ICD code H67.2 – Otitis media in diseases classified elsewhere, left ear

Key Takeaways

H67.2 covers left-ear otitis media that arises as a manifestation of a disease classified in another ICD-10-CM chapter, such as plasminogen deficiency. Influenza, measles, scarlet fever, and tuberculosis are Excludes1 conditions, not code-first partners.

H67’s code-first note names plasminogen deficiency (E88.02) and viral disease NEC (B00-B34), and that underlying code is sequenced before H67.2.

H67 carries a use-additional-code note for an associated perforated tympanic membrane (H72.-). Add that code when the chart documents a perforation.

Pabau’s claims management software flags incomplete code sequences before submission, reducing H67.2-related denials caused by missing etiology codes.

ICD-10 code H67.2: Definition, billable status, and FY2026 validity

ICD-10 code H67.2 is a billable, claim-submittable ICD-10-CM code with a full official descriptor of “Otitis media in diseases classified elsewhere, left ear.” Its FY2026 effective date is October 1, 2025, and it remains valid through September 30, 2026, per the CMS ICD-10 codes release.

The phrase “diseases classified elsewhere” is the operative clinical signal. It means the otitis media is not the primary condition; it is a manifestation of a systemic disease that belongs to a different ICD-10-CM chapter. Coding H67.2 as a standalone principal diagnosis is a sequencing error and a common denial trigger.

Coders using medical billing workflows should note that H67.2 sits within the H65-H75 block, which covers diseases of the middle ear and mastoid. That block context matters when comparing H67.2 with the suppurative otitis media codes in the adjacent H66 category.

Code first: How to sequence ICD-10 code H67.2 correctly

H67.2 follows the etiology/manifestation convention, meaning the underlying systemic disease is always sequenced first, with H67.2 appearing second (or later) in the diagnosis list. According to the WHO ICD-10 classification framework, manifestation codes represent conditions that arise as the expression of an underlying disease, not as primary diagnoses.

The ICD-10-CM tabular notes for H67 explicitly state: “Code first underlying disease, such as: plasminogen deficiency (E88.02); viral disease NEC (B00-B34).” These are instructional notes, not suggestions. Submitting H67.2 first violates the sequencing rule and signals to the payer that the middle-ear infection is the presenting condition rather than a complication.

A correct sequence for a patient with a documented viral infection and left-ear otitis media looks like this:

1. B34.9 or the more specific viral disease NEC code the chart supports (B00-B34) – the underlying disease, sequenced first
2. H67.2 – otitis media in diseases classified elsewhere, left ear – the manifestation, sequenced after
3. H72.- – perforation of tympanic membrane – added only when a perforation is documented

The CMS ICD-10-CM Official Guidelines for Coding and Reporting Section I.C govern the etiology/manifestation convention in full. Influenza, measles, scarlet fever, and tuberculosis are not code-first partners for H67. Each of those diseases carries its own otitis media code, and H67 excludes all four outright. The check before submission is whether the documented underlying disease has a combination code of its own.

Use additional code: Reporting an associated perforated tympanic membrane

A code from category H72 (Perforation of tympanic membrane) is added when the clinical documentation records a perforation alongside the otitis media episode. The add-on is instructional: the tabular notes for H67 direct coders to “use additional code for any associated perforated tympanic membrane (H72.-).” H72 codes carry their own site and laterality detail, so the otoscopic finding has to support the specific code chosen.

• When to add an H72 code: the otoscopic exam, operative note, or discharge summary records a perforated tympanic membrane during the same episode
• When not to add one: the tympanic membrane is intact, an old perforation is documented as healed, or a tympanostomy tube is in place
• Sequencing position: the H72 code follows H67.2 in the code list; neither is the principal diagnosis

Excludes notes for H67.2 and the H67 category

The H67 category carries Excludes1 notes that prohibit dual coding with certain other otitis media conditions. Understanding these is essential. Submitting a code listed under Excludes1 on the same claim as H67.2 is a hard coding violation, not a billing choice.

The practical implication is simple. When the chart names influenza, measles, scarlet fever, or tuberculosis as the cause, the combination code for that disease is the whole answer. H67.2 is not added on top of it. H67.2 applies when the underlying disease has no combination code of its own. That is exactly why the code-first note points to plasminogen deficiency and viral disease NEC. Review the AAPC ICD-10-CM code lookup notes for the full H67 exclusion list when auditing these claims.

H67.2 in the H67 code hierarchy

H67.2 sits four levels deep in the ICD-10-CM hierarchy. Understanding the full taxonomy prevents navigation errors when coders search by chapter or block rather than by code directly.

• Chapter 8: Diseases of the ear and mastoid process (H60-H95)
• Block H65-H75: Diseases of middle ear and mastoid
• Category H67: Otitis media in diseases classified elsewhere
• Code H67.2: Otitis media in diseases classified elsewhere, left ear

H67 itself is a non-billable parent category – it cannot be submitted for reimbursement and must always be extended to a laterality-specific child code. Submitting plain H67 (without the .1, .2, .3, or .9 extension) will be rejected by payer edits as insufficiently specific. For related coding context in the ear and audiology space, see how ICD-10-CM specificity requirements apply across specialty code sets.

Sibling codes: Comparing H67.1, H67.2, H67.3, and H67.9

The four child codes under H67 differ only by laterality. Selecting the wrong sibling is the most straightforward documentation error in this family. Payer audits catch it through laterality consistency checks against procedure codes.

H67.2 vs H67.9: When to query the provider

H67.9 (unspecified ear) is frequently overused. ICD-10-CM specificity guidelines require the most specific code the documentation supports. If the clinician’s note documents the otoscopic finding or treatment in the left ear, H67.2 is the correct code, and H67.9 should not be used.

When documentation is genuinely silent on laterality, coders should query the provider before defaulting to H67.9. Most ENT and primary-care EHR templates have laterality checkboxes precisely because ICD-10-CM requires it. Defaulting to H67.9 across a practice’s H67 claims suppresses the specificity of the coded data. It may also flag the practice in payer data analytics as a documentation-quality outlier.

H67.2 vs H67.3: Bilateral documentation requirements

H67.3 (bilateral) requires documented evidence of involvement in both ears during the same encounter. A chart that notes “left ear consistent with otitis media, right ear clear” supports H67.2 only, not H67.3. Coding bilateral when unilateral involvement is documented inflates specificity artificially and creates a consistency risk if associated procedure codes (e.g. myringotomy CPT codes) are unilateral.

Common underlying diseases that lead to H67.2

The ICD-10-CM tabular notes for H67 name two example underlying diseases. They are illustrative, not exhaustive. Any disease classified in another chapter can serve as the “code first” etiology code. It has to be documented as causing the otitis media, and it must have no combination code of its own.

An important nuance: the B00-B34 range is broad, so coders should select the most specific viral code the documentation supports rather than defaulting to B34.9. Verify the pairing with the CDC/NCHS ICD-10-CM web tool before submission. Diseases that carry their own otitis media combination code, including measles, scarlet fever, influenza, and tuberculosis, never pair with H67.2.

H67.2 in audiology and ENT billing

H67.2 appears in audiology encounters when a patient presents with conductive hearing loss or middle-ear effusion in the context of an active systemic illness. Audiologists do not diagnose otitis media, but they document middle-ear status through tympanometry and audiogram findings. When a physician has already coded an underlying disease, and the audiologist’s findings show middle-ear involvement, H67.2 may be reported as a secondary diagnosis. It supports the clinical picture documented in the audiology and speech-language pathology encounter.

In ENT practice, H67.2 is most commonly encountered during follow-up visits for systemic illness with ear complications. The ASHA audiology reference guide includes H67.1 through H67.9 in its ICD-10-CM audiology code set, grouping them under the “Otitis media codes” section. For CPT codes for audiology visits, the most common pairings with H67.2 include 92550 (tympanometry and acoustic reflex testing) and 92552 (pure tone audiometry). Both apply when assessing conductive hearing loss related to the middle-ear condition.

The American Speech-Language-Hearing Association (ASHA) publishes annually updated ICD-10-CM reference guides for audiologists. Those guides list H67 category codes alongside the hearing loss codes (H90-H91) commonly co-documented in these encounters.

ICD-9-CM crosswalk for ICD-10 code H67.2

Legacy data analysis, payer audits, and multi-year trend reporting sometimes require mapping H67.2 back to its ICD-9-CM predecessor. These crosswalks are approximate equivalences, not exact matches, because ICD-10-CM introduced laterality specificity that ICD-9-CM lacked. For detailed crosswalk methodology, see how ICD-10 crosswalk methodology applies across multi-system code transitions.

For rigorous crosswalk lookups, the ResDAC ICD codes in Medicare files guide explains how ICD-9 to ICD-10 transition files are structured. That includes the General Equivalence Mappings (GEMs) used by CMS for research and payer auditing.

Coding tips and common errors with ICD-10 code H67.2

Most H67.2 claim problems are preventable at the documentation and pre-submission stage. The four errors below account for the majority of denials on this code family. Each maps to the common denial codes in medical billing associated with manifestation code violations.

• Error 1 – H67.2 submitted as the principal diagnosis: Payers reject claims where a manifestation code leads the diagnosis list. The underlying disease code must always be first. This is the single most common reason H67.2 claims are denied on first submission.
• Error 2 – Missing the H72 code: If the otoscopic exam records a perforated tympanic membrane, the tabular notes call for an additional code from H72.-. Omitting it does not void the claim outright, but it understates the episode and creates a documentation-to-coding gap that surfaces in audits.
• Error 3 – Using H67.2 when an Excludes1 condition applies: Influenza, measles, scarlet fever, and tuberculosis each carry their own otitis media code. None of them may appear on a claim with H67.2. Coders must confirm the underlying disease has no combination code of its own before selecting H67.2.
• Error 4 – Defaulting to H67.9 instead of querying for laterality: When documentation is silent, the correct action is a provider query. Automatic assignment of H67.9 is not acceptable. Persistent use of H67.9 across a practice’s H67 claims draws payer attention and reduces data quality for the practice. Understanding manifestation code sequencing rules across diagnostic categories helps coders apply consistent logic.

Practices using electronic claims via Claim.MD benefit from real-time claim edits that flag sequencing issues before submission. The integration routes claims through 4,000+ US payers and validates ICD-10-CM code combinations against payer-specific edit sets. That catches common H67.2 sequencing errors before they generate a denial. For broader context on keeping claims clean from the start, see submitting a clean claim and how pre-submission validation works in practice.

Stop H67.2 denials before they happen

Pabau’s claims management software validates ICD-10-CM code sequences before submission, flags missing etiology codes, and connects to 4,000+ US payers through our Claim.MD integration. See how practices eliminate coding errors at the source.

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Conclusion

ICD-10 code H67.2 is straightforward in concept but consistently generates denials in practice. Coders submit it as a principal diagnosis rather than a manifestation code. The underlying disease always leads; H67.2 follows. Add a code from H72.- when a perforated tympanic membrane is documented. Choose H67.2 over H67.9 whenever the chart specifies the left ear, and check the Excludes1 list before finalizing the claim.

Pabau’s claims management software validates code sequences against payer edits before submission. That reduces the manual review burden on coders working with manifestation code families like H67. To see how the workflow handles ICD-10-CM sequencing validation, book a demo.

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