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The AAP Pediatric Coding Newsletter™ is a monthly newsletter from the American Academy of Pediatrics. Along with providing solutions to the most urgent pediatric coding questions, the Newsletter also features “Transitioning to 10,” a monthly column with practical advice on the upcoming ICD-10-CM transition.

Sample Article:

Transitioning to 10: Documentation and Coding of Otitis Media

March 2014

As preparations continue for the October 1, 2014, transition to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), some physicians and practices may have concerns about how well current documentation practices will support code assignment in ICD-10-CM.

One option for implementing a documentation review and improvement project in relation to ICD-10-CM is to start with a list of the physician's or practice's most frequently reported International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. To focus on documentation to support specific codes, it is necessary to determine the elements that support code selection for a specific condition. For instance, ICD-9-CM code 382.9 ranked third in the top 25 diagnosis codes reported by pediatricians for encounters with children up to age 18 years for the years 2008–2010. This code represents unspecified otitis media and could be more specifically reported in ICD-9-CM if documentation provides the necessary information. (See "Top 25 Pediatric Diagnoses Revisited" in the August 2013 issue of AAP Pediatric Coding Newsletter™ to learn how this code indicates a lack of specificity in documentation.) Once you have selected a condition to review, look carefully at the ICD-10-CM codes for that condition and create a list or table of the documentation elements that support code selection. The Table shows in 4 columns the documentation elements necessary to specifically identify otitis media using ICD-10-CM. A documentation element from each of the 4 columns is necessary to support specific code selection.

To take this a step further, note whether there is documentation of tobacco use or exposure, as this is reported in addition to otitis media when documented.

Alternatively, you can start dual coding for certain conditions now. This is a bit time consuming because it involves assignment of ICD-9-CM and ICD-10-CM codes to current services (officially reporting only ICD-9-CM codes). However, this brings real-world ICD-10-CM coding experience to your practice prior to the date when these codes will actually be billed. This may help offset the expected October work delays related to the transition while clearly illustrating where documentation lacks information to assign specific codes. Documentation references such as the Table may be built and used as improvement tools as you find necessary during the project.

Whichever method you choose, these are exercises that offer opportunity now to not only prepare for ICD-10-CM but also to report the codes that most specifically describe the conditions managed and support the necessity of services provided. Who knows? You may be pleasantly surprised that documentation for ICD-10-CM is not so different from ICD-9-CM.

 Documentation Elements of Otitis Media​ ​ ​ ​ 

LateralityIncidence​​Type (Suppurative and nonsuppurativer are less specific than other terms.)Tympanic Membrane Status​







Acute recurrent


In disease classified elsewherea (eg, influenza

Allergic (includes otitis media stated as allergic and mucoid sanguineous, or serous)


Glue ear






Nonsuppurative/with effusion/catarrhal




Benign chronic suppurative

With associated perforation

Without associated perforation


aType is not designated in codes for otitis media in disease classified elsewhere.

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