ED Coding and Reimbursement Alert

Answer: No, food allergies are not the same as food intolerances. Basically stated, “food allergies, such as allergies to nuts or shellfish, are caused by a problem with your immune system. Food sensitivities or intolerances, such as reactions to wheat or milk, are caused by a problem with your digestive system,” according to the U.S. Department of Health and Human Services (HHS) (www.womenshealth.gov/healthy-eating/food-allergies-and-sensitivities).

The difference between the two is critical from a clinical perspective. An allergic food reaction can be severe or life-threatening, whereas food intolerance symptoms are generally less serious. From a coding perspective, this means you have to look to different chapters of ICD-10 to find the codes you need to describe a patient’s food allergy or sensitivity status.

Food allergy codes are easily found as they have their own subcategory of codes — Z91.01- (Food allergy status). Food intolerance codes, however, are a little more difficult to track down, though many of them can be found in the Diseases of the Digestive System chapter and coded to the K90.4- (Other malabsorption due to intolerance) ICD-10 subcategory.

Patients who suffer from lactose intolerance cannot break down sugar in dairy products due to a deficiency in the enzyme lactase. Because of this, the code is categorized in the Endocrine, Nutritional and Metabolic Diseases chapter of ICD-10 and not in the Diseases of the Digestive System chapter. This means you should use a code that is specific to lactose intolerance from the E73.- (Lactose intolerance) codes. It also means you should not use Z91.011 (Allergy to milk products). This is reinforced by the Excludes1 note to Z91.011, which tells you should not code Z91.011 with a code from E73.-.