Allergy Shot Diagnosis

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We recently received a denial on one of our patient's for all of the allergy shots the patient has received. We are a primary care office and only administer the serum when it is sent to us from the allergist. We do not diagnose the allergy or do allergy testing. This was a Humana claim and strangely this is the only patient this has happened with so far. The claims are denying for not a covered diagnosis. Z51.6 with 95115 or 95117. We called to check on this and were told they now follow CMS guidelines for allergy shots which does not allow you to use Z51.6 but only one of the codes listed below. Someone else said their ICD 10 books indicates that z51.6 should not be used alone. I check and my 2017 book has no such note.

The list below makes little sense to me as the T codes I would think would be unusable as they can't be a primary code. Also if you are suffering the effects currently of a bite or sting I can't imagine that being the best time to administer an allergy shot. I'm having trouble understanding why a code for desensitization of allergens would not be acceptable for allergy shots. I have not received denials from any other carrier or even on any other patient. What are your experiences and can you offer any advise?

ICD-10 Code Description
H10.411 - H10.413 - Chronic giant papillary conjunctivitis, right eye - Chronic giant papillary conjunctivitis, bilateral
H10.419 Chronic giant papillary conjunctivitis, unspecified eye
H10.45 Other chronic allergic conjunctivitis
J30.0 - J30.2 Vasomotor rhinitis - Other seasonal allergic rhinitis
J30.81 Allergic rhinitis due to animal (cat) (dog) hair and dander
J30.89 Other allergic rhinitis
J30.9 Allergic rhinitis, unspecified
J45.21 Mild intermittent asthma with (acute) exacerbation
J45.22 Mild intermittent asthma with status asthmaticus
J45.31 Mild persistent asthma with (acute) exacerbation
J45.32 Mild persistent asthma with status asthmaticus
J45.41 Moderate persistent asthma with (acute) exacerbation
J45.42 Moderate persistent asthma with status asthmaticus
J45.51 Severe persistent asthma with (acute) exacerbation
J45.52 Severe persistent asthma with status asthmaticus
J45.901 Unspecified asthma with (acute) exacerbation
J45.902 Unspecified asthma with status asthmaticus
J45.909 Unspecified asthma, uncomplicated
J45.998 Other asthma
J82 Pulmonary eosinophilia, not elsewhere classified
T63.421A Toxic effect of venom of ants, accidental (unintentional), initial encounter
T63.421D Toxic effect of venom of ants, accidental (unintentional), subsequent encounter
T63.422A Toxic effect of venom of ants, intentional self-harm, initial encounter
T63.422D Toxic effect of venom of ants, intentional self-harm, subsequent encounter
T63.423A Toxic effect of venom of ants, assault, initial encounter
T63.423D Toxic effect of venom of ants, assault, subsequent encounter
T63.424A Toxic effect of venom of ants, undetermined, initial encounter
T63.424D Toxic effect of venom of ants, undetermined, subsequent encounter
T63.441A Toxic effect of venom of bees, accidental (unintentional), initial encounter
T63.441D Toxic effect of venom of bees, accidental (unintentional), subsequent encounter
T63.442A Toxic effect of venom of bees, intentional self-harm, initial encounter
T63.442D Toxic effect of venom of bees, intentional self-harm, subsequent encounter
T63.443A Toxic effect of venom of bees, assault, initial encounter
T63.443D Toxic effect of venom of bees, assault, subsequent encounter
T63.444A Toxic effect of venom of bees, undetermined, initial encounter
T63.444D Toxic effect of venom of bees, undetermined, subsequent encounter
T63.451A Toxic effect of venom of hornets, accidental (unintentional), initial encounter
T63.451D Toxic effect of venom of hornets, accidental (unintentional), subsequent encounter
T63.452A Toxic effect of venom of hornets, intentional self-harm, initial encounter
T63.452D Toxic effect of venom of hornets, intentional self-harm, subsequent encounter
T63.453A Toxic effect of venom of hornets, assault, initial encounter
T63.453D Toxic effect of venom of hornets, assault, subsequent encounter
T63.454A Toxic effect of venom of hornets, undetermined, initial encounter
T63.454D Toxic effect of venom of hornets, undetermined, subsequent encounter
T63.461A Toxic effect of venom of wasps, accidental (unintentional), initial encounter
T63.461D Toxic effect of venom of wasps, accidental (unintentional), subsequent encounter
T63.462A Toxic effect of venom of wasps, intentional self-harm, initial encounter
T63.462D Toxic effect of venom of wasps, intentional self-harm, subsequent encounter
T63.463A Toxic effect of venom of wasps, assault, initial encounter
T63.463D Toxic effect of venom of wasps, assault, subsequent encounter
T63.464A Toxic effect of venom of wasps, undetermined, initial encounter
T63.464D Toxic effect of venom of wasps, undetermined, subsequent encounter
T78.2XXA Anaphylactic shock, unspecified, initial encounter
T78.40XA Allergy, unspecified, initial encounter
T78.49XA Other allergy, initial encounter
T88.6XXA Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, initial encounter
Z91.030 Bee allergy status
Z91.038 Other insect allergy status
Z91.048 Other nonmedicinal substance allergy status
Z91.09 Other allergy status, other than to drugs and biological substances
 
Z51.6 is the correct code for allergy injections. The Z51 category does instruct to use the additional code for the condition which is the allergy status, from subcategory Z91.0- . You do need to check the carrier however as many do consider prophylactic allergy injections to be patient responsibility.
 
mitchellde said:
Z51.6 is the correct code for allergy injections. The Z51 category does instruct to use the additional code for the condition which is the allergy status, from subcategory Z91.0- . You do need to check the carrier however as many do consider prophylactic allergy injections to be patient responsibility.
Click to expand...

Thank you. The issue I can see is most of ours would fall under unspecified codes. Those may be denied by some other carriers. I'm still confused as to why someone would get an allergy shot as a result of a toxic insect bite. That seems a bit insane to me and sure to cause the patient to be hospitalized.
 
allergy coding

CoderCat said:
We recently received a denial on one of our patient's for all of the allergy shots the patient has received. We are a primary care office and only administer the serum when it is sent to us from the allergist. We do not diagnose the allergy or do allergy testing. This was a Humana claim and strangely this is the only patient this has happened with so far. The claims are denying for not a covered diagnosis. Z51.6 with 95115 or 95117. We called to check on this and were told they now follow CMS guidelines for allergy shots which does not allow you to use Z51.6 but only one of the codes listed below. Someone else said their ICD 10 books indicates that z51.6 should not be used alone. I check and my 2017 book has no such note.

The list below makes little sense to me as the T codes I would think would be unusable as they can't be a primary code. Also if you are suffering the effects currently of a bite or sting I can't imagine that being the best time to administer an allergy shot. I'm having trouble understanding why a code for desensitization of allergens would not be acceptable for allergy shots. I have not received denials from any other carrier or even on any other patient. What are your experiences and can you offer any advise?

ICD-10 Code Description
H10.411 - H10.413 - Chronic giant papillary conjunctivitis, right eye - Chronic giant papillary conjunctivitis, bilateral
H10.419 Chronic giant papillary conjunctivitis, unspecified eye
H10.45 Other chronic allergic conjunctivitis
J30.0 - J30.2 Vasomotor rhinitis - Other seasonal allergic rhinitis
J30.81 Allergic rhinitis due to animal (cat) (dog) hair and dander
J30.89 Other allergic rhinitis
J30.9 Allergic rhinitis, unspecified
J45.21 Mild intermittent asthma with (acute) exacerbation
J45.22 Mild intermittent asthma with status asthmaticus
J45.31 Mild persistent asthma with (acute) exacerbation
J45.32 Mild persistent asthma with status asthmaticus
J45.41 Moderate persistent asthma with (acute) exacerbation
J45.42 Moderate persistent asthma with status asthmaticus
J45.51 Severe persistent asthma with (acute) exacerbation
J45.52 Severe persistent asthma with status asthmaticus
J45.901 Unspecified asthma with (acute) exacerbation
J45.902 Unspecified asthma with status asthmaticus
J45.909 Unspecified asthma, uncomplicated
J45.998 Other asthma
J82 Pulmonary eosinophilia, not elsewhere classified
T63.421A Toxic effect of venom of ants, accidental (unintentional), initial encounter
T63.421D Toxic effect of venom of ants, accidental (unintentional), subsequent encounter
T63.422A Toxic effect of venom of ants, intentional self-harm, initial encounter
T63.422D Toxic effect of venom of ants, intentional self-harm, subsequent encounter
T63.423A Toxic effect of venom of ants, assault, initial encounter
T63.423D Toxic effect of venom of ants, assault, subsequent encounter
T63.424A Toxic effect of venom of ants, undetermined, initial encounter
T63.424D Toxic effect of venom of ants, undetermined, subsequent encounter
T63.441A Toxic effect of venom of bees, accidental (unintentional), initial encounter
T63.441D Toxic effect of venom of bees, accidental (unintentional), subsequent encounter
T63.442A Toxic effect of venom of bees, intentional self-harm, initial encounter
T63.442D Toxic effect of venom of bees, intentional self-harm, subsequent encounter
T63.443A Toxic effect of venom of bees, assault, initial encounter
T63.443D Toxic effect of venom of bees, assault, subsequent encounter
T63.444A Toxic effect of venom of bees, undetermined, initial encounter
T63.444D Toxic effect of venom of bees, undetermined, subsequent encounter
T63.451A Toxic effect of venom of hornets, accidental (unintentional), initial encounter
T63.451D Toxic effect of venom of hornets, accidental (unintentional), subsequent encounter
T63.452A Toxic effect of venom of hornets, intentional self-harm, initial encounter
T63.452D Toxic effect of venom of hornets, intentional self-harm, subsequent encounter
T63.453A Toxic effect of venom of hornets, assault, initial encounter
T63.453D Toxic effect of venom of hornets, assault, subsequent encounter
T63.454A Toxic effect of venom of hornets, undetermined, initial encounter
T63.454D Toxic effect of venom of hornets, undetermined, subsequent encounter
T63.461A Toxic effect of venom of wasps, accidental (unintentional), initial encounter
T63.461D Toxic effect of venom of wasps, accidental (unintentional), subsequent encounter
T63.462A Toxic effect of venom of wasps, intentional self-harm, initial encounter
T63.462D Toxic effect of venom of wasps, intentional self-harm, subsequent encounter
T63.463A Toxic effect of venom of wasps, assault, initial encounter
T63.463D Toxic effect of venom of wasps, assault, subsequent encounter
T63.464A Toxic effect of venom of wasps, undetermined, initial encounter
T63.464D Toxic effect of venom of wasps, undetermined, subsequent encounter
T78.2XXA Anaphylactic shock, unspecified, initial encounter
T78.40XA Allergy, unspecified, initial encounter
T78.49XA Other allergy, initial encounter
T88.6XXA Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, initial encounter
Z91.030 Bee allergy status
Z91.038 Other insect allergy status
Z91.048 Other nonmedicinal substance allergy status
Z91.09 Other allergy status, other than to drugs and biological substances
Click to expand...

We bill the 95115, 95117 with all the allergies as in J30.2 etc and the last dx code being Z51.6 and have no issues

Thank You
Heather Hudlemeyer
CPC
 
Last edited:
I am being told by the manager of our office that we should be billing a nurse visit with 95117 due to they monitor this patient for 30 minutes to 1 hour after the allergy injection is given. Has anyone else had any success with this and if so do you use a modifier also? From what I am seeing you can't bill a 99211 or any E/M with this code unless they have other issues going on like a reaction,etc.

Any help would be appreciated.
 
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