# tick bite



## mgord (Jun 22, 2010)

the tick was still in the wound - what diagnosis code would we use. I looked up bite but there was no tick and under 989.5 it says tick paralysis.

also the provider debrided some infected tissue, would you code cellulitis?

Thanks!


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## vj_tiwari (Jun 23, 2010)

Hey,

I think you want to try for Injury --> Superficial by site --> (Plus the 4th digit as 4 or 5). & E code will be E906.4.

Hope this helps! 

VJ.


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## mgord (Jun 23, 2010)

you're right, I didnt even think of that. thank you so much!!


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## hthompson (Feb 27, 2012)

I am on board with the superficial injury, by site + E906.4, but it did get me to thinking...

Why is this a non-venomous arthropod when they have antivenom for tick bites?

Wikipedia: Tick paralysis=Tick paralysis is the only tick-borne disease that is not caused by an infectious organism. The illness is caused by a neurotoxin produced in the tick's salivary gland. After prolonged attachment, the engorged tick transmits the toxin to its host. The incidence of tick paralysis is unknown.

If it CAN cause tick paralysis, even though that's not the usual case that we see, I'm trying to justify using a non-venomous code for the tick bite.  The toxin from a tick doesn't cause symptoms immediately, so if we are removing the tick or they just got bitten very recently, how would we know until the patient returns if it's going to react?  Also, am I remembering wrong that you only code the E code for the patient's first visit with this "injury"?

Does anyone have documentation that explicitly says that ticks are non-venomous arthropods?  Amended to add that OxfordMedicine.com states:  "Most medically important arthropods are insects (including mosquitoes, midges, other flies, bedbugs and other true bugs, lice, fleas, and cockroaches) or arachnids (spiders, ticks, mites, scorpions)."

Thanks!!


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## vj_tiwari (Mar 5, 2012)

Hey  

I think, "Ticks can infect you but they don't have  venom like an ant mite"


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## hthompson (Mar 7, 2012)

Thanks 

I have 2 more questions.

Is it appropriate to bill for a removal of foreign body in this scenario:

Small tick. Unable to pull out.  Local xylo 1%. 2mm punch bx to get tick out. Dressed w/Bacitracin & pressure dressing w/Coban.

If yes, would it be 10120 or 28190?


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## vj_tiwari (Mar 9, 2012)

Hey Heidi ,

I think this Px is bundled in E/M. And we can use 10120 or 28190 if incision is made for FB removal or else no need to charge CPT. 

Hope this helps!!!



VJ


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## m.edwards (Aug 23, 2012)

Using a punch biopsy tool to remove the tick should allow you to bill for the removal of a foreign body.  An incision is being made into the skin via the punch tool.  It is simply a slightly different method than the norm.

Also, listed on several poison control websites and a venom research website, they list ticks as a venomous member of the Arachnida class.


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