CM Codes

H65.90* Unspecified nonsuppurative otitis media, unspecified ear
H65.91* Unspecified nonsuppurative otitis media, right ear
H65.92* Unspecified nonsuppurative otitis media, left ear
H65.93* Unspecified nonsuppurative otitis media, bilateral

Acute Suppurative Otitis Media ICD-9-CM

382.00 Otitis Media, Acute Suppurative
382.01 Acute Suppurative Otitis Media with spontaneous rupture of eardrum

ICD-10-CM Codes

H66.001 Acute suppurative otitis media without spontaneous rupture of ear drum, right ear
H66.002 Acute suppurative otitis media without spontaneous rupture of ear drum, left ear
H66.003 Acute suppurative otitis media without spontaneous rupture of ear drum, bilateral
H66.004 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear
H66.005 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left ear
H66.006 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, bilateral
H66.007* Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, unspecified ear
H66.009* Acute suppurative otitis media without spontaneous rupture of ear drum, unspecified ear
H66.011 Acute suppurative otitis media with spontaneous rupture of ear drum, right ear
H66.012 Acute suppurative otitis media with spontaneous rupture of ear drum, left ear
H66.013 Acute suppurative otitis media with spontaneous rupture of ear drum, bilateral
H66.014 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, right ear
H66.015 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, left ear
H66.016 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, bilateral
H66.017* Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, unspecified ear
H66.019* Acute suppurative otitis media with spontaneous rupture of ear drum, unspecified ear

Chronic Tubotympanic Suppurative Otitis Media ICD-9-CM

382.1 Chronic tubotympanic suppurative Otitis Media

ICD-10-CM Codes

H66.10* Chronic tubotympanic suppurative otitis media, unspecified
H66.11 Chronic tubotympanic suppurative otitis media, right ear
H66.12 Chronic tubotympanic suppurative otitis media, left ear
H66.13 Chronic tubotympanic suppurative otitis media, bilateral

Chronic Atticoantral Suppurative Otitis Media ICD-9-CM

382.2 Chronic atticoantral suppurative Otitis Media

ICD-10-CM Codes

H66.20* Chronic atticoantral suppurative otitis media, unspecified ear
H66.21 Chronic atticoantral suppurative otitis media, right ear
H66.22 Chronic atticoantral suppurative otitis media, left ear
H66.23 Chronic atticoantral suppurative otitis media, bilateral

Other Chronic Suppurative Otitis Media ICD-9-CM

382.3 Unclassified chronic suppurative Otitis Media

ICD-10-CM Codes

H66.3X1 Other chronic suppurative otitis media, right ear
H66.3X2 Other chronic suppurative otitis media, left ear
H66.3X3 Other chronic suppurative otitis media, bilateral
H66.3X9* Other chronic suppurative otitis media, unspecified ear

Suppurative Otitis Media, Unspecified ICD-9-CM

382.4 Unspecified chronic suppurative Otitis Media

ICD-10-CM Codes

H66.40* Suppurative otitis media, unspecified, unspecified ear
H66.41* Suppurative otitis media, unspecified, right ear
H66.42* Suppurative otitis media, unspecified, left ear
H66.43* Suppurative otitis media, unspecified, bilateral

Otitis media, Unspecified ICD-9-CM

382.9 Unspecified Otitis Media

ICD-10-CM Codes

H66.90* Otitis media, unspecified, unspecified ear
H66.91* Otitis media, unspecified, right ear
H66.92* Otitis media, unspecified, left ear
H66.93* Otitis media, unspecified, bilateral

Otitis Media in Diseases Classified Elsewhere ICD-9-CM

382.02 Acute suppurative Otitis Media in diseases classified elsewhere

ICD-10-CM Codes

H67.1 Otitis media in diseases classified elsewhere, right ear
H67.2 Otitis media in diseases classified elsewhere, left ear
H67.3 Otitis media in diseases classified elsewhere, bilateral
H67.9* Otitis media in diseases classified elsewhere, unspecified ear

*Codes with a greater degree of specificity should be considered first. For a comprehensive list of ICD-10 diagnosis codes you can download the following files by clicking on the appropriate links:

Please bear in mind these are only the most common icd 10 codes for pediatrics. Should you need more information on ICD-10 Codes for Otitis Media, please feel free to visit our comprehensive ICD-10 database.

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