Otolaryngology Coding Alert

Chronic rhinitis patient? Check tobacco exposure level.

When you are choosing the correct diagnosis code for rhinitis, you’ll first have to decide between the different rhinitis types.

Not so fast: If the patient has chronic rhinitis, one ICD-10 code might not be enough to fully represent the patient’s diagnosis. In order to submit a complete picture of the chronic rhinitis patient, ICD-10 directs you to include another code if the patient experiences tobacco exposure, either due to personal or environmental factors.

Check out this knowledge on when, and how, to use additional codes to complete the diagnosis coding picture for chronic rhinitis patients.

Look Out for Evidence of Tobacco Use, Exposure

ICD-10 wants otolaryngology coders to use an additional code to identify tobacco use/exposure because “you should always code to the highest specificity, which means not only using the most specific primary [ICD-10] code, but also any additional code that could affect the illness, injury or disease,” says Catherine Tinkey, administrator for ENT Medical Services, PC, in Iowa City, Iowa.

In the descriptor for chronic rhinitis (J31), ICD-10 states it wants a supplemental code to indicate tobacco use or exposure to tobacco smoke, when applicable. You’ll use secondary, or supplemental, diagnosis codes “to represent underlying factors for the medical necessity of the patient encounter,” explains Catherine Brink, BS, CMM, CPC, CMSCS, CPOM, president of Healthcare Resource Management Inc. in Spring Lake, N.J. Therefore, if a person were exposed to tobacco somehow — either through personal use or environmental factors — it’s important to include another code in order to get the most accurate rhinitis diagnosis.

Tobacco use/exposure “would definitely be associated with increased prevalence of rhinitis symptoms,” Tinkey explains.

When your otolaryngologist treats a chronic rhinitis patient with a history of tobacco use/exposure, choose from the following ICD-10 codes as a secondary diagnosis, depending on encounter specifics:

• Z77.22, Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic)
• P96.81, Exposure to (parental) (environmental) tobacco smoke in the perinatal period
• Z87.891, Personal history of nicotine dependence
• Z57.31, Occupational exposure to environmental tobacco smoke
• F17.-, Nicotine dependence
• Z72.0, Tobacco use

Also: On the claim, the otolaryngologist should document the relationship between the diagnosis and the tobacco use, abuse, exposure, or dependence.

Supplemental Code Could Guide Physician Actions

If one of the above codes apply to a patient suffering from chronic rhinitis, it will absolutely affect treatment, says Lisa Jones, CPC, consultant at 360 Practice Management Solutions in Hollywood, Fla.

“The physician is going to recommend limiting exposure [to smoke] or stopping [smoking] completely in order to see the highest improvement from treatment,” Jones says.

Reason: Avoidance of any type of smoke is the only way to improve some chronic rhinitis patients. If a patient smokes or is exposed to a high level of environmental smoke, decongestants, antihistamines, and nasal steroids are of little help.