Generally, allergies can occur when the immune system reacts to foreign substances such as pollen, bee venom molds, animal dander, latex, insect stings or even certain food items. Reports from the Clevelandclinic.org show that about 50 million Americans (1 in 6) experience allergies, including indoor/outdoor allergies, food and drug, latex, insect, skin and eye allergies. However, the type and severity of allergies vary from person to person and range from minor irritation to severe allergic reactions. Anaphylaxis is one such severe, life-threatening allergic reaction to certain foods, medications, insect venom or latex. It causes the immune system to release a flood of chemicals that can lead to a potentially fatal condition known as “anaphylactic shock”. Allergy specialists treating anaphylaxis patients must provide adequate treatment and also ensure that the medical coding for this specific disorder is properly done on the medical claims. Outsourcing coding to a professional medical coding company can help physicians submit their medical claims without errors.

According to the Asthma and Allergy Foundation of America (AAFA), each year there are 200,000 hospital visits due to food allergies in the United States (2020 statistics). As a person’s body is in constant contact with foreign substances, it produces antibodies to defend itself from these substances. In most cases, the body doesn’t react to the antibodies being released. However, when anaphylaxis occurs, the immune system overreacts to substances in a way that causes a full allergic body reaction. Common anaphylaxis triggers in children include food allergies, such as to peanuts, tree nuts, fish, shellfish and milk. In adults, these triggers include – certain medications (including antibiotics, aspirin and other over-the-counter pain relievers, and the intravenous (IV) contrast used in some imaging tests), stings from bees, wasps, hornets, fire ants and latex.

Though not so common, some people develop allergic reactions from aerobic exercise such as jogging, or even less intense physical activity, such as walking.

Signs and Symptoms of Anaphylaxis

Generally, signs and symptoms of anaphylaxis usually occur within minutes of exposure to an allergen. In certain other cases, the symptoms can occur half an hour (or longer) after exposure. Common signs and symptoms include –

  • Skin reactions, including hives and itching and flushed or pale skin
  • Wheezing and breathing trouble
  • Slurred speech
  • Shock
  • Nausea, vomiting or diarrhea
  • Low blood pressure (hypotension)
  • Facial swelling
  • Dizziness or fainting
  • Difficulty swallowing
  • Constriction of airways and a swollen tongue or throat
  • Anxiety and confusion
  • Abdominal pain
  • A weak and rapid pulse

There are not many known risk factors for anaphylaxis, but certain things may increase the potential risk associated with the condition and these include – previous anaphylaxis, allergies or asthma and certain other conditions (like heart disease and an abnormal accumulation of a certain type of white blood cell (mastocytosis).

How Is Anaphylaxis Diagnosed and Treated?

Any person who experiences a severe allergic reaction requires urgent medical attention. First aid for anaphylaxis includes – asking the person about the kind of allergies they suffer from, removing the allergen (if possible), asking the person to sit, recline or lie down flat and helping them take any allergic medications that they carry. If the person has had previous allergic reactions, they may be carrying an auto-injector (such as an EpiPen) – that provides a dose of epinephrine, a form of adrenaline.

Diagnosis of this condition begins with a detailed analysis of the previous allergic reactions including whether a person has allergic reactions to particular food items, medications, latex and insect stings. To confirm the diagnosis, a detailed blood test will be performed to measure the amount of a certain enzyme (tryptase – that can be elevated up to three hours after anaphylaxis). Other allergy tests like skin tests or blood tests may be performed to determine the type and severity of triggers. Creatinine tests and urinalysis may also be performed as part of the diagnosis.

Emergency treatment involves an injection of epinephrine, or adrenaline. During an anaphylactic attack, the patient may receive cardiopulmonary resuscitation (CPR) if he/she experiences breathing problems. Epinephrine helps in several ways such as constricting blood vessels, reducing swelling, increasing blood pressure, relaxing the muscles around the lungs and limiting the reaction by blocking the body’s release of additional chemicals. Intravenous (IV) antihistamines and cortisone may be administered to reduce inflammation of air passages and improve breathing problems. In most cases, patients respond well to the treatment and the symptoms usually start to subside right away. On the other hand, if there are no visible improvements in the symptoms, the patient will be administered another dosage of medications or injection after 10 minutes. The patient may need to remain under continuous observation in a hospital for at least 24 hours.

ICD-10 Codes to Report Anaphylaxis

  • T78 Adverse effects, not elsewhere classified
  • T78.0 Anaphylactic reaction due to food
    • T78.00 Anaphylactic reaction due to unspecified food
      • T78.00XA …… initial encounter
      • T78.00XD …… subsequent encounter
      • T78.00XS …… sequela
    • T78.01 Anaphylactic reaction due to peanuts
      • T78.01XA …… initial encounter
      • T78.01XD …… subsequent encounter
      • T78.01XS …… sequela
    • T78.02 Anaphylactic reaction due to shellfish (crustaceans)
      • T78.02XA …… initial encounter
      • T78.02XD …… subsequent encounter
      • T78.02XS …… sequela
    • T78.03 Anaphylactic reaction due to other fish
      • T78.03XA …… initial encounter
      • T78.03XD …… subsequent encounter
      • T78.03XS …… sequela
    • T78.04 Anaphylactic reaction due to fruits and vegetables
      • T78.04XA …… initial encounter
      • T78.04XD …… subsequent encounter
      • T78.04XS …… sequela
    • T78.05 Anaphylactic reaction due to tree nuts and seeds
      • T78.05XA …… initial encounter
      • T78.05XD …… subsequent encounter
      • T78.05XS …… sequela
    • T78.06 Anaphylactic reaction due to food additives
      • T78.06XA …… initial encounter
      • T78.06XD …… subsequent encounter
      • T78.06XS …… sequela
    • T78.07 Anaphylactic reaction due to milk and dairy products
      • T78.07XA …… initial encounter
      • T78.07XD …… subsequent encounter
      • T78.07XS …… sequela
    • T78.08 Anaphylactic reaction due to eggs
      • T78.08XA …… initial encounter
      • T78.08XD …… subsequent encounter
      • T78.08XS …… sequela
    • T78.09 Anaphylactic reaction due to other food products
      • T78.09XA …… initial encounter
      • T78.09XD …… subsequent encounter
      • T78.09XS …… sequela
    • T78.1 Other adverse food reactions, not elsewhere classified
      • T78.1XXA …… initial encounter
      • T78.1XXD …… subsequent encounter
      • T78.1XXS …… sequela
    • T78.2 Anaphylactic shock, unspecified
      • T78.2XXA …… initial encounter
      • T78.2XXD …… subsequent encounter
      • T78.2XXS …… sequela

As allergic reactions are unpredictable, it is crucial to avoid any known allergens, even if they have never ever caused severe reactions. For instance, if a person has a history of allergic reactions, it is important that family members, friends and physicians are aware of the same. Identifying and avoiding allergens that trigger a reaction is an important aspect in anaphylaxis prevention. Allergic patients need to always carry adrenaline medications, such as epinephrine injector, to counter the reaction. Other prevention steps include – wearing a medical alert necklace or bracelet (that indicates that a person has an allergy to specific drugs or other substances), exercising caution (in the case of a person who is allergic to insect stings), and carefully reading the labels of all the foods before eating, in case of food allergies.

Allergy and sleep medicine medical billing and coding can be challenging as there are many medical codes associated with the condition. Healthcare practices can ensure correct and timely medical billing and claims submission by outsourcing medical billing and coding to a reliable provider that provides the services of AAPC–certified coding specialists.