- Welcome to Food Allergy Support.
Posted by rebekahc
- September 30, 2011, 10:32:31 AMYes, I think CM's probably right. Though you would think that if other symptoms were present beyond just cardiac or just respiratory, even without cutaneous symptoms, the medical community would look deeper.
DS has had status asthmaticus twice and it looked nothing like his allergic reactions. Both times the ER didn't recognize it even as asthma because "he isn't wheezing". It wasn't until they would check O2 sats they would even realize something was wrong. Um, when my kid can't even get his peak flow meter to move blowing as hard as possible - something is most definitely wrong. You don't hear wheezing because he's not moving enough air to hear anything! So, I guess it really doesn't surprise me they can't properly recognize anaphylaxis.
Have I ever mentioned the time he was in the ER for status asthmaticus and they gave him Motrin even though I told them our allergist advised us to avoid it? Yeah, he reacted and needed 4 days of IV steroids to keep the hives at bay. It's a wonder they didn't kill him.
DS has had status asthmaticus twice and it looked nothing like his allergic reactions. Both times the ER didn't recognize it even as asthma because "he isn't wheezing". It wasn't until they would check O2 sats they would even realize something was wrong. Um, when my kid can't even get his peak flow meter to move blowing as hard as possible - something is most definitely wrong. You don't hear wheezing because he's not moving enough air to hear anything! So, I guess it really doesn't surprise me they can't properly recognize anaphylaxis.
Have I ever mentioned the time he was in the ER for status asthmaticus and they gave him Motrin even though I told them our allergist advised us to avoid it? Yeah, he reacted and needed 4 days of IV steroids to keep the hives at bay. It's a wonder they didn't kill him. Posted by CMdeux
- September 30, 2011, 09:36:26 AMAjas, I think that we are never going to be able to know what those numbers are-- because there are simply far too many probable fatalities caused by *something* that causes unexplained cardiac insufficiency or shock in people who are not of an age to be suffering sudden cardiac death...
but--
without cutaneous symptoms
many first responders simply REFUSE to believe that they are dealing with anaphylaxis.
I'm guessing that the most common designation for this sort of episode is likely to be
cardiac arrest
or
status asthmaticus.
The former is probably the one that is most overlooked as anaphylaxis-- at least that is our allergist's assertion. Medical professionals who aren't experts in this area tend to look to cutaneous symptoms and airway narrowing as the sole-- and essential-- diagnostic features.
It's a likely reason, by the way, for the peculiar observation that systemic reactions without cutaneous symptoms seem to be more likely to lead to fatalities.
Of course, the question in my mind then becomes-- if the people coding this aren't identifying it correctly as anaphylaxis DURING the episode, then why would they in retrospect? They wouldn't. They'd be mislabeled even at point of death or discharge.
but--
without cutaneous symptoms
many first responders simply REFUSE to believe that they are dealing with anaphylaxis.
I'm guessing that the most common designation for this sort of episode is likely to be
cardiac arrest
or
status asthmaticus.
The former is probably the one that is most overlooked as anaphylaxis-- at least that is our allergist's assertion. Medical professionals who aren't experts in this area tend to look to cutaneous symptoms and airway narrowing as the sole-- and essential-- diagnostic features.
It's a likely reason, by the way, for the peculiar observation that systemic reactions without cutaneous symptoms seem to be more likely to lead to fatalities.
Of course, the question in my mind then becomes-- if the people coding this aren't identifying it correctly as anaphylaxis DURING the episode, then why would they in retrospect? They wouldn't. They'd be mislabeled even at point of death or discharge.
Posted by ajasfolks2
- September 30, 2011, 05:50:38 AMBear with me here . . . and thanks for all the help!
What are the ICD-9 codes for Death by anaphylaxis: food allergy?
Are they E codes?
What other codes might be used -- primary, secondary, terciary in these situations of death -- both if accurately reported and if misreported?
(Example -- allergic reaction results in anaphylaxis results in blood pressure loss results in cardiac arrest results in death . . . so which of those ICD9 codes would be listed PRIMARY if done correctly? Which of those add'l codes might end up being used as PRIMARY if done incorrectly?)
Putting this quote here that I found & may shed some light on ONE direction I'm going with this:
Quote is from study published 2003 as to # of cases of anaphylaxis death due to immunizations:
Risk of Anaphylaxis After Vaccination of Children and Adolescents
Pediatrics Vol. 112 No. 4 October 1, 2003
pp. 815 -820
(doi: 10.1542/peds.112.4.815)
Link to full .pdf (free)
http://www.pediatricsdigest.mobi/content/112/4/815.full.pdf+html
~ ~ ~
Connecting dots now.
Need some meaningful data regarding # of injuries due to LTFA -- non-ana AND anaphylactic would be ideal, but likely the best we'll get is something regarding anaphylaxis only. My estimation (and going from anecdotal info over the 12 years our family has been dealing with LTFA) is that most non-ana reax don't even end up seeking professional medical care, so there won't be ICD9 codes on record, etc.
Though it might be interesting to see a study of LTFA families and their use of med profession (and/or even reporting of reax) for non-ana reax. KWIM?
I am beginning to get where I'm going with this.
Anyone else?
But first, I really need help with the ICD9 code questions to try to flesh out all the codes to use and flag.
What are the ICD-9 codes for Death by anaphylaxis: food allergy?
Are they E codes?
What other codes might be used -- primary, secondary, terciary in these situations of death -- both if accurately reported and if misreported?
(Example -- allergic reaction results in anaphylaxis results in blood pressure loss results in cardiac arrest results in death . . . so which of those ICD9 codes would be listed PRIMARY if done correctly? Which of those add'l codes might end up being used as PRIMARY if done incorrectly?)
Putting this quote here that I found & may shed some light on ONE direction I'm going with this:
Quote
We searched for diagnoses of ICD-9 code 995.0 (anaphylactic shock), E948.0 through E948.9 (adverse reaction from bacterial vaccines), and E949.0 through E949.9 (adverse reaction from other vaccines and biological substances). We restricted our review to diagnoses occurring on days 0 to 2 after vaccination (day 0 defined as the same day as vaccination) for ICD-9 code 995.0 and day 0 for ICD-9 codes E948.0 to E948.9 and E949.0 to E949.9. Because some cases of anaphylaxis may receive other related allergy diagnoses, at 1 of the study sites, we also performed a chart review of all day 0 diagnoses of 708.0 (allergic urticaria), 708.9 (urticaria unspecified), 995.1 (angioneurotic edema), 995.3 (allergy unspecified), 695.1 (erythema multiforme), and 995.2 (unspecified adverse effect of drug, medicinal and biological substance).
Quote is from study published 2003 as to # of cases of anaphylaxis death due to immunizations:
Risk of Anaphylaxis After Vaccination of Children and Adolescents
Pediatrics Vol. 112 No. 4 October 1, 2003
pp. 815 -820
(doi: 10.1542/peds.112.4.815)
Link to full .pdf (free)
http://www.pediatricsdigest.mobi/content/112/4/815.full.pdf+html
~ ~ ~
Connecting dots now.
Need some meaningful data regarding # of injuries due to LTFA -- non-ana AND anaphylactic would be ideal, but likely the best we'll get is something regarding anaphylaxis only. My estimation (and going from anecdotal info over the 12 years our family has been dealing with LTFA) is that most non-ana reax don't even end up seeking professional medical care, so there won't be ICD9 codes on record, etc.
Though it might be interesting to see a study of LTFA families and their use of med profession (and/or even reporting of reax) for non-ana reax. KWIM?
I am beginning to get where I'm going with this.
Anyone else?
But first, I really need help with the ICD9 code questions to try to flesh out all the codes to use and flag.
Posted by ajasfolks2
- September 27, 2011, 04:28:35 PMNo failure, no worries. Anything you might add, anytime, is just great! 
Posted by GoingNuts
- September 27, 2011, 04:02:28 PMAbsolutely no time to check into it today, and I won't be back at work until Monday. Sorry, I've failed you. 
Posted by ajasfolks2
- September 26, 2011, 04:50:07 PMSee, though, there has to be meaningful buy-in from the medical community generally to affect change of the ICD-9 codes, if I recall. (Though I don't have official info into this thread as to HOW and WHY and WHEN those diagnosis codes are officially changed -- would like to have that here as well.)
WRT the LTFA physician-community there is a great deal of disparity and disagreement as to linking mode of allergen ingestion and reaction cause (beyond true EATING of the FOOD) . . . not to mention the problem with the INVISIBILITY of allergen residue and the lack of ability to truly test after reaction to KNOW what the body reacted or anaphylaxed to.
WRT the LTFA physician-community there is a great deal of disparity and disagreement as to linking mode of allergen ingestion and reaction cause (beyond true EATING of the FOOD) . . . not to mention the problem with the INVISIBILITY of allergen residue and the lack of ability to truly test after reaction to KNOW what the body reacted or anaphylaxed to.
Posted by CMdeux
- September 26, 2011, 04:33:02 PMYeah-- it's an oversight.
Because I'm pretty sensitive to shellfish. But not like DD is to peanuts.
It's a huge functional difference in terms of day-to-day management, and several allergists now have said that she is, by virtue of her history, a "poor risk" even for SPT.
I'm guessing that ought to be in a different category clinically.
Because I'm pretty sensitive to shellfish. But not like DD is to peanuts.
It's a huge functional difference in terms of day-to-day management, and several allergists now have said that she is, by virtue of her history, a "poor risk" even for SPT.
I'm guessing that ought to be in a different category clinically.
Posted by ajasfolks2
- September 26, 2011, 04:27:15 PMWhat's interesting to me is that there is nothing so far as modifier which addresses the allergen route of exposure.
There is a growing practice by laypeople, parents, educators (even as part of their 504 eval), and even medical community to attempt to describe or classify those with life-threatening food allergy (risk of anaphylaxis, properly diagnosed by physician with adequate training and certification) as having the condition TO A DEGREE --
"severe"
"more severe"
"most severe"
"exquisite"
AND often also attaching to that a qualifier as to the mode of allergen contact that is responsible for the reaction(s): skin contact, ingestion -- residue or actual food --, inhalant, aerisolized are just some of the verbiage being used (not saying necessarily correctly)
However, there sure doesn't seem to be any diagnosis codes or instruction to support this.
Just stating the facts. No opinions either way as to level of "life-threat" and allergy.
Thoughts anyone?
There is a growing practice by laypeople, parents, educators (even as part of their 504 eval), and even medical community to attempt to describe or classify those with life-threatening food allergy (risk of anaphylaxis, properly diagnosed by physician with adequate training and certification) as having the condition TO A DEGREE --
"severe"
"more severe"
"most severe"
"exquisite"
AND often also attaching to that a qualifier as to the mode of allergen contact that is responsible for the reaction(s): skin contact, ingestion -- residue or actual food --, inhalant, aerisolized are just some of the verbiage being used (not saying necessarily correctly)
However, there sure doesn't seem to be any diagnosis codes or instruction to support this.
Just stating the facts. No opinions either way as to level of "life-threat" and allergy.
Thoughts anyone?
Posted by GoingNuts
- September 26, 2011, 04:12:21 PMHmmm, didn't have as much time to delve as I would have liked, but yes, 995.61 for anaphylaxis to peanut. "Food" in general is 995.60.
Under Anaphylactic shock or reaction, there was also purpura with a code of 287.0.
I didn't see any modifiers for route of ingestion, but like I said, I didn't have much time to delve.
If there's more time tomorrow, I'll check the asthma, urticaria and contact derm.
I don't know what your purpose is wrt to this research, but as I was looking at the books it really hit me how under-diagnosed anaphylaxis probably is.
Maybe that's your point, LOL.
ETA: Interestingly, no code for idiopathic.
Under Anaphylactic shock or reaction, there was also purpura with a code of 287.0.
I didn't see any modifiers for route of ingestion, but like I said, I didn't have much time to delve.
If there's more time tomorrow, I'll check the asthma, urticaria and contact derm.
I don't know what your purpose is wrt to this research, but as I was looking at the books it really hit me how under-diagnosed anaphylaxis probably is.
Maybe that's your point, LOL.
ETA: Interestingly, no code for idiopathic.
Posted by ajasfolks2
- September 26, 2011, 03:46:58 AMThat article is helpful!!
I'm wondering too if I should be trying to find modifier for
INHALATION reaction as well, so far as peanut ana.
~ ~ ~
I'm wondering too if I should be trying to find modifier for
INHALATION reaction as well, so far as peanut ana.
~ ~ ~
Posted by rebekahc
- September 25, 2011, 09:54:03 PMThat last link I added had other codes as well - allergic diarrhea and allergic colitis among others.
Posted by ajasfolks2
- September 25, 2011, 02:16:41 PMAs to dermatitis and urticaria --
we should examine those Dx (diagnoses) as well with all modifiers.
Anything else directly related?
Recapping:
All the anaphylaxis and related codes
All the food allergy and related codes
All the contact dermatitis and related codes
All the urticaria and related codes
AND all the V- codes in those same areas.
What have we missed?
we should examine those Dx (diagnoses) as well with all modifiers.
Anything else directly related?
Recapping:
All the anaphylaxis and related codes
All the food allergy and related codes
All the contact dermatitis and related codes
All the urticaria and related codes
AND all the V- codes in those same areas.
What have we missed?
Posted by rebekahc
- September 25, 2011, 02:16:03 PMOne of those links had an option to translate into newer versions...
Posted by ajasfolks2
- September 25, 2011, 02:14:27 PM. . . just in case there have been UPDATES to the last-published version . . . things that would likely come to MD and insurance offices . . . beyond what might be viewable at online sites (such as at links provided above). . .
Posted by rebekahc
- September 25, 2011, 02:08:17 PMWell, I couldn't find any additional modifiers unless you added one for contact dermatitis or something. But I think that would not be standard and would just be a separate dx?
ETA: did some more searching. The article is older, but might give you a starting point to use in one of those other links I posted earlier.
http://www.fortherecordmag.com/archives/ftr_01212008p25.shtml
ETA: did some more searching. The article is older, but might give you a starting point to use in one of those other links I posted earlier.
http://www.fortherecordmag.com/archives/ftr_01212008p25.shtml