General Surgery Coding Alert

Question: A patient reported to our office with a history of tick exposure approximately six months ago during a camping trip. Since then, they have experienced multiple episodes of hives, abdominal discomfort, and difficulty breathing within a few hours after consuming red meat. Upon examination, the patient appears in mild distress due to abdominal discomfort. Their skin shows multiple hives, primarily on the trunk and arms. Respiratory and cardiovascular examination is within normal limits. Their abdomen is soft, non-tender with no palpable masses. A specific immunoglobin E (IgE) test was conducted to confirm the suspicion of alpha-gal syndrome. The results showed elevated levels of IgE antibodies to the alpha-gal carbohydrate, supporting the diagnosis. What is alpha-gal syndrome and how should I code this visit?

AAPC Forum Participant

Answer: Alpha-gal syndrome (AGS) is a type of allergy where individuals react to a sugar present in all mammals except humans and other primates. This condition is also referred to as mammalian meat allergy, alpha-gal allergy, red meat allergy, or tick bite meat allergy. Individuals with this allergy experience an allergic reaction with symptoms such as skin rash, nausea, vomiting, and diarrhea when they consume meat like beef, pork, lamb, or venison. These symptoms typically manifest three to six hours after eating. In severe cases, patients may experience an immediate, potentially fatal anaphylactic reaction that requires an immediate medical intervention.

On your claim, you should code the following:

• For the IgE testing, you will use code 86003 (Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each).
• You will also want to choose an appropriate office/outpatient evaluation and management (E/M) code from the 99202-99215 (Office or other outpatient visit …) code set for your claim.
• Code AGS with Z91.014 (Allergy to mammalian meats).
• For the allergic reaction to the ingestion of the meat, you would code T78.19XA (Other adverse food reactions, not elsewhere classified) adding the 7^th character “A” for the initial encounter.
• Because code T78.19XA asks that you specify the reaction (if applicable), you should also code L50.0 (Allergic urticaria) and R10.9 (Unspecified abdominal pain) for the hives and abdominal discomfort the patient was experiencing upon arrival.

Lindsey Bush, BA, MA, CPC, Production Editor, AAPC