re: Bizarre new ICD-10 codes

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The US has only had since the 90s to prepare for ICD 10

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And they are giving bonuses to the providers for providing as much of this information as possible. The more they get the more they give in bonuses. And they are now ranking the providers on the "quality of care". And this ranking is not based on how good the providers are, it's based on how much information hey gather and report.

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Exactly. It isn't s big deal

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The following is a list of choices for bee sting diagnosis codes, along with discussion of correct application:

ICD-10CM Code Description

T63.44-- Toxic effect of venom of bees, accidental
T63.45-- Toxic effect of venom of hornets, accidental
T63.46-- Toxic effect of venom of wasps, accidental

Z91.030 Bee allergy status
Z91.038 Other insect allergy status

Options
1 accidental (unintentional) A Initial (active tx)
2 intentional, self-harm D Subsequent
3 assault S Sequela
4 undetermined

With the expansion of the ICD-10CM codes for bee venom patients, as well as changes to the terminology of the codes, a clear understanding of the terminology is necessary to make the appropriate selection for the patient’s encounter.

Toxic effect is defined in the ICD-10CM book as “any harmful substance which is either ingested or comes in contact with a person.” The bee sting is considered a toxic effect for the patient.

The Z codes assigned for bee venom patients are considered status codes, but are also listed in the alphabetic section as personal history codes. The status definition indicates a patient is either a carrier of a disease or has the sequela or residual of a past disease or condition.

It will also be necessary to assign a course of treatment character to the T category codes to indicate the status of the patient. This is defined with a 7th character. The 7th character is required to have a complete code. The 7th character options are “A, D and S”.

The definition of “A” was clarified in 2015. The 7th character “A” initial encounter is used while the patient is receiving active treatment for the condition. Examples of active treatment are emergency department encounters, and evaluation and continuing treatment by the same or a different physician. While the patient may be seen by a new or different provider over the course of treatment for an injury or other disease, assignment of the 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first-time.

The 7th character “D’ for subsequent encounter is used for encounters after the patient has received active treatment of the condition, and is receiving routine care for the condition during the healing or recovery phase. Examples of subsequent care are medication adjustments, or other aftercare and follow-up visits, following treatment of the condition.

The 7th character “S” Sequela is for use for complications or conditions that arise as a direct result of a condition such as a scar, or urticaria, caused by the bee sting. When using the 7th character “S,” it is necessary to use both the toxic effect code that precipitated the sequela and the code for the sequela itself.

Case Scenario:
If a patient presents with a history of reactions to bee/wasp/hornets stings and is not skin tested, should the visit be coded using the toxic effect codes (T63….) or an allergy status code (Z91.030) Bee allergy status, or Z91.038 – Other insect allergy status?
Response:
If there is active treatment for the patient, and the patient is seeking treatment for a recent encounter with a “bee”, the correct diagnosis code would be T63……… If the patient is giving historical information based on past encounters and the patient is not seeking active treatment, the appropriate code would be the Z91.030 – Bee allergy status.

Case Scenario:
Assume that a patient provides a history of reaction to bee/wasp/hornets stings, is skin tested and skin testing is negative. What would be the appropriate ICD-10 code to choose?
Response:
If the patient had not been recently stung and has not been actively treated by a provider, the appropriate code would be the Z91.030 – Bee allergy status. The diagnosis code Z01.82 for allergy testing is to be used when there is no sign, symptom, or complaint to use to support the testing.

Case Scenario
A patient presents with history of reactions to bee/wasp/hornet stings and is skin tested. The testing is positive. A T code is assigned, but what would be the appropriate 7th digit, A, D, S?
Response:
The appropriate 7th digit would be the A, since the patient is undergoing active workup and treatment for the diagnosis of toxic effect of bees.

Case Scenario
A patient is evaluated for bee/wasp/hornet stings, and decides to return on a different day for testing. Would the 7th character be A, D, S?
Response:
The 7th character would be A since the patient is continuing to undergo active treatment and workup for the diagnosis.

Case Scenario
A patient is seen back in consultation for adjustments on their doses while on bee immunotherapy. What 7th character would be appropriate?
Response:
In this scenario, since we are making medication adjustments and the patient is receiving routine care, the appropriate 7th character would be D for subsequent encounter. However, a provider may also select the “A” as the 7th Character since the patient is still receiving active treatment. In checking LCD’s from Medicare carriers, both diagnosis codes are listed as appropriate.

Case Scenario:
Patient is on immunotherapy for venom desensitization, what would be appropriate 7th character?
Response:
The appropriate 7th character for this patient would be “D,” since the patient is on routine care for the toxic effect to bees. The patient is still receiving active treatment and an argument for the use of the “A” may also be made. Guidance from the ICD-10CM committee needs to be given for further clarification.

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