Pediatric Coding Alert

Hint: Approach codes for allergy, intolerance, and immunotherapy with caution.

“As many as6 million children in the United States have some form of food allergy,” according to the American College of Allergy, Asthma & Immunology (Source: acaai.org/allergies/who-has-allergies/children-allergies). Consequently, pediatric practices have an important role in helping young patients deal with this condition.

Even though your pediatrician probably won’t test the patient to determine the cause of a food allergy or food intolerance, there are still a number of questions you’ll need to be able to answer before and after the diagnosis whenever your provider sees patients with these conditions. Here are four to ask that will help lead you to flawless reporting.

What Tests Could Your Pediatrician Use if Food Allergies or Intolerance Are Suspected?

A number of common foods — fish and shellfish, milk products, peanuts and tree nuts, soy, eggs, and wheat — can produce allergic reactions or digestive problems. If your pediatrician suspects a patient may be experiencing such conditions, he or she may test your patient for immunoglobulin E (IgE), an antibody that triggers food allergies, using a blood test such as 82785 (Gammaglobulin (immunoglobulin); IgE)  before referring the patient out to an allergist for more specific testing.

What is the Difference Between a Food Allergy and Food Intolerance?

The distinction between the two conditions is sometimes hard to determine, because “a food intolerance can cause some of the same signs and symptoms as a food allergy,” according to Dr. James Li of the Mayo Clinic (Source: www.mayoclinic.org/diseases-conditions/food-allergy/expert-answers/food-allergy/faq-20058538).

However, understanding the difference between the two states is important, as it will help you determine the codes you will use should you encounter these situations. “A true food allergy causes an immune system reaction that affects numerous organs in the body. … In some cases, an allergic food reaction can be severe or life-threatening … [producing] a life-threatening allergic reaction (anaphylaxis).” However, “intolerance symptoms are generally less serious and often limited to digestive problems,” Li goes on to explain, leading you to mostly choose codes from Chapter 11: Diseases of the Digestive System when the final patient diagnosis is a food intolerance.

What ICD-10 Codes Are Associated With Food Allergies and Food Intolerance?

Whether the patient has a food allergy or simply has a problem with tolerating certain foods, coding choices are relatively straightforward. However, no matter what condition the patient may have, there are a couple of pitfalls you will need to avoid.

“Food allergies have their own subcategory of codes — Z91.01 [Food allergy status]” notes Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana. They include

• Z91.010 — Allergy to peanuts
• Z91.011 — Allergy to milk products
• Z91.012 — Allergy to eggs
• Z91.013 — Allergy to seafood
• Z91.018 — Allergy to other foods.

Coding caution 1: Be sure to follow the note to Z91.018, which states that you should use this code if your patient is diagnosed with an allergy to nuts other than peanuts.

If the patient suffers from food intolerance, however, you’ll use a different set of codes. You can code a number of conditions with codes from the K90.4 (Other malabsorption due to intolerance) subcategory.

Coding caution 2: Again, make sure you read the notes to these codes, as even though two other intolerance conditions, celiac disease and lactose intolerance, are included in these codes as Excludes2 codes, they are more accurately coded as K90.0 (Celiac disease) and E73.- (Lactose intolerance).

What Immunotherapy Codes Might You Need?

Two other procedure codes you might use once a patient has been diagnosed with a food allergy are 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) and 95117 (Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections). You would use them “when children have gone to the allergist and then present with the immunotherapy vials to be administered by the pediatric office when the office did not provide the medication,” says Holle.  “If your provider only administers one injection, you would use the 95115 and, if more than one, you would use the 95117,” Holle adds as a reminder.

Coding caution 3: “If your patient undergoes allergy testing or allergy potency testing, you should not report immunotherapy codes on the same day,” according to Sherika Charles, CDIP, CCS, CPC, CPMA, compliance analyst with UT Southwestern Medical Center in Dallas, Texas. Simply put, “testing for allergies has to occur before the therapy can be administered, so unless testing on the same day as the therapy involves testing for different allergens, the two procedures should be documented in sequence and on different days,” Charles adds.