Otolaryngology Coding Alert

You’ll be checking the ‘J30.x’ section to find the right rhinitis code next year.

Rhinitis can be a common diagnosis for otolaryngologists throughout the year, which means you’ll need to know how to report it when ICD-10 takes effect next year. Once again, careful and complete physician documentation will determine which diagnosis code you can report.

Definition: Rhinitis is inflammation of the nasal membranes characterized by a combination of the sneezing, nasal congestion, nasal itching, and rhinorrhea. The patient’s eyes, ears, sinuses, and throat can also be involved. Allergic rhinitis – a collection of symptoms that occur when you breathe in something you are allergic to – is the most common cause of rhinitis. The causes of allergic rhinitis may differ depending on whether the symptoms are seasonal, perennial, or sporadic/episodic.

Under ICD-9: ICD-9-CM guidelines direct you to report 477.9 (Allergic rhinitis, cause unspecified) when the physician does not document a specific cause for the patient’s allergic rhinitis. Report a more specific diagnosis (such as 477.0, Allergic rhinitis due to pollen) when possible. Include an additional code on the claim to identify the infectious organism.

ICD-10 changes: When ICD-10 goes into effect in October 2014 which is less than a year away, you’ll have two condition-specific codes to choose between: J30.0 (Vasomotor rhinitis) and J30.9 (Allergic rhinitis, unspecified). You’ll find both codes in Chapter 10, Diseases of the Respiratory System; under the subsection Other Diseases of Upper Respiratory Tract (J30-J39).

Documentation: Obtaining a detailed history is important in the evaluation of allergic rhinitis. A thorough history (including factors such as family history of allergic diseases and environmental or occupational exposures) may help identify specific triggers for the condition.

You might test the patient for reaction to specific allergens in order to confirm the diagnosis of allergic rhinitis and determine specific allergic triggers. Skin testing is the most common method of allergy testing, but physicians might also obtain a nasal smear to establish the diagnosis.

Coder tips: ICD-10 will include several diagnoses for specific causes of allergic rhinitis (which you might find documented in your physician’s chart as hay fever or nasal allergies). Study all your choices in the diagnosis J30 family (Vasomotor and allergic rhinitis) before assigning a code:

• J30.0 – Vasomotor rhinitis
• J30.1 – Allergic rhinitis due to pollen (includes allergy NOS due to pollen, hay fever, and pollinosis)
• J30.2 – Other seasonal allergic rhinitis
• J30.5 – Allergic rhinitis due to food
• J30.8 – Other allergic rhinitis
• J30.81 – Allergic rhinitis due to animal (cat) (dog) hair and dander
• J30.89 – Other allergic rhinitis (includes perennial allergic rhinitis)
• J30.9 – Allergic rhinitis, unspecified.

Coding guidelines note that J30.9 will include spasmodic rhinorrhea. You’ll submit different codes, however, for allergic rhinitis with asthma (bronchial) (J45.909) or rhinitis NOS (J31.0).

Your physician will need to specify the cause of allergic rhinitis so you can code more accurately. Once a patient is diagnosed with allergic rhinitis and receives ongoing treatments, you can continue to include the code on your claims.

Example: A patient is undergoing a treatment plan of allergy injections for allergic rhinitis. When the patient returns to your office for additional treatments, add the appropriate allergic rhinitis diagnosis to the claim because that’s the reason for the patient’s office visit.