Pediatric Coding Alert

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

Although rhinitis cases are probably heating up now as spring approaches, your practice may see this diagnosis all year-round, so you’ll need to know how to report it when ICD-10 takes effect next year. Once again, careful and complete physician documentation will be necessary to support the ICD-10 code for this condition.

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.

ICD-9 Coding Rules: ICD-9-CM guidelines direct you to report 477.9 (Allergic rhinitis, cause unspecified) when the pediatrician 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, you’ll have two codes to choose between when you would have relied on 477.9 in the past. The two options will be J30.0 (Vasomotor rhinitis) and J30.9 (Allergic rhinitis, unspecified). Both codes will be found 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. Important elements include an evaluation of the nature, duration, and time course of symptoms; possible triggers for symptoms; response to medications; comorbid conditions; family history of allergic diseases; environmental exposures; occupational exposures; and effects on quality of life. A thorough history 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 to determine specific allergic triggers. Skin testing is the most common method of allergy testing. Physicians might also obtain a nasal smear to establish the diagnosis.

More common terms for allergic rhinitis that you might document include hay fever and nasal allergies.

Coder Tips: ICD-10 will include several diagnoses for specific causes of allergic rhinitis. 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).

You 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.