Otitis externa, commonly known as swimmer’s ear, is an inflammatory or infectious condition of the external ear. This article explores the nuances of swimmer’s ear, diving into its symptoms, causes, diagnosis, treatment, and the associated ICD-10-CM codes.
Parts of the Ear
Before we dive into the nuances of swimmer’s ear, let’s explore the part of the ear affected by otitis externa – the external ear. According to the Cleveland Clinic, otitis externa specifically targets the external ear, known as the auricle or pinna, which is the visible outer part of the ear. Consisting of ridged cartilage, skin, and glands producing earwax, the external ear features a funnel-shaped canal that leads to the eardrum or tympanic membrane.
Breaking Down Otitis Externa
Otitis externa can be broken down into its word parts to determine its meaning: Otitis means inflammation of the ear; ot means ear, and -itis means inflammation. Externa means outside and relates to the location of the inflammation. Otitis externa is inflammation of the external auditory canal, otherwise known as swimmer’s ear.
Alternative names for swimmer’s ear include ear infection, outer ear, acute; otitis externa, acute; chronic swimmer’s ear; otitis externa, chronic; ear infection, outer ear, chronic.
Understanding Swimmer’s Ear
Now, let’s dive into the nuances of swimmer’s ear.
Otitis externa is a widespread condition, with about 10% of the population experiencing it during their lifetime, according to StatPearls [Internet]. Typically associated with recurrent swimming or water sports, otitis externa is more prevalent in tropical climates with high humidity, where the ears are prone to retaining water. However, it can occur at any time of the year.
Symptoms of Swimmer’s Ear
Symptoms of swimmer’s ear usually begin within days of swimming and can worsen without treatment. These symptoms include earache, itching, redness, swelling of the ear canal, draining from the ear, and other discomforts, as detailed by MedicineNet.
Causes of Swimmer’s Ear
Acute Swimmer’s Ear: Lasting less than six weeks, acute swimmer’s ear is most commonly caused by bacteria like Streptococcus, Staphylococcus, or Pseudomonas. It is often linked to unclean water in pools or other recreational settings. Repeated exposure to water, along with cuts or scratches from objects like cotton swabs, can lead to infections.
Chronic Swimmer’s Ear: Lasting more than six weeks, chronic swimmer’s ear may be caused by bacteria, fungi, skin conditions, chronic irritation, allergies, or nervous habits of continued ear scratching. Importantly, swimmer’s ear is not contagious.
Swimmer’s ear is usually diagnosed through initial office visits. According to the Mayo Clinic, physicians employ otoscopes to examine the ear canal for signs of swelling, redness, or flaking of the skin or other debris. An otoscope can also help identify any tears or damage in the tympanic membrane.
Further testing may be recommended in severe or persistent cases, often conducted by an ENT specialist. Another reason for further testing is if the infection does not respond to treatment. In this situation, the physician may take a sample of discharge or debris from the ear to determine the specific microorganism causing the infection.
The primary goal is to stop the infection and promote healing. Treatment involves using a suction device to clean the ear canal, followed by prescription eardrops. The type of eardrops depends on the infection’s nature and severity. In advanced cases, oral antibiotics may be prescribed, along with pain relievers.
Complications of Swimmer’s Ear
Complications are rare but can include temporary hearing loss, chronic otitis externa, periauricular cellulitis, and, in severe cases, malignant or necrotizing otitis externa. In extremely rare instances, the infection can spread to other body areas.
ICD-10-CM Coding for Otitis Externa/Swimmer’s Ear
Swimmer’s ear, along with other types of otitis externa, is reported with ICD-10-CM codes located in Chapter 8: Diseases of the ear and mastoid process, under H60-H62 (Diseases of the external ear). These codes are further classified according to type and laterality, with codes specific to swimmer’s ear listed under H60.3, Other infective otitis externa (shown in bold below).
H60.00‑H60.03 H60.0 Abscess of external ear
H60.10‑H60.13 H60.1 Cellulitis of external ear
H60.20‑H60.23 H60.2 Malignant otitis externa
H60.331‑H60.399 H60.3 Other infective otitis externa
H60.40-H60.43 H60.4 Cholesteatoma of external ear
H60.501‑H60.599 H60.5 Acute noninfective otitis externa
H60.60‑H60.63 H60.6 Unspecified chronic otitis externa
H60.8X1‑H60.8X9 H60.8 Other otitis externa
H60.90‑H60.93 H60.9 Unspecified otitis externa
H60.3, Other infective otitis externa, includes four different types, including swimmer’s ear is reported with codes H60.331-H60.339.
H60.311‑H60.319 H60.31 Diffuse otitis externa
H60.321‑H60.329 H60.32 Hemorrhagic otitis externa
H60.331-H60.339 H60.33 Swimmer’s ear
H60.391-H60.399 H60.39 Other infective otitis externa
Swimmer’s ear is reported based on laterality and using these codes:
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
Always review the instructional notes provided before making your final code selections. For example, at the beginning of Chapter 8, it tells the coder that an external cause code should be assigned as a secondary code to the ear condition, if applicable, to identify the cause of the ear condition. Furthermore, there is an Excludes2 note that specifies certain conditions that should be coded along with the swimmer’s ear if they are provided in the patient’s documentation. Be sure to review this list of conditions.
Coding for “Unspecified” and “Other” Otitis externa
In certain situations, you must assign an “unspecified” code or “other” code based on the documentation. For example, say the documentation only provides a diagnosis of swimmer’s ear but does not indicate which ear is affected. In this case, the coder must assign H60.339, swimmer’s ear, unspecified. This rule, as outlined in the ICD-10-CM Official Guidelines for Coding and Reporting, states “Codes titled “unspecified” are for use when the information in the medical record is insufficient to assign a more specific code.”
A note of warning: Be careful about using an unspecified code, as it may be frowned upon by some third-party payers.
Suppose the provider documents another type of otitis externa not mentioned in the list above. You must assign a code from H60.8, Other otitis externa, as per the Official Guidelines, which state: “Codes titled “other” or “other specified” are for use when the information in the medical record provides detail for which a specific code does not exist.”
Codes for Otitis Externa in Other Diseases Classified Elsewhere (H62)
As we discussed, specific types of otitis externa, including swimmer’s ear, are reported with a code from category H60. However, category H62 also includes otitis externa codes that you should be aware of even though these codes will not be used when reporting for swimmer’s ear. Otitis externa in other diseases classified elsewhere are reported with codes H62.4- and are used when the documentation indicates otitis externa not classified in H60.-. Like the codes in H60, the codes in H62 are classified according to laterality and include:
H62.40 Otitis externa in other diseases classified elsewhere, unspecified ear
H62.41 Otitis externa in other diseases classified elsewhere, right ear
H62.42 Otitis externa in other diseases classified elsewhere, left ear
H62.43 Otitis externa in other diseases classified elsewhere, bilateral
When assigning one of these codes, code first the underlying disease, as documented, such as erysipelas (A46) or impetigo (L01.0).
If you would like to explore a related challenge on ICD-10-CM coding for swimmer’s ear I encourage you to see the post below:
In summary, this article aims to provide valuable insights into the anatomy of the ear and break down the terminology to dive into the prevalence, symptoms, causes, diagnosis, treatment, and ICD-10-CM coding. We have navigated the intricacies of otitis externa. As discussed, swimmer’s ear is common but treatable. By understanding this condition and the associated codes in ICD-10-CM, medical coders can effectively assign the correct codes based on the coding guidelines and conventions.