From the Guidelines
The CPT code for treating an infant with an ear infection (acute otitis media) with amoxicillin would be 99213 or 99214, depending on the complexity of the visit. This code represents an office or outpatient visit for evaluation and management of an established patient. For a new patient, codes 99202-99204 would be used instead. The specific code selection depends on the level of medical decision-making, history taking, and examination performed during the visit.
- Key considerations for coding include:
- The level of medical decision-making
- The extent of history taking
- The thoroughness of the examination
- Additionally, you would use the ICD-10 diagnosis code H66.90 for unspecified otitis media, or more specific codes like H65.00 for acute serous otitis media or H66.001 for acute suppurative otitis media if those diagnoses apply, as per standard medical coding practices 1.
- The medication itself (amoxicillin) would not have a CPT code but would be documented in the patient's record with appropriate dosing, typically 40 mg/kg/day divided twice daily for 5 days for infants with acute otitis media, as recommended by the World Health Organization 1.
- Proper documentation of the visit components is essential to support the CPT code billed.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
CPT Code for Infant with Ear Infection Treated with Amox
- The provided studies do not directly address the CPT code for an infant with an ear infection treated with amoxicillin.
- However, the studies discuss the efficacy of amoxicillin and other antibiotics in treating acute otitis media (AOM) in children, including infants 2, 3, 4, 5, 6.
- The American Academy of Pediatrics (AAP) recommends amoxicillin as the first-line treatment for AOM in children, including infants 2.
- The CPT code for the treatment of AOM with amoxicillin would depend on the specific procedure or service provided, such as an office visit or a prescription for amoxicillin.
- Some possible CPT codes related to the treatment of AOM in infants include:
- 99213: Office or other outpatient visit for the evaluation and management of an established patient, which may include the diagnosis and treatment of AOM.
- 87070: Urinalysis, which may be performed to rule out other conditions or to monitor the infant's response to treatment.
- 90715: Administration of vaccine, which may be recommended for infants with recurrent AOM.
Treatment of AOM with Amoxicillin
- The studies provide evidence for the efficacy of amoxicillin in treating AOM in children, including infants 2, 3, 4, 5, 6.
- The recommended dosage of amoxicillin for AOM in infants is 40-90 mg/kg/day, divided into 2-3 doses 2, 6.
- The duration of treatment with amoxicillin for AOM in infants is typically 7-10 days 4, 5, 6.
- The studies also discuss the importance of considering the possibility of resistant pathogens, such as penicillin-resistant Streptococcus pneumoniae, when treating AOM in infants 2, 6.