What is the correct order of diagnosis codes for a patient with influenza and otitis media, considering exposure to a contagious disease?

Diagnosis Code Sequencing for Influenza with Otitis Media and Exposure to Contagious Disease

List the definitive diagnoses (influenza and otitis media) first, followed by the exposure code, as exposure codes are supplementary and should not be sequenced as the principal diagnosis when an actual disease is present.

Correct Sequencing Order

The proper order for your diagnosis codes should be:

1. Influenza (primary diagnosis)
2. Otitis media (complication/secondary diagnosis)
3. Exposure to contagious disease (supplementary code)

Clinical Rationale

Influenza should be listed first because it represents the primary infectious disease requiring treatment and management. 1 Otitis media is a well-recognized bacterial superinfection and complication of influenza, particularly common in children under 5 years of age, occurring in approximately 25% of pediatric influenza cases. 1

Why This Order Matters

• Influenza drives the clinical presentation and treatment decisions, including antiviral therapy with oseltamivir, which has been shown to significantly reduce the emergence of new acute otitis media infections (relative risk 0.57) when started within 48 hours of symptom onset. 2

• Otitis media represents a complication that develops secondary to the influenza infection, typically appearing during or shortly after the viral illness. 1 The median time to presentation with bacterial upper respiratory infections following influenza is approximately 12 days. 3

• Exposure codes are supplementary and provide context about potential disease transmission but do not represent an actual diagnosis requiring treatment. These codes should never be the principal diagnosis when a confirmed disease is present.

Common Pitfalls to Avoid

• Do not list exposure codes first - they are meant to supplement, not replace, actual disease diagnoses
• Do not separate influenza from its complications - the relationship between influenza and otitis media is clinically significant and should be reflected in the sequencing
• Ensure both conditions are documented - otitis media is the most common bacterial superinfection of influenza and requires specific antibiotic coverage for Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. 1