Otolaryngology Coding Alert

Use chronic codes for patients with rhinitis for 12-plus weeks.

Otolaryngology practices could treat patients suffering from a variation of rhinitis types — and since ICD-10 rolled out with its more specific diagnosis codes across the board, choosing the right code for these conditions is nothing to sniff at.

Read on for more information on how to identify the different types of rhinitis, and you’ll know how to fix any diagnosis coding issues before they occur.

I.D. Rhinitis Type First

In basic clinical terms “rhinitis is inflammation of the mucous lining of the nose,” explains Catherine Tinkey, administrator for ENT Medical Services, PC, in Iowa City, Iowa. When it comes to deciding which ICD-10 code to choose for the condition, however, things can get tricky fast.

Here’s a rundown of the types of rhinitis that your otolaryngologist is most likely to treat, along with a quick list of symptoms you might spot in the documentation to confirm the rhinitis type. Use this list to identify the different rhinitis issues you might have to code at your practice:

Vasomotor rhinitis

Definition Vasomotor rhinitis is also known as “nonallergic rhinitis,” explains Lisa Jones, CPC, consultant at 360 Practice Management Solutions in Hollywood, Fla. You’ll report instances of vasomotor rhinitis with J30.0 (Vasomotor rhinitis).

Symptoms of a vasomotor rhinitis sufferer “are similar to an allergic reaction, but the causes differ. [Allergic reactions] cause the nasal linings to swell and cause excessive blood vessel dilation,” says Jones. On the other hand, “the most common cause of nonallergic rhinitis is acute viral infection,” she continues.

Allergic rhinitis

Definition: Allergic rhinitis is “an inflammation of the nasal passages caused by allergic reaction to airborne substances,” Tinkey relays. You’ll report allergic rhinitis with codes from the J30.1 (Allergic rhinitis due to pollen) through J30.9 (Allergic rhinitis, unspecified) code set.

“Allergic rhinitis may be seasonal, perennial, or occupational and is the most common type of rhinitis,” Jones explains.

Symptom clues: Allergic rhinitis is systemic, so its symptoms might differ from traditional rhinitis clues. When a patient is suffering from allergic rhinitis, the condition “may be associated with constitutional symptoms such as fatigue, malaise, post nasal drip and headache. It also may be a comorbidity in patients with asthma, eczema, or chronic sinusitis,” says Jones.

Chronic rhinitis

Definition: Chronic rhinitis is “a protracted sluggish inflammation of the nasal mucous membrane [and] inflammation of the sinuses for more than 12 weeks,” explains Tinkey. You’ll report chronic rhinitis with J31.0 (Chronic rhinitis).

A patient might have chronic rhinitis if “symptoms include nasal congestion, facial pressure, cough, and thick nasal discharge,” says Jones. Danger zones for chronic rhinitis development include after a patient suffers a cold or during times of ongoing allergic rhinitis symptoms, Jones continues.

Physician Could Use Many Services to Dx Rhinitis

Symptom-wise, most rhinitis sufferers will exhibit similar problems no matter the final diagnosis code. For each rhinitis ICD-10 code, “the symptoms could all be very similar — congestion, post-nasal drip, itchy nose, sneezing,” explains Tinkey. In order to diagnose the specific type of rhinitis the patient has, your provider might need to perform one (or more) of the following services/tests in an office setting:

• Office evaluation and management (E/M) service: 99201 (Office or other outpatient visitfor the evaluation and management of a new patient, which requires these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making) through 99205 (… a comprehensive history; a comprehensive examination; medical decision making of high complexity) or 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem[s] are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a comprehensive history; a compre­hensive examination; medical decision making of high complexity)
• Diagnostic nasal endoscopy: 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) through 31235 (Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy [via puncture of sphenoidal face or cannulation of ostium]) 
• Allergy testing, such as 95004 (Percutaneous tests [scratch, puncture, prick] with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests), 95024 (Intracu­taneous [intradermal] tests with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests), and 95027 (Intracutaneous [intradermal] tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report, specify number of tests)
• CT scan, such as 76380 (Computed tomography, limited or localized follow-up study), 70450 (Computed tomography, head or brain; without contrast material), or 70470 (Computed tomography, head or brain; without contrast material, followed by contrast material[s] and further sections)

If your otolaryngologist performs one of the services above, she might be trying to get a definitive rhinitis or perhaps a sinusitis diagnosis.

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