Primary Care Coding Alert

Primary Care Coding:

Include This Z Code When Reporting Prescription

Question: I work at a primary care provider’s office. A provider saw a patient who came in for a sore throat. The provider ordered a rapid test for strep and the patient tested positive. The provider diagnosed the patient with streptococcal pharyngitis and prescribed antibiotics. In the patient’s personal history, the documentation says the patient is allergic to penicillin. Do I include this allergy on the claim?

South Carolina Subscriber

Answer: Since penicillin or related drugs, like amoxicillin, are often prescribed to treat streptococcal infections, noting that a patient has an allergy to the medication helps present a more complete narrative of the patient’s health and can make sure that the treatment doesn’t endanger them.

Remember, in this situation, coding the allergy first would be incorrect. First report the strep throat with J02.0 (Streptococcal pharyngitis), and then you can include the medication allergy by reporting Z88.0 (Allergy status to penicillin).

Don’t forget, when coding pharyngitis, the ICD-10-CM guidelines instruct coders to use additional codes to reflect exposure to tobacco, if applicable. These codes are:

  • Z77.22 (Exposure to environmental tobacco smoke)
  • P96.81 (Exposure to tobacco smoke in the perinatal period)
  • Z87.891 (Personal history of nicotine dependence)
  • Z57.31 (Occupational exposure to environmental tobacco smoke)
  • F17.- (Nicotine dependence)
  • Z72.0 (Tobacco use).

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC