ICD-10 Coding for Allergy to Amoxicillin(T36.0X5A, Z88.0)
Complete ICD-10-CM coding and documentation guide for Allergy to Amoxicillin. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Allergy to Amoxicillin
T36.0X5A-T36.0X5SPrimary Range
Adverse effects of systemic antibiotics
This range includes codes for adverse effects of antibiotics, including amoxicillin.
Personal history of allergy to penicillin
This code is used for documenting a history of penicillin allergy, including amoxicillin.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| T36.0X5A | Adverse effect of penicillins, initial encounter | Use for initial encounters of adverse effects due to amoxicillin. |
|
| Z88.0 | Personal history of allergy to penicillin | Use for documenting history of allergy without current symptoms. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for allergy to amoxicillin
Essential facts and insights about Allergy to Amoxicillin
Primary ICD-10-CM Codes for allergy to amoxicillin
Decision Criteria
clinical Criteria
- Presence of immediate hypersensitivity reaction
documentation Criteria
- Detailed description of reaction and timing
Applicable To
- Adverse effect of amoxicillin
Excludes
- Allergic reaction NOS (T78.40XA)
Clinical Validation Requirements
- Documented adverse reaction to amoxicillin
- Symptoms such as urticaria or angioedema within 1 hour of administration
Code-Specific Risks
- Incorrectly using without documentation of adverse effect
Coding Notes
- Ensure documentation specifies adverse effect and timing relative to drug administration.
Z88.0 - Personal history of allergy to penicillin
Use for documenting history of allergy without current symptoms.
Applicable To
- History of amoxicillin allergy
Excludes
- Current adverse reaction (T36.0X5A)
Clinical Validation Requirements
- Patient-reported history of allergy
- No current adverse reaction
Coding Notes
Ensure history is verified and documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Allergy to Amoxicillin to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code T36.0X5A.
Impact
Clinical: Inaccurate patient allergy records., Regulatory: Potential audit issues., Financial: Denied claims due to insufficient documentation.
Mitigation Strategy
Train staff on detailed documentation practices.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Use T36.0X5A for active adverse reactions.
Impact
Risk of audits due to vague or incorrect allergy documentation.
Mitigation Strategy
Implement detailed documentation protocols.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Allergy to Amoxicillin, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Allergy to Amoxicillin
Use these documentation templates to ensure complete and accurate documentation for Allergy to Amoxicillin. These templates include all required elements for proper coding and billing.
Initial Encounter for Amoxicillin Allergy
Specialty: Allergy and ImmunologyRequired Elements
- Reaction type and timing
- Specific symptoms
- Verification of allergy
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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