** This post was reviewed and updated on January 16, 2024. **
Take the 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. 😉
The Coding Challenge
Question: 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. The patient is diagnosed with swimmer’s ear in the right ear, and ear drops are prescribed. Assign the ICD-10-CM code.
Diagnosis – Swimmer’s Ear
According to the documentation, after examination, the patient was diagnosed with swimmer’s ear of the right ear. Swimmer’s ear, another name for otitis externa, is a common condition often caused by moisture that is trapped in the ear canal.
Swimmer’s Ear in ICD-10-CM
Locate and Verify
To find the correct code for the above scenario, look in the Alphabetic Index under Swimmer’s/ear H60.33-/H60.331 swimmer’s ear, right ear. In the Tabular, we can verify this code as:
H60.331, Swimmer’s ear, right ear
Other codes listed under H60.33-, based on laterality, are:
- H60.332, Swimmer’s ear, left ear
- H60.333, Swimmer’s ear, bilateral
- H60.339, Swimmer’s ear, unspecified ear
Before assigning H60.331, be sure to read any and all notes provided in the Tabular related to the specific code. For example, a note at the beginning of Chapter 8 indicates an external cause code should be assigned as a secondary code to identify the cause of the ear condition, if applicable. Nothing was mentioned about the cause in this scenario. However, suppose, the child had been swimming at the local public pool. The coder would need to assign Y92.34, Swimming pool (public), as the place of occurrence of the external cause, after H60.331.
An Excludes2 note indicates if the patient has any of the conditions listed that they should also be reported 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.”
Nothing documented in the record indicates the patient has another condition listed in the Excludes2 note, so we cannot code for it.
Signs and symptoms: Pain, itching, and swelling are integral to swimmer’s ear and, therefore, should not be reported.
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 in the middle ear. According to 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. As Very Well Health indicates, 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.
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!