Otolaryngology Coding Alert

Question: The otolaryngologist diagnosed a patient with persistent allergic rhinitis. They have been in several times, and most recently presented with symptoms, including sneezing, runny nose, and nasal congestion, that “seem to never go away.” The provider noted year-round symptoms and prescribed OTC daily allergy medication.

The symptoms are constant, so this doesn’t seem like a typical seasonal allergy, and the patient’s history does not include pollen allergy, so I’ve ruled out J30.1. Can you help me figure out which code I should report?

Mississippi Subscriber

Answer: Your logic behind discarding J30.1 (Allergic rhinitis due to pollen) is solid because the provider makes no mention of pollen. Also, pollen allergies tend to present when pollen counts are high, and this patient’s symptoms don’t seem to wax and wane during different seasons.

Your first instinct may be to consider the possibility of chronic rhinitis to account for the persistence of symptoms. However, the Excludes1 note for J31.0 (Chronic rhinitis) lists allergic rhinitis. The provider specifically diagnosed allergic rhinitis, which eliminates J31.0 as a possibility.

Next, examine the remaining allergic rhinitis codes:

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

We’ve already ruled out J30.1, and J30.2 still implies a seasonal trigger. There is no mention of a food or dander allergy, which probably rules out J30.5 and J30.81.

That leaves us with J30.89, which includes perennial allergic rhinitis, and J30.9 as possibilities. Remember too, the patient feels as though the symptoms never go away, which is an important detail.

If the condition can’t be considered chronic, but symptoms are always present, that means the patient must suffer from perennial allergic rhinitis, coded to J30.89. The main difference between perennial allergic rhinitis and other allergic types is the year-round component.