Otolaryngology Coding Alert

Seasonal Coding:

Check 4 Quick Tips for Flawless Winter Diagnosis Coding

Published on Mon Nov 15, 2021

Check these instructions and guidelines you need to make it through the season.

The temperatures are starting to drop, and your waiting room is beginning to get more and more crowded with patients who are severely affected by the cold temperatures. So, now would be a good time to refresh your knowledge of coding some of the more common winter conditions.

We’ve put together this collection of tips to help you navigate many of the ICD-10 instructions and guidelines that pertain to the codes you’re most likely to see this winter. But be sure to read to the end, as we’ve also added a reminder about some new codes that you’ll be leaning on heavily in the next few months and beyond.

Tip 1: Obey the Lower Anatomic Site Note to J00-J99

You may see diagnoses like nasopharyngitis or pharyngitis during the winter months, but one thing that’s important to note is that you must understand the anatomic system before you select the right code.

One of the trickiest parts of coding respiratory system conditions is remembering the note at the beginning of ICD-10 Chapter 10 telling you that “when a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site.” But you overlook the note at your peril because the note applies to all the codes in the section.

To avoid this particular coding error, your best bet is to refresh your knowledge of the respiratory system. If your otolaryngologist documents both nasopharyngitis and chronic pharyngitis, for example, knowing that the pharynx is anatomically lower in the system than the nasal passages will lead you to correctly code J31.2 (Chronic pharyngitis) on its own.

And don’t forget: “You need to add exposure to smoking when applicable,” cautions Donelle Holle, RN, a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana.

That’s because the entire J00-J99 code section also carries a Use additional code instruction telling you to use codes such as Z77.22 (Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic)), F17.- (Nicotine dependence), or Z72.0 (Tobacco use) for any associated tobacco exposure, dependence, or use, Holle reminds coders.

Tip 2: Remember the Excludes1 Instructions for the J30 Codes

While J30.1 is your go-to code for hay fever and pollen-induced allergies, you don’t want to overlook some of the other codes in the J30 (Vasomotor and allergic rhinitis) category if your provider’s notes specify similar conditions. Those other choices include:

J30.0 (Vasomotor rhinitis)
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 (includes perennial allergic rhinitis))
J30.9 (Allergic rhinitis, unspecified)

Coding caution: Confusingly, ICD-10 has a second code for seasonal allergic rhinitis: J30.2. However, if you know the etiology of the two conditions, you will be able to distinguish between them easily.

“Seasonal allergic rhinitis can occur in spring, summer and early fall,” says Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico. “The typical causes are airborne mold spores, dust mites, or pollens from grass, trees and weeds. Since J30.1 specifically cites pollen as the cause, you would report J30.2 if the airborne mold spores or dust mites cause the condition,” Witt notes.

“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 for unspecified,” Johnson suggests.

A number of similar codes may possibly come into play. Vasomotor rhinitis (J30.0), for example, has a number of symptoms, such as sneezing, a runny nose, and nasal congestion, which are very similar to allergic rhinitis.

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) (Source: www.aaaai.org/conditions-and-treatments/conditions-dictionary/nonallergic-rhinitis-vasomotor).

Perennial allergic rhinitis, coded to J30.89, may also appear in your provider’s notes. Like vasomotor rhinitis, causes for this condition also differ from seasonal allergies. Primary causes are “dust mites, mold, animal dander, and cockroach debris” (Source: www.aafa.org/rhinitis-nasal-allergy-hayfever/). However, “the main difference between perennial rhinitis and other kinds of allergic rhinitis is that the patient has the condition year-round, but the cause is not stipulated,” says Witt.

Before you go ahead and assign a code to your patient’s condition, make sure you read the Excludes1 note for the J30 codes. Two other rhinitis codes — allergic rhinitis with asthma (bronchial), which is coded to J45.909 (Unspecified asthma, uncomplicated), and rhinitis NOS, which is a condition that has lasted for more than 12 weeks and is coded to J31.0. (Chronic rhinitis) — cannot be coded with any of the J30 conditions.

Tip 3: Look to Guideline I.C.10.c. for Influenza Probability

Coding for the J09.- (Influenza due to certain identified influenza viruses) and J10.- (Influenza due to other identified influenza virus) code groups is subject to another tricky, chapter-specific guideline that tells you to “code only confirmed cases of influenza.” The guideline goes on to tell you that confirmation “does not require documentation of positive laboratory testing specific for avian or other novel influenza A or other identified influenza virus.”

Instead, the guideline indicates that “coding should be based on the provider’s diagnostic statement that the patient has avian influenza, or other novel influenza A, for category J09, or has another particular identified strain of influenza, such as H1N1 or H3N2, but not identified as novel or variant, for category J10.” And for cases of influenza recorded by the provider as “‘suspected,’ ‘possible,’ or ‘probable,’” ICD-10 instructs you to assign an appropriate influenza code from category J11 (Influenza due to unidentified influenza virus).

What this means: This is one of those times when the chapter-specific guideline will override guideline IV.H, which instructs you not to “code diagnoses documented as ‘probable,’ ‘suspected,’ ‘questionable,’ ‘rule out,’ ‘compatible with,’ ‘consistent with,’ or ‘working diagnosis’ or other similar terms indicating uncertainty” when coding and reporting diagnoses in outpatient settings.

So, a patient reports to your otolaryngology specialist with fever, muscle pain, sore throat, earache, cough, and a runny nose. Your ENT physician documents that the patient has suspected influenza with otitis media and a perforated tympanic membrane. “Clinical judgment and experience are as valid as any test result for some conditions,” notes Jan Blanchard, CPC, CPEDC, CPMA, of Physician’s Computer Company in Winooski, Vermont. In this case, you would choose a code from J11, specifically J11.83 (Influenza due to unidentified influenza virus with otitis media) and use an additional code from H72.- (Perforation of tympanic membrane) for any associated perforated tympanic membrane.

Tip 4: Don’t Forget the New Cough Codes

Other codes that are sure to get a workout this winter are the new cough codes that are effective now. This newly expanded code group includes codes for different levels of severity, including:

R05.1 (Acute cough)
R05.2 (Subacute cough)
R05.3 (Chronic cough)

Remember: You’ll use R05.3 if your otolaryngologist documents persistent cough, refractory cough (a cough that persists despite treatment), or unexplained cough, as ICD-10 has added all three as synonyms for this code.