ICD-10 Coding for Augmentin Allergy(T36.0X5A, T36.1X5A, Z88.0, Z88.1)
Complete ICD-10-CM coding and documentation guide for Augmentin Allergy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Augmentin Allergy
T36.0-T36.1Primary Range
Poisoning by, adverse effect of and underdosing of systemic antibiotics
Covers adverse effects and poisoning by antibiotics, including penicillins and other beta-lactams.
Personal history of allergy to drugs, medicaments and biological substances
Used for documenting a patient's history of drug allergies, including penicillins and other antibiotics.
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 the adverse reaction is specifically due to the penicillin component of Augmentin. |
|
| T36.1X5A | Adverse effect of other beta-lactam antibiotics, initial encounter | Use when the adverse reaction is specifically due to the clavulanate component of Augmentin. |
|
| Z88.0 | Personal history of allergy to penicillin | Use to document a patient's known allergy to penicillin. |
|
| Z88.1 | Personal history of allergy to other antibiotics | Use to document a patient's known allergy to clavulanate or other non-penicillin antibiotics. |
|
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 Augmentin allergy
Essential facts and insights about Augmentin Allergy
Primary ICD-10-CM Codes for augmentin allergy
Decision Criteria
clinical Criteria
- Reaction confirmed to be due to amoxicillin
Applicable To
- Adverse effect of amoxicillin
Excludes
- Allergy to penicillin (Z88.0)
Clinical Validation Requirements
- Documented adverse reaction to amoxicillin
- Symptoms such as rash, hives, or anaphylaxis
Code-Specific Risks
- Misclassification if the reaction is due to clavulanate
Coding Notes
- Ensure documentation specifies the component causing the reaction.
T36.1X5A - Adverse effect of other beta-lactam antibiotics, initial encounter
Use when the adverse reaction is specifically due to the clavulanate component of Augmentin.
Applicable To
- Adverse effect of clavulanate
Excludes
- Allergy to other antibiotics (Z88.1)
Clinical Validation Requirements
- Documented adverse reaction to clavulanate
- Symptoms such as rash, hives, or anaphylaxis
Coding Notes
Ensure documentation specifies the component causing the reaction.
Z88.0 - Personal history of allergy to penicillin
Use to document a patient's known allergy to penicillin.
Applicable To
- History of allergy to amoxicillin
Excludes
- Current adverse effect of penicillins (T36.0X5A)
Clinical Validation Requirements
- Documented history of allergic reaction to penicillin
Coding Notes
Ensure allergy history is clearly documented.
Z88.1 - Personal history of allergy to other antibiotics
Use to document a patient's known allergy to clavulanate or other non-penicillin antibiotics.
Applicable To
- History of allergy to clavulanate
Excludes
- Current adverse effect of other beta-lactams (T36.1X5A)
Clinical Validation Requirements
- Documented history of allergic reaction to clavulanate
Coding Notes
Ensure allergy history is clearly 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 Augmentin 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: Potential for inappropriate future prescribing, Regulatory: Non-compliance with documentation standards, Financial: Possible claim denials due to vague coding
Mitigation Strategy
Train staff on the importance of specific documentation, Use templates that prompt for detailed information
Impact
Reimbursement: Incorrect coding may lead to claim denials, Compliance: Non-compliance with ICD-10 coding guidelines, Data Quality: Inaccurate patient allergy records
Mitigation Strategy
Use Z88.1 for clavulanate allergy
Impact
Inadequate documentation of specific drug components causing reactions
Mitigation Strategy
Implement detailed documentation protocols and regular audits
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 Augmentin Allergy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Augmentin Allergy
Use these documentation templates to ensure complete and accurate documentation for Augmentin Allergy. These templates include all required elements for proper coding and billing.
Allergy Clinic Note
Specialty: Allergy and ImmunologyRequired Elements
- Medication name and dose
- Timing of reaction
- Symptoms observed
- Testing performed
- Diagnosis and allergy status
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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