neonates or sexually active adults who may be at risk for chlamydial or gonnococcal infections) during the decision-making process, providers will be better equipped to provide accurate diagnosis and treatment. Thank you,
Jackie Sheikh, A., Hurwitz, B., van Schayck, C. P., McLean, S., & Nurmatov, U. (2012). Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database of Systematic Reviews , (9). - org.chamberlainuniversity.idm.oclc.org/10.1002/14651858.CD001211.pub3 Hi Dr. Bethel, Thank you for pointing that out. I think I have determined the difference between the two ICD codes and I can see why choosing the code that provides the most detailed and accurate information would be important. The code “acute atopic conjunctivitis, bilateral” describes an IgE-mediated hypersensitivity response to airborne allergens that are usually seasonal in nature – that is, they come and go, rather than persisting throughout the year. Patients with this condition often have a familial predisposition or personal history of other atopic conditions like asthma or allergic rhinitis (Akerman, Smith, & Gomes, 2016). As we well know, the patient in this scenario does have a PMH of seasonal allergic rhinitis with springtime triggers which would typically be related to grass pollen. However, it would not be surprising if his current symptoms were a result of the airborne ragweed pollen that the fall season brings (Dunphy, Winland-Brown, Porter, & Thomas, 2015). The ICD10 code that I originally chose is for chronic allergic conjunctivitis, which would indicate that his symptoms are ongoing and caused by an IgE-mediated response to triggers such as pet dander or mold – allergens that can be bothersome year-long, and this can be a much more concerning diagnosis. The acute phase of allergic conjunctivitis results from immediate release of histamine from mast-cells after exposure to an allergen. This is what produces the ocular itch sensation. As the allergic response progresses, other immune cells, such as neutrophils, T cells, basophils, and eosinophils contribute to further inflammation. Unfortunately, continuous activation of the cytotoxic protein-secreting eosinophils can lead to fibrosis and structural damage over time (Ackerman et al., 2016). So, to answer your question, yes, there is a distinctive difference between these two diagnoses and I appreciate you guiding me to the correct one. Thank you, Jackie Ackerman, S., Smith, L. M., & Gomes, P. J. (2016). Ocular itch associated with allergic conjunctivitis: latest evidence and clinical management. Therapeutic Advances in Chronic Disease, 7( 1), 52-67. doi:10.1177/2040622315612745 Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary care: The art and science of advanced practice nursing (4th ed.). Philadelphia, PA: F.A. Davis Company.
Hi Anna, I really enjoyed reading your post. You did an especially great job of summarizing all of the pertinent positive and negative findings. I had not even thought about the fact that our patient is living in a different state, but now that you mentioned it, it seems like such a crucial piece of information.
- Fall '15
- Allergic conjunctivitis