1. Allergy, Asthma, & Immunology
ICD-10 CM Training
Allergy, Asthma, & Immunology

2. ICD-10-CM Compliance Dates
ICD-10-CM will be valid for dates of service on or after October 1, 2015
Outpatient dates of service of October 1, 2015 and beyond.
Inpatient hospital service claims, is effective for dates of discharge after September 30, 2015

3. Covered and Non-Covered Entities
Everyone covered by the Health Insurance Portability Accountability Act (HIPPA)
Non-Covered Entities
Worker’s Compensation
Auto Insurance
Non covered HIPAA entities are exempt but are encouraged to adapt the new code set

4. ICD-10 Code Structure 21 Chapters
Alpha-numeric codes; not case-sensitive
Codes begin with Alpha letter, A-Z, excluding U
Common errors
I verses 1
O verses 0
“X” Placeholder
3 to 7 characters
Decimal following 3rd character

5. ICD-10 Code Structure Placeholder “X”
Used for future expansion of a code
Fills in empty characters when a 6th and/or 7th character apply
The placeholder may be used in different scenarios but should never serve as the final character.
Example: W19.XXXA Unspecified fall, Initial Encounter

6. ICD-10 Code Structure 7th Character
Provides specified information regarding the clinical visit
Is required for certain categories and must be reported in the seventh position
May be alpha or numeric
Has different meanings depending on the coding category

7. ICD-10 Code Structure Laterality
Some ICD-10-CM codes indicate laterality, specifying whether the condition occurs on the left, right or is bilateral.
If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side.
If the side is not identified in the medical record, assign the code for the unspecified side.
OGCR section 1.B.13

8. ICD-10 Code Structure “Other” Codes “Unspecified” Codes
Codes titled “other” or “other specified” are for use when the information in the medical record provides detail for which a specific code does not exist.
“Unspecified” Codes
Codes titled “unspecified” are for use when the information in the medical record is insufficient to assign a more specific code.
OGCR section 1.A.9.a.b

9. ICD-10 Structure Excludes Notes Excludes1 Excludes2
A type 1 Excludes note is a pure excludes note
It means “NOT CODED HERE”
The code excluded should never be used at the same time
When two conditions cannot occur together
Excludes2
Represents “Not included here”
The condition excluded is not part of the condition represented by the code
It is acceptable to use both the code and the excluded code together, when appropriate
OGCR section 1.A.12.a.b

10. ICD-10 Code Structure “Code First” and “Use Additional Code”
ICD-10 has a coding convention that requires the underlying condition be sequenced first followed by the manifestation.
These instructional notes indicate the proper sequencing order of the codes.
OGCR section 1.A.13
The “-” indicates there are additional reporting options

11. Most Common Diagnosis Codes

12. Allergic rhinitis 477.0 J30.9 Allergic rhinitis, unspecified
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
477.0
J30.9
Allergic rhinitis, unspecified
allergic rhinitis with asthma (bronchial) (J45.909)
rhinitis NOS (J31.0)
N/A
There are more specific code choice selections:
477.9
J30.0
Vasomotor rhinitis
J30.1
Allergic rhinitis due to pollen
477.8
J30.2
Other seasonal allergic rhinitis
477.1
J30.5
Allergic rhinitis due to food
477.2
J30.81
Allergic rhinitis due to animal (cat) (dog) hair and dander
J30.89
Other allergic rhinitis
Use additional code, where applicable, to identify:
exposure to environmental tobacco smoke (Z77.22)
exposure to tobacco smoke in the perinatal period (P96.81)
history of tobacco use (Z87.891)
occupational exposure to environmental tobacco smoke (Z57.31)
tobacco dependence (F17.-)
tobacco use (Z72.0

13. Allergic Rhinitis Documentation Tips
Type
Due to animal hair and dander
Due to food
Due to pollen
Other seasonal allergic
Other allergic
Unspecified

14. Other chronic allergic conjunctivitis
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
372.14
H10.45
keratoconjunctivitis (H16.2-)
N/A

15. Documentation Tips Identify side: Left Right Bilateral Unspecified
Use an external cause code following the code for the eye condition, if applicable, to identify the cause of the eye condition

16. Asthma ICD-9 Code ICD-10 Code Description Excludes1 Excludes2
493.00,
J45.20
Mild intermittent asthma, uncomplicated or NOS
bronchitis due to chemicals, gases, fumes and vapors (J68.0)
cystic fibrosis (E84.-)
493.01,
J45.22
Mild intermittent asthma with status asthmaticus
N/A
493.02,
J45.21
Mild intermittent asthma with (acute) exacerbation
493.82
J45.991
Cough variant asthma
493.90
J45.909
J45.998
Unspecified asthma, uncomplicated
Other asthma
493.91
J45.902
Unspecified asthma with status asthmaticus
493.92
J45.901
Unspecified asthma with (acute) exacerbation

17. Asthma Severity Chart INTERMITTENT MILD PERSISTENT MODERATE PERSISTENT
SEVERE PERSISTENT
SYMPTOMS
2 or less days
per week
More than 2
days per
week
Daily
Throughout
the day
NIGHTIME AWAKENINGS
2 x’s per
month or less
3 – 4 x’s per
month
More than
once per
week but not
nightly
Nightly
RESCUE INHALER USE
week, but not
daily
Several times
per day
INTERFERENCE WITH NORMAL ACTIVITY
None
Minor
limitation
Some
Extremely
limited
LUNG FUNCTION
FEVI>80% predicted and normal between exacerbations
FEV1>80%
predicted
FEV1 60 –
80%
FEV1 less
than 60%

18. Documentation Tips
When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).
Use additional code, where applicable, to identify:
exposure to environmental tobacco smoke (Z77.22)
exposure to tobacco smoke in the perinatal period (P96.81)
history of tobacco use (Z87.891)
occupational exposure to environmental tobacco smoke (Z57.31)
tobacco dependence (F17.-)
tobacco use (Z72.0)

19. Toxic Effect of Venom 989.5 T63.-
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
989.5
T63.-
Toxic effect of unspecified, chiefly nonmedicinal as to source, venom
Includes:
bite or touch of venomous animal
pricked or stuck by thorn or leaf
contact with and (suspected) exposure to toxic substances (Z77.-)
ingestion of toxic animal or plant (T61.-, T62.-)
989.5 crosswalks to 152 ICD-10-CM codes
Use additional code(s):
for all associated manifestations of toxic effect, such as: respiratory conditions due to external agents (J60-J70)
personal history of foreign body fully removed (Z87.821)
to identify any retained foreign body, if applicable (Z18.-)
The appropriate 7th character is to be added to each code from category T63
A - initial encounter
D - subsequent encounter
S - sequela

20. Documentation Tips
When no intent is indicated code to accidental. Undetermined intent is only for use when there is specific documentation in the record that the intent of the toxic effect cannot be determined.

21. Other adverse food reactions
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
995.7
T78.1XX-
Other adverse food reactions, not elsewhere classified, initial encounter
anaphylactic reaction or shock due to adverse food reaction (T78.0-)
anaphylactic reaction due to food (T78.0-)
bacterial food borne intoxications (A05.-)
allergic and dietetic gastroenteritis and colitis (K52.2)
allergic rhinitis due to food (J30.5)
dermatitis due to food in contact with skin (L23.6, L24.6, L25.4)
dermatitis due to ingested food (L27.2)
Use additional code to identify the type of reaction
The appropriate 7th character is to be added to code T66
A - initial encounter
D - subsequent encounter
S - sequela

22. Documentation Tips
Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code

23. Cough ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 786.2 R05
Cough with hemorrhage (R04.2)
Smoker’s Cough (J41.0)
N/A

24. Cough Documentation Tips
Symptom Codes
Codes that describe symptoms and signs are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider.
Use of a symptom code with a definitive diagnosis code
Codes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis code.
Signs or symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.

25. Allergy to other foods V15.05 Z91.018 Applicable To:
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
V15.05
Z91.018
Applicable To:
Allergy to nuts other than peanuts
N/A
contact with and (suspected) exposures hazardous to health (Z77.-)
exposure to pollution and other problems related to physical environment (Z77.1-)
personal history of physical injury and trauma (Z87.81, Z87.82-)
occupational exposure to risk factors (Z57.-)
Allergy status to drugs, medicaments, and biological substances (Z88.-)
Code also any follow-up examination (Z08-Z09)
Z91.010
Allergy to peanuts
Z91.011
Allergy to milk products
Z91.012
Allergy to eggs
Z91.013
Allergy to seafood

26. Documentation Tips
Z is considered unacceptable as a principal diagnosis as it describes a circumstance which influences an individual's health status but not a current illness or injury, or the diagnosis may not be a specific manifestation but may be due to an underlying cause.

27. Documentation Tips
Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as 'diagnoses' or 'problems'. This can a rise in two main ways:
(a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.
(b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.

28. Atopic Dermatitis 691.8 L20.0 Besnier's prurigo N/A
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
691.8
L20.0
Besnier's prurigo
N/A
chronic (childhood) granulomatous disease (D71)
dermatitis gangrenosa (L08.0)
dermatitis herpetiformis (L13.0)
dry skin dermatitis (L85.3)
factitial dermatitis (L98.1)
perioral dermatitis (L71.0)
radiation-related disorders of the skin and subcutaneous tissue (L55-L59)
stasis dermatitis (I83.1-I83.2
L20.81
Atopic neurodermatitis
Applicable To:
Diffuse neurodermatitis
L20.82
Flexural eczema
L20.84
Intrinsic (allergic) eczema
L20.89
Other atopic dermatitis

29. Documentation Tips
In (L20-L30) codes the terms dermatitis and eczema are used synonymously and interchangeably.

30. Chronic rhinitis 472.0 J31.0 Applicable To:
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
472.0
J31.0
Applicable To:
Atrophic rhinitis (chronic)
Granulomatous rhinitis (chronic)
Hypertrophic rhinitis (chronic)
Obstructive rhinitis (chronic)
Ozena
Purulent rhinitis (chronic)
Rhinitis (chronic) NOS
Ulcerative rhinitis (chronic)
allergic rhinitis (J30.1-J30.9)
vasomotor rhinitis (J30.0)
N/A
Use additional code, where applicable, to identify:
exposure to environmental tobacco smoke (Z77.22)
exposure to tobacco smoke in the perinatal period (P96.81)
history of tobacco use (Z87.891)
occupational exposure to environmental tobacco smoke (Z57.31)
tobacco dependence (F17.-)
tobacco use (Z72.0)

31. Documentation Tips Identify:
Rhinitis type
Allergic Rhinitis type
When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).

32. Unspecified acute conjunctivitis
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
372.00
H10.33
Unspecified acute conjunctivitis, bilateral
Ophthalmia neonatorum NOS (P39.1)
keratoconjunctivitis (H16.2-)
N/A
There are more specific code choice selections
H10.30
Unspecified acute conjunctivitis, unspecified eye
H10.31
Unspecified acute conjunctivitis, right eye
H10.32
Unspecified acute conjunctivitis, left eye

33. Unspecified acute conjunctivitis, bilateral Documentation Tips
Conjunctivitis Type
Acute type
Chronic type
Laterality
Use an external cause code following the code for the eye condition, if applicable, to identify the cause of the eye condition

34. Unspecified contact dermatitis, unspecified cause
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
692.9
L25.9
Applicable To
Contact dermatitis (occupational) NOS
Contact eczema (occupational) NOS
allergic contact dermatitis (L23.-)
allergy NOS (T78.40)
dermatitis NOS (L30.9)
irritant contact dermatitis (L24.-)
chronic (childhood) granulomatous disease (D71)
dermatitis gangrenosa (L08.0)
dermatitis herpetiformis (L13.0)
dry skin dermatitis (L85.3)
factitial dermatitis (L98.1)
perioral dermatitis (L71.0)
radiation-related disorders of the skin and subcutaneous tissue (L55-L59)
stasis dermatitis (I83.1-I83.2)
dermatitis due to ingested substances (L27.-)
dermatitis of eyelid (H01.1-)
eczema of external ear (H60.5-)
There are more specific code choice selections
692.81
L25.0
Unspecified contact dermatitis due to cosmetics
692.3
L25.1
Unspecified contact dermatitis due to drugs in contact with skin
692.89
L25.2
Unspecified contact dermatitis due to dyes
692.4
L25.3
Unspecified contact dermatitis due to other chemical products
692.5
L25.4
Unspecified contact dermatitis due to food in contact with skin
692.6
L25.5
Unspecified contact dermatitis due to plants, except food
L25.8
Unspecified contact dermatitis due to other agents

35. Allergic Rhinitis Documentation Tips
In this block the terms dermatitis and eczema are used synonymously and interchangeably.

36. Other adverse food reactions
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
995.7
T78.1XX-
Other adverse food reactions, not elsewhere classified
anaphylactic reaction or shock due to adverse food reaction (T78.0-)
anaphylactic reaction due to food (T78.0-)
bacterial food borne intoxications (A05.-)
complications of surgical and medical care NEC (T80-T88)
allergic and dietetic gastroenteritis and colitis (K52.2)
allergic rhinitis due to food (J30.5)
dermatitis due to food in contact with skin (L23.6, L24.6, L25.4)
dermatitis due to ingested food (L27.2)
There are more specific code choice selections below:
T78.0-
Anaphylactic reaction due to food
The appropriate 7th character is to be added to code T66
A - initial encounter
D - subsequent encounter
S - sequela

37. Documentation Tips
Use additional code to identify the type of reaction
Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code

38. Angioneurotic edema 995.1 T783XX- Applicable to: Allergic angioedema
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
995.1
T783XX-
Applicable to:
Allergic angioedema
Giant urticaria
Quincke's edema
serum urticaria (T80.6-)
urticaria (L50.-)
complications of surgical and medical care NEC (T80-T88)
The appropriate 7th character is to be added to each code from category T78
A - initial encounter
D - subsequent encounter
S - sequela

39. Documentation Tips
Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the Tsection that include the external cause do not require an additional external cause code

40. Urticaria 708.9 L50.9 Urticaria, unspecified Lyme disease (A69.2-)
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
708.9
L50.9
Urticaria, unspecified
Lyme disease (A69.2-)
rosacea (L71.-)
allergic contact dermatitis (L23.-)
angioneurotic edema (T78.3)
giant urticaria (T78.3)
hereditary angio-edema (D84.1)
Quincke's edema (T78.3)
serum urticaria (T80.6-)
solar urticaria (L56.3)
urticaria neonatorum (P83.8)
urticaria papulosa (L28.2)
urticaria pigmentosa (Q82.2)
N/A
There are more specific code choice selections below:
708.0
L50.0
Allergic urticaria
708.1
L50.1
Idiopathic urticaria
708.2
L50.2
Urticaria due to cold and heat
708.3
L50.3
Dermatographic urticaria
708.4
L50.4
Vibratory urticaria
708.5
L50.5
Cholinergic urticaria
708.8
L50.6
Contact urticaria
L50.8
Other urticaria

41. Chronic sinusitis ICD-9 Code ICD-10 Code Description Excludes1
473.0
J32.0
Chronic maxillary sinusitis
Applicable To:
Antritis (chronic)
Maxillary sinusitis NOS
N/A
certain conditions originating in the perinatal period (P04-P96)
certain infectious and parasitic diseases (A00-B99)
complications of pregnancy, childbirth and the puerperium (O00-O9A)
congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
endocrine, nutritional and metabolic diseases (E00-E88)
injury, poisoning and certain other consequences of external causes (S00-T88)
neoplasms (C00-D49)
smoke inhalation (T59.81-)
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
473.1
J32.1
Chronic frontal sinusitis, NOS
473.2
J32.2
Chronic ethmoidal sinusitis, NOS
473.3
J32.3
Chronic sphenoidal sinusitis, NOS
473.8,
J32.4
Chronic pansinusitis
Pansinusitis NOS
J32.8
Other chronic sinusitis
Sinusitis (chronic) involving more than one sinus but not pansinusitis
473.9
J32.9
Chronic sinusitis, unspecified, NOS
Sinusitis (chronic) NOS

42. Chronic sinusitis, unspecified Documentation Tips
Use additional code, where applicable, to identify:
exposure to environmental tobacco smoke (Z77.22)
exposure to tobacco smoke in the perinatal period (P96.81)
history of tobacco use (Z87.891)
occupational exposure to environmental tobacco smoke (Z57.31)
tobacco dependence (F17.-)
tobacco use (Z72.0)

43. Monitor Claims
On October 01, 2015 we will monitor claims for date of service rules
Outpatient claims cannot have crossover dates
Outpatient claims will be coded according to date of service
Inpatient facility claims will be coded per date of discharge
We will monitor claims to resolve any unanticipated problems with the submission process

44. Claim Denial and Management
We will monitor for claim denials
We will monitor editing trends for ICD-10 Coding guidelines
We will provide feedback to the physicians regarding supporting documentation requirements
We will monitor WC or Liability carriers for published rules on use of ICD-9 or ICD-10 code sets

45. Client Responsibilities
Client will need to update
Templates
Order Sets
Superbills
Favorites
Future Orders
Remove ICD-9 code add ICD-10 code

46. Documentation – Start Now
All Conditions treated or assessed must be documented in the medical record. In addition to the documentation tips reviewed, below are more areas to document that will ensure proper ICD-10-CM code selection.
Site specificity
Document notation of qualifiers
Exacerbation
Manifestations
Relapse
Status
Stages
Indicate acute or chronic
Indicate underlying or external cause factors
Medication
Smoke
Accidents
Mechanical failure
Laterality
Bilateral
Right
Left

47. Documentation – Start Now
Episode of Care for injuries, poisoning, external causes and other conditions
Initial Encounter
Use while the patient is receiving active treatment of the condition
Active treatment includes surgical treatment, an emergency encounter, and evaluation and treatment by a new physician
Subsequent Encounter
Used on encounter after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase.
Medication adjustments, aftercare, device adjustments, cast change
Sequela
Used for complications or conditions that arise as a direct result of a condition, late effect

48. Documentation – Start Now
Combination codes that capture
Etiology and manifestation
Related conditions
Disease, injury or other medical condition and complications
Disease or other medical conditions and common signs or symptoms
Add ICD-10 Codes to patient Problem List

49. Questions
Centers for Disease Control and Prevention (ICD-10-CM)
Offical Guidelines, Alpha Index, Tabular Index, Neoplasm Table, Drug Table, External Cause of Injury Index