December 19, 2016

Coding of Allergies Presents Unique Challenges

By Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer

While I was traveling to the airport last week, our local radio station had an allergist as a guest on their early morning talk show. The allergist was reporting that the holiday season is a very dangerous time for people who have food allergies.

For one thing, people are attending parties that feature many different food items and special dishes, and many visitors may not communicate their food allergies to their hosts. This physician also noted that patients with allergies should have an action plan for any severe allergic reactions. He said that if a patient experiences such a reaction, they should:

Try an over-the-counter remedy such as Benadryl as the initial course of treatment.
If the reaction continues, use the EpiPen (or something similar) and call 9-1-1.
An emergency department visit is necessary following the use of the EpiPen if the condition does not improve.

I recently started to look at the coding of any type of allergies in ICD-10-CM. There are a few documentation issues. There is an allergy status (patient has a known allergy to a food or substance) and an allergic reaction (patient is having a current reaction to a substance/food item).

It is important that the documentation is specific to the circumstances as well as the cause to support accurate code assignment.

The allergy status is found in the ICD-10-CM Index by looking under history, personal, allergy. The code description does not include personal history, which makes this condition difficult to locate in the Index. The specificity of the known allergy is found under this entry. Allergies can be specified to classes of medications and high-frequency food allergies. Some code examples of allergy status are:

Contrast media	Z91.041 (Radiographic dye allergy status)
Penicillin	Z88.0 (Allergy status to penicillin)
Latex	Z91.040 (Latex allergy status)
Eggs	Z91.012 (Allergy to eggs)
Peanuts	Z91.010 (Allergy to peanuts)

Some organizations do not code the allergy information on a routine basis. Determine if your provider or organization captures this information as part of their provider/organization-specific guidelines.

Allergic reaction is found under the main term of “allergy” in the ICD-10-CM Index. The next piece of information listed is the substance or food that instigated the reaction. Additional instructions may be found in the Index. For example:

            Allergic reaction to bee sting: See Toxicity, Venom, Arthropod, Bee

            Drug, correctly used: See Table of Drugs and Chemicals, Specific Drug, Adverse Reaction

            Drug, incorrectly used: See Table of Drugs and Chemicals, Specific Drug, Accidental Poisoning

The manifestation of the allergic reaction is coded first (e.g. hives or gastrointestinal upset). Use T78.1 when the manifestation is unknown or undocumented.

This time of year presents a wonderful opportunity to appreciate family and friends through time spent together and the special foods that are prepared. Be cognizant of any food allergies of your guests in order to prevent allergic reactions.

And have a wonderful holiday season!

Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer

Laurie M. Johnson, MS, RHIA, FAHIMA is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an American Health Information Management Association (AHIMA) approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.