Who are our experts? The Advocacy Council of ACAAI utilizes the same team of experts who served you as the Joint Council of Allergy, Asthma and Immunology (JCAAI): J. Allen Meadows, MD, FACAAI, chair; Stephen Imbeau, MD, FACAAI, vice chair; Donald Aaronson, MD, JD, MPH, FACAAI, director of governmental affairs; and Gary Gross, MD, FACAAI, associate director of governmental affairs.

One of the new changes in ICD-10 is the introduction of the seventh digit; A (initial encounter), D (subsequent encounter) and S (sequela).

Q: For patients on venom immunotherapy, one question is whether the immunotherapy following a systemic reaction is “ongoing care” of an episode of anaphylaxis or “subsequent care?”

A: The Advocacy Council is of the opinion that the emergency room code would be anaphylaxis - initial care (A) - but that the allergist would use anaphylaxis subsequent care (D) for the office visit since the patient is now receiving routine care for this diagnosis such as auto-injector instructions and education about anaphylaxis.

The other code for immunotherapy would be different. The toxic effect of venom (varies depending on insect) would be active, so there you would use “A” as the seventh digit - i.e., T63.451A - for patients who are hornet sensitive and receiving IT. Once the course of IT is complete (after three to five years), follow-up visits are considered subsequent care so the seventh digit would change to “D.”

Patient Encounters

In ICD-10, seventh digit “A,” initial encounter, is used while the patient is receiving active treatment for the condition. Examples of active treatment are: surgical treatment, emergency department encounter and evaluation, and continuing treatment by the same or a different physician.; Seventh digit “D,” subsequent encounter, is used for encounters after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. The seventh digit extension “S” is assigned for complications or conditions that arise as a direct result of an injury. An example of a sequela is a scar resulting from a burn.

ICD-10 flexibilities

ICD-10 is looming on the horizon, but CMS has been releasing information about some flexibilities that will be in place after Oct. 1. On July 6, CMS issued a press release announcing these “flexibilities,” and on August 6, released additional clarification, especially to the specificity of the level of ICD-10 coding required during the first 12 months of implementation. Questions 3 and 5 are particularly important for you. They explain what CMS will consider a “valid” ICD-10 code, as well as what is meant by a “family of codes.”

The College and the Advocacy Council are here for you during this transition. We have numerous resources available, and our experts are on hand to answer your questions. Don’t hesitate to reach out to us.