Pediatric Coding Alert

Our experts’ advice is nothing to sneeze at.

‘Tis the season for seasonal allergies. That means it’s time for peds coders to separate fact from fiction and brush off their allergy coding knowledge once again.

Here are three myths surrounding the J30 (Vasomotor and allergic rhinitis) diagnosis codes that you should bust for accurate allergy coding.

Myth 1: ICD-10 code J30.2 is your go-to code for hay fever.

This myth stems from the fact that the J30 (Vasomotor and allergic rhinitis) section of ICD-10 contains a number of similar-sounding allergy codes.

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, CPC, MA, 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 you 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.

Myth 2: All the J30 codes describe allergic conditions.

Again, this myth comes from the similarities between the code descriptors. However, two of the codes are different from the others in that they do not describe conditions related to the immune system.

Vasomotor rhinitis (J30.0), for example, features symptoms such as sneezing, a runny nose, and nasal congestion that are very similar to allergic rhinitis symptoms. While the conditions 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), they are not related to the immune system (Source: www.aaaai.org/conditions-and-treatments/conditions-dictionary/nonallergic-rhinitis-vasomotor).

Similarly, causes for J30.89 (Perennial allergic rhinitis) 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.

Finally, “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 3: All the codes needed for allergies can be found in the J30 codes.

Actually, there are a number of rhinitis and allergy codes found outside of the J30 category. Chronic rhinitis, which is a condition that has lasted for more than 12 weeks, is coded to J31.0, while J45.909 (Unspecified asthma, uncomplicated) describes a condition of allergic rhinitis with asthma (bronchial).

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 T78.49X- (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.

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