Look to Cause, Not Timing on Allergy Dx
Question: A patient presents with complaints of runny nose, sneezing, nasal congestion, and itchy eyes. They have mild, persistent asthma but notice that they feel the worst in the summer when they gather at a lake house with extended family. After further questioning, the provider discovered that one of the extended family members brings a dog and says that the dog’s hair and dander might be causing the patient’s asthma flare-ups. The patient says they have no interactions with dogs except during the summer and that they had a test that confirmed an allergy to pet dander. Would I code this as an exacerbation of asthma due to seasonal allergies since the exposure is seasonal, even though the provider documents that the dog is the cause? Pennsylvania Subscriber Answer: Although the provider documents that the patient probably has an allergy to dog hair and dander, in this situation, you should code the asthma first. When coding asthma, ICD-10-CM guidelines say that both the cause and effect of asthma should be documented and reported. In this situation, you’d report two codes: one for the asthma and another for the cause of exacerbation, which, in this case, would be an allergy to pet hair or dander. Accordingly, start with J45.31 (Mild persistent asthma with (acute) exacerbation) for the patient’s asthma flare-up. Then, you’ll assign J30.81 (Allergic rhinitis due to animal (cat) (dog) hair and dander) to report the exacerbation caused by spending the summer with a dog. Even though the exacerbation is “seasonal” for this patient due to their summer traditions, seasonal allergies are due to environmental airborne allergens like tree pollen that occur only at certain points of the year. An allergy to pet hair or dander is considered perennial instead of seasonal. Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC
