Assault by Allergen

By CodingStrategies on June 1st, 2018

When someone says they have an allergy, it can encompass a number of conditions caused by the hypersensitivity of the immune system to something in the environment that doesn’t affect most people. Common allergens include pollen (potentially causing hay fever or allergic asthma), insect stings, medications and certain foods (typically causing rashes or swelling). The presence of an allergy could be genetic, or it could be attributed to environmental factors. The diagnosis of allergic reaction is generally based on the individual’s medical history, but further testing may be required to determine the specific nature of the irritant.

There is an Internet story surrounding a sales representative in England who frequented a client’s office where they kept a supply of herbal tea on hand for her visits. She had an allergy to dairy products, so her tea was always brewed without the addition of milk or cream. During one visit, however, a new employee offered to make her tea. He asked if she wanted the tea bag left in the cup or on the side of the saucer. He was poised with teaspoon in hand to haul the bag out of the cup, when one of his coworkers yelled at him to not use that teaspoon!

He immediately put the spoon down, swore he hadn’t put it in the cup and the tea was consumed with the bag in place. Later, the novice tea maker questioned what ingredient in the teaspoon would cause an allergic reaction, only to be told that the use of a community spoon to remove the bag may have resulted in milk cross-contamination. For example, if the spoon was previously used to stir the tea of someone who added milk to their beverage, set aside for others to use when stirring their beverages, then placed in a cup for someone who was allergic to dairy product. Even a small amount of milk residue on the teaspoon could have triggered an allergic reaction in a sensitive person.

Millions of children and adults are diagnosed with allergies every year. For example, people may be allergic to cats, dogs, reptiles, consuming meat, wool clothing, drinking certain wines and pollinated fruit. Some folks are allergic to the metals in cell phones, their own sweat, inexpensive jewelry, water, cold, sunlight, grasshoppers and pancakes. And approximately 7 million people have developed a severe allergy to shellfish, as well as tuna and salmon. Seafood allergies often develop in adults, most sufferers have multiple reactions over time, and these reactions frequently include severe symptoms.

An allergic reaction to certain proteins in seafood can cause life-threatening anaphylaxis – a sudden severe and potentially fatal reaction that results in low blood pressure, throat swelling, and labored breathing. In addition, some seafood allergies cause a severe skin reaction or can trigger an asthma attack. According to the Food Allergy and Anaphylaxis Network, food-induced anaphylaxis causes approximately 30,000 emergency room visits and about 150 to 200 deaths each year in the United States. One recent survey found that fish and shellfish allergies are more common in adults ages 40 to 60. In addition, some allergic reactions are caused simply by smelling fish! The codes for these anaphylactic reactions include:

T78.02XA             Anaphylactic reaction due to shellfish (crustaceans), initial encounter

T78.03XA             Anaphylactic reaction due to other fish, initial encounter

In a related true story, a young man had a girlfriend who was allergic to seafood – not just shellfish, but all seafood. She didn’t carry an EpiPen because the allergic reaction that occurred wasn’t life-threatening, but she was very careful to ask questions about ingredients and preparation when eating food she didn’t personally prepare. Her boyfriend’s mother didn’t believe the young lady had food allergies; Mom was insulted by all the questions and suspected that these “allergies” were just an excuse to question her cooking.

 

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The couple visited his parents for a fish fry, with fried chicken also on the menu to accommodate the young lady’s allergies. The usual questions were asked about meal preparation to ensure that chicken and fish were separately prepared, and everyone settled down to enjoy a fine meal. Approximately 30 minutes into the cookout, the young lady complained that her face itched, and took a Benadryl. However, she continued to experience problems, became flushed and her eyes began to swell shut. The cookout was cut short by a trip to the emergency room for a cortisone shot that alleviated the allergic reaction.

It was as the young couple left for the hospital that Mom confessed to frying both the fish and chicken in the same oil. Mom admitted that she lied about it when the young lady asked, and stated that she had believed the allergy claims to be false. She decided to test her theory and see if the allergies truly existed. Seeing her error, Mom apologized and stated she would pay the emergency room charges. However, the young lady decided that one attempt to poison her was enough; she broke off the relationship and decided to look for someone whose family would accept her, allergies and all.

BY ALYSSA JUNG

There are several ICD-10-CM codes that may apply in this poisoning scenario:

T61.8X3A             Toxic effect of other seafood, assault, initial encounter

R60.0                     Localized edema

L29.8                      Other pruritus  

R23.2                     Flushing

Z91.013                 Allergy to seafood

Perhaps Mom should take a page from best-selling science fiction author C. J. Cherryh, who states “Poisoning rarely happens in a well-managed kitchen.”