Part B Coding Coach: Debunk These 3 Common Allergy Coding Myths

Always make sure the trigger of an asthma flare is reported. Since allergy season is at its peak, it’s important to be prepared to capture asthma exacerbation visits accurately. The task isn’t always straightforward, and coders often have to search carefully through documentation to identify the correct code. Let’s clear up some common misconceptions about asthma and allergy coding.

Myth 1: Cause-and-effect coding isn’t required for asthma exacerbation

Whenever the provider documents the cause of a condition in the record, it must be coded. The cause-and-effect relationship for asthma needs to be identified and coded. Documentation should reflect the severity, whether it is chronic, and if the patient is experiencing an exacerbation or status asthmaticus.

Scenario

A patient comes in with an exacerbation of moderate persistent asthma. The episode was triggered after a neighbor mowed the lawn, which led to a worsening of symptoms. The provider documents an acute exacerbation of moderate persistent asthma due to hay fever.

In this case, two ICD-10-CM codes are required. The exacerbation has to be linked to the hay fever, and the hay fever must be coded separately. The correct codes are:

• J45.41 - Moderate persistent asthma with (acute) exacerbation
• J30.1 - Allergic rhinitis due to pollen (hay fever is included under this code)

Critical Point

Though the scenario focuses on “moderate persistent asthma,” there are situations where the patient may arrive with symptoms severe enough to be classified as “status asthmaticus.”

Status asthmaticus refers to an acute asthma attack that does not initially improve with bronchodilator treatment. The appropriate ICD-10-CM code for this condition is J45.52 (Severe persistent asthma with status asthmaticus).

This is a life-threatening condition that demands immediate medical care. Patients in this state may appear restless or disoriented, struggle to speak full sentences, have trouble concentrating, or display bluish lips, all of which are warning signs of possible respiratory failure.

Myth 2: Pet allergies are not considered allergic rhinitis

If a provider documents allergic rhinitis caused by exposure to pet hair or dander from animals such as cats or dogs, the correct coding path is the J30.8- (Other allergic rhinitis) category. This category requires a fifth character to identify the specific type of allergic rhinitis.

Scenario

A returning patient reports symptoms including a runny nose, sneezing, nasal congestion, and itchy eyes. The history notes mild persistent asthma, which has recently worsened. The patient also shares that they have adopted a cat. The provider diagnoses an acute exacerbation of mild persistent asthma triggered by cat hair and dander.

In this case, two ICD-10-CM codes are needed:

• J45.31 - Mild persistent asthma with (acute) exacerbation
• J30.81 - Allergic rhinitis due to animal (cat) (dog) hair and dander

The key point is that when an exacerbation occurs, the underlying trigger must be documented and coded separately. This requires one code for the asthma and another for the allergy or other identified cause.

Condition Definition

Allergic rhinitis is a disorder in which the patient develops multiple nasal symptoms. Although it is often referred to as hay fever, the reaction is not limited to exposure to hay; a variety of environmental triggers can set off symptoms.

Common signs of allergic rhinitis include:

• Runny nose
• Watery, irritated eyes
• Sneezing
• Coughing
• Itching

Myth 3: Perennial allergic rhinitis is caused by flowers

While the term “perennial” is often associated with flowers that bloom year after year, perennial allergic rhinitis does not stem from flowers. In this context, “perennial” refers to allergies that occur year-round rather than being limited to a seasonal pattern.

Common triggers of perennial allergic rhinitis include:

• Dust mites
• Cats and dogs
• Fungi or molds

Perennial allergic rhinitis is listed as a synonym for J30.89 (Other allergic rhinitis). This code is used to report the diagnosis. It is also the correct choice when the provider identifies a specific allergen as the cause of the rhinitis, but there is no precise code for that condition within ICD-10-CM.

BillingFreedom: Your Partner in Allergy & Asthma Billing Accuracy

Accurate reporting for allergy testing, immunotherapy, and asthma encounters requires more than just familiarity with CPT® codes; it demands precision and compliance at every step. From percutaneous and patch tests to intradermal, venom, and drug testing, each service must be coded with attention to detail. 

Similarly, documenting the cause of asthma exacerbations during peak allergy season ensures claims are submitted correctly and reimbursement reflects the care provided. Errors in units, code selection, or documentation can quickly result in denials or lost revenue.

BillingFreedom brings specialized expertise in Allergy & Immunology Medical Billing Services, helping practices navigate these complexities with confidence. Our team reviews encounters thoroughly, applies the right CPT® codes, and ensures documentation supports every claim. By partnering with us, practices can streamline billing, avoid costly mistakes, and maintain compliance while protecting their revenue cycle.

For more details about our exceptional Allergy & Immunology medical billing services, please don't hesitate to contact us via email at info@billingfreedom.com or call us at +1 (855) 415-3472. Your financial tranquility is our priority!