# ICD-9 Code



## vickiete (Nov 26, 2014)

I am a new coder to Med Allergy.  Could someone give me some guidance on the ICD-9 code you would use when the patient comes in for their allergy Shot. I have a note which reads patient returns for follow-up of venom allergy and allergic rhinitis. He has been on immunotherapy for honey bee allergy.  What would be the diagnosis?  Any help would be greatly appreciated.

Thanks.


----------



## mitchellde (Nov 26, 2014)

vickiete said:


> I am a new coder to Med Allergy.  Could someone give me some guidance on the ICD-9 code you would use when the patient comes in for their allergy Shot. I have a note which reads patient returns for follow-up of venom allergy and allergic rhinitis. He has been on immunotherapy for honey bee allergy.  What would be the diagnosis?  Any help would be greatly appreciated.
> 
> Thanks.



You will need V codes lik a V 67 for the follow up and a V 15 or two for the allergy history .


----------



## Candice_Fenildo (Dec 1, 2014)

Hi Vicki, For the allergic rhinitis I would use ICD-9 Code 477.8 (Allergic Rhinitis due to other allergen). The patient is actively receiving injections for the allergy. I would not use a "History of" code if the patient is actively getting treatment for his/her allergies.


----------



## mitchellde (Dec 1, 2014)

i have to disagree if you read the coding guidelines this is not how you would code a condition that does not currently exist.  Allergic rhinitis is an acute condition it does not represent a condition that does not cureently exist but is being prophylactically being treated.
The definition of allergic rhinitis is:
Allergic rhinitis is a diagnosis associated with a group of symptoms affecting the nose. These symptoms occur when you breathe in something you are allergic to, such as dust, animal dander, or pollen. 
The patient does not have allergic rhinitis when they present for routine allergy injections they are getting the injections to prevent the occurrence of the allergic rhinitis, this is why there are V codes for the history of having the the allergy.


----------



## Candice_Fenildo (Dec 2, 2014)

Debra, I respect your answer, but if you go back and read her note. It reads...

 Patient is here for follow up of venom allergy and allergic rhinitis. He has been on immunotherapy for honey  bee allergy.

The patient is receiving "routine" allergy injections for the honey bee allergy NOT the allergic rhinitis. 

My answer stands that this should be coded as 477.8


----------



## mitchellde (Dec 2, 2014)

If the patient is no longer symptomatic the it would be coded as a follow up.  With a V67 code.  The code for allergic rhinitis would be use if the patient presented with symptoms and the provided diagnosed the patient for that encounter as allergic rhinitis. So follow up for allergic rhinitis is not the same as symptomatic rhinitis.  The reason for the visit is stated as presenting for the allergy shot, it does not specify that this is for the honey bee allergy only.  But it appears from the way this is stated that this was an encounter for just an allergy shot.


----------



## maebelle@gmail.com (Dec 15, 2014)

I have to agree with the use of diagnosis code 477.8. Allergies are considered chronic conditions - the condition still exists even though the patient is not having acute symptoms. The patient receives injections to prevent the symptoms, but they still have the allergy.


----------



## mitchellde (Dec 15, 2014)

The allergy is to the dust or other substance the rhinitis is the reaction to the substance.  There is no current reaction of rhinitis.  Rhinitis is not a chronic condition.  The allergy is the chronic condition.  To receive injections is a prophylactic injection to help prevent the reaction of rhinitis it does not treat rhinitis.  Sorry I still disagree.


----------



## Shawnee (Jan 29, 2015)

I have a similar question. If a patient is actively receiving allergy shots for insect bite desensitation  what dx code would you use.

I have always used 95115 with 989.5 and had success with getting it paid. Now, Florida Blue is asking for the accident report because 989.5 is basically reporting an injury.  What dx code should I be using??

ANY help/suggestions is/are definetly appreciated!!!


----------



## ahonkomp (Jan 29, 2015)

Our office had used V07.1 in the past but Blue Cross revised policy and would no longer accept V07.1. They directed us to use codes from the 477 range and that is what we are using currently.


----------



## Shawnee (Feb 3, 2015)

*there is no rhinitis*

477.8 is "rhinitis"..a patient who is allergic to bees is going to die if they get stung... there is NO rhinitis.  What code would you use if you are giving an allergy shot to desensitize the patient from a reaction to bee stings? 

Now in 2015 if 989.5 is used medicare is denying, and blue cross is asking for accident information.

All opinions greatly appreciated!


----------



## mitchellde (Feb 3, 2015)

Shawnee said:


> 477.8 is "rhinitis"..a patient who is allergic to bees is going to die if they get stung... there is NO rhinitis.  What code would you use if you are giving an allergy shot to desensitize the patient from a reaction to bee stings?
> 
> Now in 2015 if 989.5 is used medicare is denying, and blue cross is asking for accident information.
> 
> All opinions greatly appreciated!


The V07.1 is the correct code.  Many payers do not cover routine allergy injections for desensitization.  They cover injections for the acute symptomatic presentation.  A payer cannot dictate what a diagnosis code can be for a given encounter. They can tell you what is considered covered.  You do not use different diagnosis codes for different payers for the same scenario.  The diagnosis is the patients not the coders or the doctors or the payers.  Just because the pay it when you use the 477 does not indicate that that is the correct code for this patient, this encounter.


----------



## Shawnee (Feb 3, 2015)

Thank you Debra!


----------

