Pathology/Lab Coding Alert

Don't miss 7^th digit 'A', 'D', or 'S.'

ICD-9 2012 changes the term "anaphylactic shock" to "anaphylactic reaction," but ICD-10 will change it back when you begin to use the new codes on Oct. 1, 2013.

If your lab bills for transfusion medicine services, and the physician notes that the patient has an anaphylactic reaction due to the transfusion, you should report the diagnosis as 999.41 (Anaphylactic reaction due to administration of blood and blood products) or 999.49 (Anaphylactic reaction due to other serum) starting Oct. 1. That's instead of 999.4 (Anaphylactic shock due to serum), which becomes inactive for ICD-9 2012.

But 999.41 will crosswalk to T80.5xx- (Anaphylactic shock due to serum) when ICD-10 goes into effect.

Problem: Often, a patient will exhibit an anaphylactic reaction, but won't go into shock. Changing the code definition in ICD-9 2012 clarifies that the code is appropriate for anaphylactic reaction even if it doesn't advance to shock. The change makes it easier to capture physician notation -- chances are your physician refers to "anaphylaxis" rather than anaphylactic shock, noted Jeffrey Linzer, MD, representing the American Academy of Pediatrics at the ICD-9-CM Coordination and Maintenance Committee meeting (proposals, summaries, and presentation slides available at www.cdc.gov/nchs/icd/icd9cm_maintenance.htm)

No problem: Even though the ICD-10 definition reverts to the word "shock," the definition following the code states, "Anaphylactic reaction due to serum."

Capture Subsequent Encounters With 7th Digit

ICD-10 requires a seventh digit for T80.5xx-. You must report the code with one of the following letters in the seventh position:

• A -- Initial encounter
• D -- Subsequent encounter
• S -- Sequela.

Use the extension "A" when the patient is receiving active treatment for the transfusion-related anaphylaxis. "D" describes a subsequent encounter following the active treatment for routine care during recovery. Reserve "S" for an encounter for late effects -- a complication or condition that arises as a direct result of the initial transfusion-related anaphylaxis.

Clarify 'x' and '-': When discussing ICD-9 codes that aren't to the highest degree of specificity, it's common to use an "x" to substitute for the non-specific digit. But ICD-10 uses the "x" as a place holder, just like a "0" when writing a number. In this case, T80.5 requires a seventh digit, but not a fifth and sixth digit. So you'll write the code as T80.5xxA, T80.5xxD, or T80.5xxS.

Because "x" serves a specific purpose in ICD-10 codes, you can use a "-" instead of an "x" to indicate that you're not specifying a digit -- such as T80.5xx-.