ICD 9 Otitis Externa – Diagnosis, Treatment, and Coding

Touseef Riaz

October 1, 2021

otitis externa

Most people attribute otitis externa or swimmer’s ear to a summer trip to the beach. It is true that the condition is normally linked to a plunge in the pool or ocean, but it can also occur in people on dry land as well. Nevertheless, no matter how the condition is contracted, it is important to identify the symptoms and get proper attention – for the healthcare providers, it is equally important to diagnose the indicators and give the required treatment, as well as properly document the diagnostic codes for timely reimbursement on claims.

According to the Centers for Disease and Prevention, otitis externa affects nearly 2.5 million people in the US alone, which makes up almost half a billion dollars in healthcare costs. In this article, we look at the symptoms, causes, diagnosis, and treatment for swimmer’s ear and touch upon the coding guidelines for ICD 9 otitis externa.

What is Otitis Externa?

Otitis externa, or swimmer’s ear, is an infection of the ear canal. The ear canal is the tube that starts from the hole in the external ear and runs all the way to the eardrum.

The swimmer’s ear infection should not be confused with the otitis media, which is the infection that takes place deeper inside the ear, behind the eardrum, and is commonly contracted after a bout of flu. Otitis externa is caused usually as a result of a bacterial attack, but can also be brought on by fungus or virus as well.

The condition commonly occurs in teens and children but is known to affect many adults as well. Depending on the severity of the disease, otitis externa can either be short-term (acute) or long-term (chronic).


Otitis externa is given the name swimmer’s ear because of the fact that it is commonly associated with frequent swimming or other water sports. However, the ear canal can get inflamed when sand, dirt, or debris as well as water enters the ear.

The bacteria that is identified as the culprit behind the swimmer’s ear is the Pseudomonas or Streptococcus. Both these bacteria are found in recreational water settings and pools, especially when the water is unclean. Some cases are reported that have been caused by simply showering or frequent exposure to water, which allows bacteria to enter the ear canal. Once the water enters the ear canal, the bacteria gets trapped and paves the way for the infection.

Otitis externa is also known to be caused by scratches and cuts caused by cotton swabs or other sharp objects that are inserted in the ear. This can cause fungi to grow in the ear canal and lead to a chronic case of swimmer’s ear.


Whatever the causes of the swimmer’s ear are, the symptoms are more or less the same. Common identifies for the condition include:

          Frequent itchiness in the ear

–          Chronic pain in the air

–          Fluid discharge from the ear

–          Ears feel tender

–          Pain in the ear from head movement

–          Muffled sounds


A healthcare physician or an ear, nose, and throat (ENT) specialist usually conducts a thorough examination of the ear canal using an otoscope. The otoscope is a small instrument with a light on one end to properly examine the ear for bacteria and fungi. During the examination, the healthcare provider:

          Look at the tympanic membrane for damage and tears and to see if there is any obstruction in the ear canal. If they find the canal blocked, a suction device may be used to clear the way.

–          Performs an examination of the canal to check for any swelling or inflammation of the skin lining the ear canal.

If the case is severe and the symptoms advanced, an ENT specialist may conduct additional tests to determine the full extent of the infection, including an examination of the middle ear to see if it is affected. It is important to check the middle ear since the treatment for outer ear infection and middle ear infection varies.

In some cases, the ear infection does not get better with treatment, hence further tests for diagnosing are performed. Sample discharge or debris from the ear may be excavated and sent to the lab to identify the bacteria/microorganism behind the infection.


Most of the time, otitis externa is not serious, but applying home remedies instead of getting proper treatment can make the infection worse. Proper treatment performed by a healthcare physician or an ENT specialist includes cleaning the ear canal if there is an obstruction, so that ear drops to fight the infection can reach the affected area. Drops are administered in the ear at least three to four times a day.

Sometimes, the ear canal is blocked not by debris, but due to swelling inside the ear. In this case, the healthcare provider inserts a wick in the ear to make way for the drops to go deeper. In chronic cases, patients are also given oral or intravenous antibiotics to fight the infection.

It normally takes three to four for the infection to start diminishing after treatment starts. In a few weeks, the infection is totally clear and the patient feels the symptoms disappearing one by one. However, the patient should avoid getting water in the ears in the time after recovery for several weeks.

 Coding for Otitis Externa ICD 9

In the ICD 9 otitis externa is referred to as swimmer’s ear. It is classified under category 380. The specific ICD 9 code for otitis externa varies, depending on the severity (acute or chronic) and the part of the ear which is affected. In cases where the case is not classified as either acute or chronic, it is assigned the default code as found in ICD 9 otitis externa.

When assigning ICD 9 codes for otitis externa cases, it is imperative for the physician to define the type of otitis and if it is chronic or acute. They are further segregated in the following:

Other Otitis Externa ICD 9 – 380.12

Acute Otitis Externa ICD 9 –  380.22

Chronic Otitis Externa ICD 9 –  380.23

Diffuse Otitis Externa/ Otitis Externa Hemorrhagic ICD 9 – 380.10

It is important to note here that the above codes should only be used for claims that have a date of service before September 2015. After that date, it is mandatory to use the corresponding ICD 10 codes since the ICD 10 code set effectively replaced the ICD 9 starting from October 1, 2015.

Crosswalking from the ICD 9 Otitis Externa to ICD 10

In the ICD 9, ears were found in a category along with diseases concerning eyes. In the ICD 10 code set, they enjoy a chapter of their own, with each condition being described in more detail. That means that there are more codes in the new code set, specifying the laterality as well as the severity. Where the ICD 9 otitis externa had only one code i.e. 382.12, the ICD 10 gives four choices to code the condition, namely:

  • H60.339 applies to acute otitis externa for unspecified ear
  • H60.331 applies to acute otitis externa for the right ear
  • H60.332 applies to acute otitis externa for the left ear
  • H60.333 applies to acute externa for both ears

The laterality means that there are four times as many codes as compared to otitis externa ICD 9. It is imperative, therefore, that healthcare providers and medical coders should be including laterality in their documentation.

The ICD 9 code otitis externa Hemorrhagic and diffuse otitis externa were joined into one code; in the new code set, there are separate codes for each. To file claims for diffuse cases, the code to be used is H60.31 and for hemorrhagic, it is H60.32.

For the ICD 9 code for Acute otitis externa, 380.22 was used to define the condition. ICD 10 further divides the condition into seven series of codes concerning laterality, including acute reactive otitis externa (H60.55), acute actinic otitis externa (H60.51), acute contact otitis externa (H60.53) to name a few.

About the ICD

The International Classification of Diseases is a standard tool developed by the World Health Organization to capture morbidity and mortality data globally. The ICD incorporates and organizes codes that specify health information which is used to get data around health care management, epidemiology, primary care, research, and treatment. The ICD is important to get a bigger picture of the general health situation in the various countries around the World.

The ICD is also essential in monitoring and reporting diseases since it serves as a standard that is followed around the world. Using the ICD, healthcare systems around the world are able to share and compare data in a consistent manner.

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