ED Coding and Reimbursement Alert

Diagnosis coding: You can find many allergy-related conditions within the J30.- (Vasomotor and allergic rhinitis) codes. For this scenario, resist the temptation to report J30.2 (Other seasonal allergic rhinitis). Even though the provider documented seasonal allergies, J30.1 (Allergic rhinitis due to pollen) is more appropriate.

While seasonal rhinitis is common in spring, and even summer and early fall, “the typical causes are airborne mold spores, dust mites, or pollens from grass, trees and weeds,” says Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico. A quick look at the alphabetic index will tell you why J30.1 is the better choice.

The ICD-10-CM index entry for hay fever refers you to J30.1. Additionally, “hay fever” is listed as one of the synonyms for J30.1. And finally, “you would report J30.2 if airborne mold spores or dust mites cause the condition; whereas you would report J30.1 for hay fever as the code specifically cites pollen as the cause,” Witt adds.

Insect Bites Could Be Serious Business

For most patients, stings and bites generally cause itching and mild discomfort. But for others, a sting or bite can cause anaphylactic shock, which can range in severity from a rash or hives to a potentially life-threatening closure of the airways.

Bites from mosquitos and ticks can also produce rashes that are symptomatic of other dangerous conditions such as Rocky Mountain spotted fever and Lyme disease.

And the coding can be tricky, as “you need to keep in mind that there are over 350 diagnoses that could relate based on site and care,” says Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California.

Diagnosis coding: For rashes caused by nonvenomous insect bites, you’ll first want to code the condition associated with the bite, such as A77.0 (Spotted fever due to Rickettsia rickettsii) for Rocky Mountain spotted fever and A69.2- (Lyme disease) for Lyme disease. Then you will use W57.XXXA (Bitten or stung by nonvenomous insect and other nonvenomous arthropods, initial encounter) for the bite. (The appropriate 7th character is nearly always A for ED encounters.)

However, rashes caused by bee stings and other venomous animal or insect bites are coded differently. Again, you’ll code the condition first — in this case, anaphylactic shock using T78.2XXA (Anaphylactic shock, unspecified, initial encounter). Then you will use T63.4- (Toxic effect of venom of other arthropods), adding the appropriate 5th digit for the kind of insect and the appropriate 6th digit to indicate intentionality (the appropriate 7th character is nearly always A for ED encounters). And this time, you will add an encounter code from Z91.03- (Insect allergy status) to indicate the anaphylaxis. These also require a 6th character, so report either Z91.030 (Bee allergy status) or Z91.038 (Other insect allergy status) for the encounter.