Acute serous otitis media, left ear

This code signifies an acute inflammation of the middle ear characterized by the presence of thin, watery fluid (serous effusion) behind the eardrum, specifically affecting the left ear. It indicates a sudden onset of middle ear fluid without signs of active infection.

Apply this code when documentation clearly states acute serous otitis media in the left ear. This diagnosis is typically supported by otoscopic findings of a bulging or retracted tympanic membrane with a visible fluid level or air bubbles, and a history of recent onset.

• Differentiate from chronic serous otitis media (H65.2-) and other types of otitis media (e.g., suppurative, mucoid).
• Ensure the laterality (left ear) is explicitly documented; if bilateral, use the appropriate bilateral code.
• Look for terms like "acute non-suppurative otitis media" or "acute middle ear effusion" with serous characteristics.