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Free ICD-10-CM Coding Challenge: Swimmer’s Ear

Take the Free ICD-10-CM Coding Challenge below and test your medical coding skills on swimmer’s ear. Then check your answer against the answer and rationale provided.

I’m pulling for you!!

Not your ear, though. I won’t pull your infected ear because that would hurt. 😉

boy with swimmer's ear and ICD-10-CM coding challenge

The Coding Challenge


A 10-year-old male complains of pain and itching in his right ear. Upon examination, there is some swelling inside the ear with clear drainage. Patient is diagnosed with swimmer’s ear in the right ear, and ear drops are prescribed. Assign the ICD-10-CM code.

A. H60.5
B. H65.01
C. H60.331
D. H60.22


Determine the correct answer before reviewing the following information.

Diagnosis – Swimmer’s Ear

Swimmer’s ear, another name for otitis externa, tends to develop in people of all ages who swim. Swimmer’s ear is an infection of the ear canal that is caused by moisture that is trapped in the canal.

Locating Otitis Externa or Swimmer’s Ear in ICD-10-CM

In the ICD-10-CM coding manual, swimmer’s ear is located in Chapter 8, Diseases of the Ear and Mastoid Process (H60-H95), within Block H60-H62, Diseases of External Ear. To find the correct code for the above scenario, look in the Alphabetic Index under Otitis (acute), externa, infective NEC, swimmer’s ear – See Swimmer’s, ear.

You can also find the code by going straight to Swimmer’s, ear H60.33-. In the Tabular, there are four codes listed under H60.33-, which are based on laterality. They are as follows:

  • H60.331, swimmer’s ear, right ear
  • H60.332, swimmer’s ear, left ear
  • H60.333, swimmer’s ear, bilateral
  • H60.339, swimmer’s ear, unspecified ear

Based on the documentation, the swimmer’s ear was in the right ear. Therefore, the correct code is H60.331.

Note that code H60.33- requires a 6th digit in order for it to be valid. The 6th digit “1” is for the right ear, “2” is for the left ear, “3” is for bilateral, and “9” is for unspecified.

Code Instructions

Before assigning H60.331, be sure to read any and all notes provided in the Tabular related to the specific code. For example, there is a note at the beginning of Chapter 8 that indicates an external cause code should be assigned as a secondary code to identify the cause of the ear condition, if applicable. 


There is also an Excludes2 note that indicates if the patient has any of the conditions listed at the Excludes2 note, they too should be coded along with the code for the swimmer’s ear. Those conditions include:

  • certain conditions originating in the perinatal period (P04-P96).
  • certain infectious and parasitic diseases (A00-B99)
  • complications of pregnancy, childbirth and the puerperium (O00-O9A)
  • congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
  • endocrine, nutritional and metabolic diseases (E00-E88)
  • injury, poisoning and certain other consequences of external causes (S00-T88)
  • neoplasms (C00-D49)
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

An Excludes2 note means, “Not included here.”

There is nothing documented in the record that indicates the patient has another condition listed in the Excludes2 note, so we cannot code for it.

Incorrect Answers

A, B, and D are incorrect.

A. H60.5, Acute noninfective otitis externa, is an invalid code and requires higher specificity. It also relates to noninfective otitis externa rather than the infective type.

B. H65.01, Acute serous otitis media, right ear, refers to fluid in the middle ear. Otitis media is inflammation in the middle ear, and serous pertains to serum or the type of fluid that is in the middle ear. According to Kristin Hayes, RN, and Very Well Health, other names for serous otitis media include otitis media with effusion, fluid in the ear, and secretory otitis media. If the condition is acute, it means it comes on suddenly and is of short duration.  

D. H60.22, Malignant otitis externa, left ear, refers to a complication of swimmer’s ear. Nurse Kristin Hayes reports that this condition, sometimes called necrotizing external otitis, is caused by swimmer’s ear spreading to surrounding tissue, including the bones of the face and jaw. Bacteria usually cause the infection, and diabetes is one of the main risk factors. Malignant otitis externa is not a malignancy or cancer, but rather an aggressive infection that can become fatal. This code refers to the left ear, which also makes it incorrect. 

Final Thoughts

How did you do? If you sailed through the ICD-10-CM Coding Challenge without any problems, you get the blue-ribbon award. Congratulations!

If you had a little trouble, don’t panic. You will get there. After all, perfect practice makes perfect in medical coding!

Inspirational quote about success and not putting limits on yourself

** This post has been updated to reflect the ICD-10-CM Coding Guidelines for FY 2023. **

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