Food Allergy and ICD-9 coding

[ajasfolks2]

No failure, no worries.  Anything you might add, anytime, is just great!   

[ajasfolks2]

Bear 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:

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.

[CMdeux]

Ajas, 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.

[rebekahc]

Yes, 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.