MDS Alert

Question: With the prevalence of food allergies these days, I know it’s just a matter of time before we welcome a resident with one. What is the difference between an intolerance and an allergy? Are there ICD-10 codes for food allergies?

Colorado Subscriber

Answer: The distinction between the two conditions is sometimes hard to determine, because a food intolerance can cause some of the same signs and symptoms as a food allergy,” according to Dr. James Li of the Mayo Clinic (Source:  www.mayoclinic.org/diseases-conditions/food-allergy/expert-answers/food-allergy/faq-20058538).

However, understanding the difference between the two states is important, as it will help you determine the codes you will use should you encounter these situations. “A true food allergy causes an immune system reaction that affects numerous organs in the body. … In some cases, an allergic food reaction can be severe or life-threatening … [producing] a life-threatening allergic reaction (anaphylaxis).” However, “intolerance symptoms are generally less serious and often limited to digestive problems,” Li goes on to explain, leading you to mostly choose codes from Chapter 11: Diseases of the Digestive System when the final diagnosis is a food intolerance.

Regardless of whether the resident has a food allergy or simply has a problem with tolerating certain foods, coding choices are relatively straightforward. However, no matter what condition the resident may have, there are a couple of pitfalls you will need to avoid.

“Food allergies have their own subcategory of codes — Z91.01 [Food allergy status]” notes Donelle Holle, RN, a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana. They include

• Z91.010 — Allergy to peanuts
• Z91.011 — Allergy to milk products
• Z91.012 — Allergy to eggs
• Z91.013 — Allergy to seafood
• Z91.018 — Allergy to other foods

Coding caution 1: Be sure to follow the note to Z91.018, which states that you should use this code if your resident has been diagnosed with an allergy to nuts other than peanuts.

If the resident suffers from food intolerance, however, you’ll use a different set of codes. You can code several conditions with codes from the K90.4 (Other malabsorption due to intolerance) subcategory.

Coding caution 2: Again, make sure you read the notes to these codes, as even though two other intolerance conditions, celiac disease and lactose intolerance, are included in these codes as Excludes2 codes, they are more accurately coded as K90.0 (Celiac disease) and E73.- (Lactose intolerance).

Don’t forget that both care planning and working with dietary services are paramount to helping a resident with food intolerances or allergies stay safe in a facility.