# Bee Allergy



## Joiaw (Aug 26, 2015)

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.


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## chriskhans (Aug 26, 2015)

Hello!  I code for an Allergy/Immunology clinic as well.  I sat in on last nights webinar with the AAAAI as well.  What specifically is it that your questioning?  Is it how they chose when to use a "T" code or a "Z" code or the assignment of the A,D,S?


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## Joiaw (Aug 27, 2015)

T code vs. Z codes. Say if a patient has been on bee immunotherapy for over a year, when is it appropriate to use the Z status codes?


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## Joiaw (Aug 27, 2015)

I have a patient whose initial visit was June 2014, she stated that she had an allergic reaction to a bee sting Aug 2013. We have since been treating her with injections. Shouldn't I be using the Z status code instead of the injury code by now?


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## chriskhans (Aug 28, 2015)

According to the AAAAI,  If the patient is not receiving active treatment and is simply providing historical information then a "Z" code should be assigned.   

If the patient is receiving active treatment (allergy shots) a "T" code would be used.


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## Joiaw (Aug 28, 2015)

That is where my confusion lies I guess. The AAAAI defines immunotherapy as preventative treatment. Preventative treatment and active treatment, are they the same?


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## mitchellde (Sep 21, 2015)

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.
i agree with this response

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.
i disagree, a past reaction is not necessarily an allergy.  Many people are stung and experience an instant reaction that is not necessarily an allergy.  This should be a screening since the patient currently has no symptoms and has never been diagnosed with an allergy.

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.
i disagree.  The patient again presents due to a history of a reaction but is currently asymptomatic.  This  is a screening followed by the Z code for allergy status due to the positive finding. 

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
again I disagree this cannot be active since there is no current injury and no active treatment.  I am unsure on this without complete documentation, if the patient does not require treatment and will return for testing, then what is the reason for the encounter..

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.
the question I have is if this is a return for the prophylactic treatment of allergy or is this continued treatment of an injury of being stung

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.
this is not active treatment if the reason for the therapy is desensitization.  This is prophylactic treatment and needs a Z code.
Reply With Quote  Multi-Quote This Message  Quick reply to this message
my responses are in red and I disagree with most of the original responses .  You cannot code prhylactic treatment as continued treatment of the original sting.


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## Shawnee (Nov 10, 2015)

*Medicare denying venom allergy shots*

I really need your advice. LCD L33804 with Medicare only contains a list of venoms for spiders, snakes or venomous animals. We have a large group of patients who receive allergy shots for mixed vespids, fire ants, bees, wasps etc.  I have been using Z91.038 to bill and Medicare is denying it stating not medically necessary and citing LCD L33804. I don't know what to do.
Can anyone help me?


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