Otolaryngology Coding Alert

Allergic rhinitis (sometimes called hay fever) is a common condition for your otolaryngologist to treat throughout the year, but especially in the fall. Patients with allergic rhinitis have an inflammation of the nasal passages, usually associated with watery nasal discharge and itchy nose and eyes. Symptoms often occur after exposure to dust, danders, or certain seasonal pollens. Sometimes, however, the cause might be unspecified. 

ICD-9 coding: The current ICD-9 diagnosis code for allergic rhinitis is 477.9 (Allergic rhinitis, cause unspecified). 

ICD-10 changes: Effective Oct. 1, 2015, two J codes will describe allergic rhinitis with unspecified cause: 

• J30.0 (Vasomotor rhinitis) 
• J30.9 (Allergic rhinitis, unspecified).

Note that the codes differentiate vasomotor rhinitis from unspecified allergic rhinitis. Vasomotor rhinitis is not caused by an infection or allergy. Instead, the cause often is unknown, but can include air pollution, a dry atmosphere, medications, or even spicy food.

Documentation: Coding guidelines state that for accurate reporting of ICD-9-CM diagnosis codes, the documentation should describe the patient’s condition, using terminology that includes specific diagnoses as well as symptoms, problems or reasons for the encounter.

Before coding an unspecified code like J30.9, you should seek out the most appropriate, specific condition first. Possibilities could be J30.1 (Allergic rhinitis due to pollen), J30.2 (Other seasonal allergic rhinitis), J30.5 (Allergic rhinitis due to food), J30.81 (Allergic rhinitis due to animal [cat] [dog] hair and dander), J30.89 (Other allergic rhinitis). If your physician is not very clear on her diagnosis choices, you should discuss with them to clarify.

Coder tips: If the physician’s notes state asthma and allergic rhinitis without specifying what they are due to, you should not use J30.9. Instead, you should report J45.20 (Mild intermittent asthma, uncomplicated). Rhinitis (J30.x) excludes allergic rhinitis with asthma (bronchial) – a fact that not many coders may not realize.