Primary Care Coding Alert

Question: The provider diagnosed a patient with persistent allergic rhinitis. She has been in several times, and she most recently presented with symptoms such as sneezing, a runny nose, and nasal congestion that “seem to never go away.” The provider noted year-round symptoms and prescribed an over-the-counter daily allergy medication to control the condition. The symptoms are constant, so this doesn’t seem like a typical seasonal allergy, and her history does not include an allergy to pollen, so I’ve ruled out J30.1. So, which code should I report?

Wisconsin Subscriber

Answer: Rhinitis can be tricky to code for many reasons. For one, there are many different codes. Your logic behind discarding J30.1 (Allergic rhinitis due to pollen) immediately 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 wane during different seasons, according to the details provided.

To properly code this diagnosis, first 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, look toward allergic rhinitis codes:

• J30.1 (Allergic rhinitis due to pollen)
• 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 J20.9 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 that year-round component.