Joiaw
Networker
I work in an Allergy Clinic and just recently did a webinar with the AAAAI. If anyone knows anything about the T63 Toxic effect of venom codes, please give me input. Here are a few case scenarios they gave us with the answers. I don't think I agree on some of the answers.
Case Scenario:
If a patient presents with a history of reactions to bee/wasp/hornets stings and is not skin tested, should
the visit be coded using the toxic effect codes (T63?.) or an allergy status code (Z91.030) Bee allergy
status, or Z91.038 ? Other insect allergy status?
Response:
If there is active treatment for the patient, and the patient is seeking treatment for a recent
encounter with a ?bee?, the correct diagnosis code would be T63??? If the patient is giving historical
information based on past encounters and the patient is not seeking active treatment, the appropriate code
would be the Z91.030 ? Bee allergy status.
Case Scenario:
Assume that a patient provides a history of reaction to bee/wasp/hornets stings, is skin tested and skin
testing is negative. What would be the appropriate ICD-10 code to choose?
Response:
If the patient had not been recently stung and has not been actively treated by a provider, the
appropriate code would be the Z91.030 ? Bee allergy status. The diagnosis code Z01.82 for allergy
testing is to be used when there is no sign, symptom, or complaint to use to support the testing.
Case Scenario
A patient presents with history of reactions to bee/wasp/hornet stings and is skin tested. The testing is
positive. A T code is assigned, but what would be the appropriate 7th digit, A, D, S?
Response:
The appropriate 7th digit would be the A, since the patient is undergoing active workup and
treatment for the diagnosis of toxic effect of bees.
Case Scenario
A patient is evaluated for bee/wasp/hornet stings, and decides to return on a different day for testing.
Would the 7th character be A, D, S?
Response:
The 7th character would be A since the patient is continuing to undergo active treatment and
workup for the diagnosis.
Case Scenario
A patient is seen back in consultation for adjustments on their doses while on bee immunotherapy. What
7
th character would be appropriate?
Response:
In this scenario, since we are making medication adjustments and the patient is receiving
routine care, the appropriate 7th character would be D for subsequent encounter. However, a provider
may also select the ?A? as the 7th Character since the patient is still receiving active treatment. In
checking LCD?s from Medicare carriers, both diagnosis codes are listed as appropriate.
Case Scenario:
Patient is on immunotherapy for venom desensitization, what would be appropriate 7th character?
Response:
The appropriate 7th character for this patient would be ?D,? since the patient is on routine care for the
toxic effect to bees. The patient is still receiving active treatment and an argument for the use of the ?A?
may also be made. Guidance from the ICD-10CM committee needs to be given for further clarification.
Case Scenario:
If a patient presents with a history of reactions to bee/wasp/hornets stings and is not skin tested, should
the visit be coded using the toxic effect codes (T63?.) or an allergy status code (Z91.030) Bee allergy
status, or Z91.038 ? Other insect allergy status?
Response:
If there is active treatment for the patient, and the patient is seeking treatment for a recent
encounter with a ?bee?, the correct diagnosis code would be T63??? If the patient is giving historical
information based on past encounters and the patient is not seeking active treatment, the appropriate code
would be the Z91.030 ? Bee allergy status.
Case Scenario:
Assume that a patient provides a history of reaction to bee/wasp/hornets stings, is skin tested and skin
testing is negative. What would be the appropriate ICD-10 code to choose?
Response:
If the patient had not been recently stung and has not been actively treated by a provider, the
appropriate code would be the Z91.030 ? Bee allergy status. The diagnosis code Z01.82 for allergy
testing is to be used when there is no sign, symptom, or complaint to use to support the testing.
Case Scenario
A patient presents with history of reactions to bee/wasp/hornet stings and is skin tested. The testing is
positive. A T code is assigned, but what would be the appropriate 7th digit, A, D, S?
Response:
The appropriate 7th digit would be the A, since the patient is undergoing active workup and
treatment for the diagnosis of toxic effect of bees.
Case Scenario
A patient is evaluated for bee/wasp/hornet stings, and decides to return on a different day for testing.
Would the 7th character be A, D, S?
Response:
The 7th character would be A since the patient is continuing to undergo active treatment and
workup for the diagnosis.
Case Scenario
A patient is seen back in consultation for adjustments on their doses while on bee immunotherapy. What
7
th character would be appropriate?
Response:
In this scenario, since we are making medication adjustments and the patient is receiving
routine care, the appropriate 7th character would be D for subsequent encounter. However, a provider
may also select the ?A? as the 7th Character since the patient is still receiving active treatment. In
checking LCD?s from Medicare carriers, both diagnosis codes are listed as appropriate.
Case Scenario:
Patient is on immunotherapy for venom desensitization, what would be appropriate 7th character?
Response:
The appropriate 7th character for this patient would be ?D,? since the patient is on routine care for the
toxic effect to bees. The patient is still receiving active treatment and an argument for the use of the ?A?
may also be made. Guidance from the ICD-10CM committee needs to be given for further clarification.
