ICD-10 Coding for Amoxicillin Allergy(T36.0X5A, Z88.0)
Complete ICD-10-CM coding and documentation guide for Amoxicillin Allergy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Amoxicillin Allergy
T36-T50Primary Range
Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances
This range includes codes for adverse effects and poisoning by antibiotics, including amoxicillin.
Personal history of allergy to drugs, medicaments and biological substances
This range is used to indicate a personal history of drug 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 when a patient experiences an adverse effect from amoxicillin during the initial encounter. |
|
| Z88.0 | Personal history of allergy to penicillin | Use when documenting a known allergy to amoxicillin without current reaction. |
|
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 amoxicillin allergy
Essential facts and insights about Amoxicillin Allergy
Primary ICD-10-CM Codes for amoxicillin allergy
Decision Criteria
clinical Criteria
- Presence of adverse reaction symptoms following amoxicillin administration
coding Criteria
- Use of 7th character 'A' for initial encounter
Applicable To
- Adverse reaction to amoxicillin
Excludes
- Poisoning by penicillins (T36.0X1-)
Clinical Validation Requirements
- Documented adverse reaction following administration of amoxicillin
- Temporal relationship between drug administration and reaction
Code-Specific Risks
- Incorrect sequencing with symptom codes
- Missing 7th character for encounter type
Coding Notes
- Ensure correct sequencing of T36.0X5A before symptom codes.
Z88.0 - Personal history of allergy to penicillin
Use when documenting a known allergy to amoxicillin without current reaction.
Applicable To
- History of allergy to amoxicillin
Excludes
- Current adverse reaction to penicillin (T36.0X5-)
Clinical Validation Requirements
- Documented history of allergic reaction to amoxicillin
- No current adverse reaction
Coding Notes
Ensure no current reaction is documented when using Z88.0.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Allergic urticaria
L50.0Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, initial encounter
T88.6XXAPersonal history of resolved allergy to amoxicillin
Z91.03Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Amoxicillin Allergy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code T36.0X5A.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials due to insufficient documentation.
Mitigation Strategy
Use specific medical terminology., Include detailed descriptions of reactions.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate patient records and data reporting.
Mitigation Strategy
Use T36.0X5A for current adverse reactions.
Impact
Using Z88.0 for current reactions instead of historical allergies.
Mitigation Strategy
Regular training on code differentiation and documentation requirements.
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 Amoxicillin Allergy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Amoxicillin Allergy
Use these documentation templates to ensure complete and accurate documentation for Amoxicillin Allergy. These templates include all required elements for proper coding and billing.
Initial Encounter with Adverse Reaction
Specialty: Allergy and ImmunologyRequired Elements
- Patient history of drug exposure
- Description of reaction
- Treatment administered
- Outcome of treatment
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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