Otolaryngology Coding Alert

Bust these three myths to boost your rhinitis coding savvy.

As we make our way into allergy season, more and more sniffles can be heard from your waiting room. The symphony of sneezes means it’s time for otolaryngology coders to separate fact from fiction and refresh their allergy coding knowledge once again.

Make sure you’re prepared to deal with this common complaint by busting these three myths surrounding the J30 (Vasomotor and allergic rhinitis) diagnosis codes, so you won’t be stumped the next time a case of the sniffles hits your desk.

Myth 1: Knowing the Reason for Rhinitis Is Unnecessary.

Your provider will often document hay fever, also known as allergic rhinitis, when a patient experiences sneezing, runny nose, watery eyes, and itching in response to a specific allergen. The key to arriving at the appropriate code to report allergies is knowing exactly what is causing the rhinitis.

When searching for the right way to report this condition, you must be able to differentiate the many similar-sounding allergy codes found in the J30 (Vasomotor and allergic rhinitis) section of ICD-10. One of them — J30.2 (Other seasonal allergic rhinitis) — is a close code for the diagnosis, as “seasonal allergic rhinitis can occur in spring, summer, and early fall, and the typical causes are airborne mold spores, dust mites, or pollens from grass, trees, and weeds,” says Melanie Witt, RN, MA, CPC, an independent coding expert based in Guadalupita, New Mexico.

However, J30.1 (Allergic rhinitis due to pollen) is a more appropriate code to report hay fever for a number of reasons. First, the ICD-10 index entry for hay fever refers to J30.1. Additionally, “hay fever” is listed as one of the synonyms for J30.1. And finally, “you would report J30.2 if the airborne mold spores or dust mites cause the condition, whereas you would report J30.1 for hay fever as the code specifically cites pollen as the cause,” Witt adds.

“In many cases, the provider will not always document the trigger or reason for the allergic rhinitis,” cautions Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/ credentialing/auditing/ coding coordinator at County of Stanislaus Health Services Agency in Modesto, California. “So, you’ll need to look for wording such as seasonal allergens, pollen, food, hair/ dander, or dust mites, and so on. If no reason is given, you’ll need to use J30.9 [Allergic rhinitis, unspecified] when the cause remains unspecified,” Johnson suggests.

Myth 2: All J30 Codes Describe Seasonal Allergies.

This myth stems from the similarities between the code descriptors. Your other J30 options, in addition to J30.1 and J30.2, include:

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

However, two of the codes are different from the others: one does not describe a condition related to an immune response and the other isn’t seasonal; it can occur any time of the year.

Vasomotor rhinitis (J30.0) features symptoms such as sneezing, a runny nose, and nasal congestion that are very similar to allergic rhinitis symptoms. However, the condition’s causes are not related to the immune system, though they can be triggered by “airborne pollutants or odors … changes in the weather or underlying chronic health problems,” according to the American Academy of Allergy Asthma and Immunology (AAAAI) (www.aaaai.org/tools-for-the-public/allergy,-asthma-immunology-glossary/nonallergic-rhinitis-vasomotor-defined).

Perennial allergic rhinitis (J30.89) may also appear in your provider’s notes. Like vasomotor rhinitis, etiologies for this condition may also differ from seasonal allergies. The primary causes are “dust mites, mold, animal dander, and cockroach debris,” (www.aafa.org/rhinitis-nasal-allergy-hayfever/). However, “the main difference between perennial allergic rhinitis and other kinds of allergic rhinitis is that the patient has the condition year-round,” says Witt. Note that you’ll also assign this code when your provider specifies the cause of the allergic rhinitis, but there is no current code that indicates the specific condition.

Myth 3: Category J30 Contains All the Codes Needed for Allergies.

Actually, several rhinitis and allergy codes are found outside of the J30 category. Chronic rhinitis — nasal inflammation lasting for more than 12 weeks — is coded to J31.0, while J45.909 (Unspecified asthma, uncomplicated) describes allergic asthma of unspecified severity that may present with rhinitis or bronchitis.

Then there is an encounter code, Z91.09 (Other allergy status, other than to drugs and biological substances), which you would use to indicate “that the condition may influence the patient’s health status even though it is not an active illness,” says Johnson. You would use this code if the condition’s status “may affect the course of treatment and its outcome,” according to ICD-10 guideline I.c.21.c.3. “Under this rule, if a patient is being treated for asthma, but also has seasonal allergies, the Z code might give more information, but it is not required if the treatment is not affected by this fact,” Witt concludes.

You may also use T78.49- (Other allergy) when “allergic rhinitis makes a patient’s asthma worse, or the patient develops a sinus or ear infection as a result of the allergy,” says Witt. That’s because “the T78 codes represent adverse effects of a person’s condition. As such, they would be used infrequently in the case of allergic rhinitis, which is normally a short-term condition and easily managed,” Witt adds.

Coding tip: As T78.49- is an external cause code, remember to add the X placeholder and the appropriate 7th character: A (… initial encounter), D (… subsequent encounter), or S (… sequela), depending on the nature of the encounter. And don’t forget the “Excludes1 note with T78.4- that states it should not be reported with J30.1,” Witt points out.