ICD-10 Coding for Alpha-gal Syndrome(Z91.014)
Complete ICD-10-CM coding and documentation guide for Alpha-gal Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Alpha-gal Syndrome
Z91.01-Z91.02Primary Range
Personal history of allergy to drugs, medicaments and biological substances
This range includes codes for allergies to mammalian meats, which is the primary concern in alpha-gal syndrome.
Anaphylactic reaction due to adverse food reaction
This range is relevant for documenting anaphylactic reactions that may occur in alpha-gal syndrome.
Bitten or stung by nonvenomous insect and other nonvenomous arthropods
This code is used to document tick bites, which are often associated with the onset of alpha-gal syndrome.
Key Information: ICD-10 code for alpha-gal syndrome
Essential facts and insights about Alpha-gal Syndrome
Primary ICD-10-CM Code for alpha gallon
Decision Criteria
clinical Criteria
- Confirmed sIgE to alpha-gal and documented allergic reaction to mammalian meats.
documentation Criteria
- History of tick bite and specific IgE test results.
Applicable To
- Alpha-gal syndrome
Excludes
- Other food allergies (Z91.018)
Clinical Validation Requirements
- sIgE to alpha-gal ≥0.1 IU/mL
- Delayed allergic reaction 2-6 hours after consumption of mammalian meat
- History of tick bite
Code-Specific Risks
- Incorrectly using a general allergy code instead of this specific code.
Coding Notes
- Ensure documentation specifies mammalian meat allergy and includes relevant clinical tests.
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.
Other food allergies
Z91.018Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Alpha-gal Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z91.014.
Impact
Clinical: May lead to inappropriate treatment plans., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims due to incorrect coding.
Mitigation Strategy
Train staff on specific documentation requirements, Use templates for allergy documentation
Impact
Reimbursement: May lead to incorrect DRG assignment affecting reimbursement., Compliance: Could result in non-compliance with coding guidelines., Data Quality: Impacts the accuracy of allergy tracking and public health data.
Mitigation Strategy
Ensure documentation specifies mammalian meat allergy and confirm with sIgE testing.
Impact
Inadequate documentation of specific allergies can lead to audit findings.
Mitigation Strategy
Ensure all allergy documentation includes specific IgE results and detailed patient history.
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 Alpha-gal Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Alpha-gal Syndrome
Use these documentation templates to ensure complete and accurate documentation for Alpha-gal Syndrome. These templates include all required elements for proper coding and billing.
Initial Diagnosis of Alpha-gal Syndrome
Specialty: Allergy and ImmunologyRequired Elements
- Patient history of tick exposure
- sIgE test results
- Symptoms and timing post-meat consumption
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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