From the Guidelines
To code a reaction to ceftriaxone, use ICD-10 code T36.1X5A for an adverse effect of cephalosporins and other beta-lactam antibiotics, initial encounter. If documenting an allergic reaction specifically, use T78.40XA for allergy, unspecified, or more specifically T78.49XA for other allergy. For anaphylaxis due to ceftriaxone, use T78.2XXA. When documenting, include details about the reaction type (rash, hives, anaphylaxis), timing relative to administration, severity, interventions required, and patient outcome. The reaction should be documented in the patient's problem list with an "allergy" flag in the electronic health record. This coding is important for patient safety as it alerts healthcare providers to avoid prescribing ceftriaxone or related cephalosporins in the future, preventing recurrent reactions. Beta-lactam allergies can cross-react within antibiotic classes, so proper documentation helps guide future antibiotic selection 1.
Key Considerations
- The most recent and highest quality study, published in 2022, provides guidance on coding reactions to ceftriaxone 1.
- The study emphasizes the importance of proper documentation to prevent recurrent reactions and guide future antibiotic selection.
- The Dutch Working Party on Antibiotic Policy (SWAB) guideline for the approach to suspected antibiotic allergy also provides recommendations for coding and managing antibiotic allergies 1.
- The guideline suggests that patients with a suspected immediate-type allergy to cephalosporins can receive penicillins with dissimilar side chains, and that cephalosporins with a dissimilar side chain can be used in patients with a suspected immediate-type allergy to a cephalosporin.
Coding Recommendations
- Use ICD-10 code T36.1X5A for an adverse effect of cephalosporins and other beta-lactam antibiotics, initial encounter.
- Use T78.40XA for allergy, unspecified, or more specifically T78.49XA for other allergy.
- Use T78.2XXA for anaphylaxis due to ceftriaxone.
- Include details about the reaction type, timing, severity, interventions required, and patient outcome in the documentation.
- Document the reaction in the patient's problem list with an "allergy" flag in the electronic health record.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Coding a Reaction to Ceftriaxone
To code a reaction to ceftriaxone, consider the following steps:
- Identify the type of reaction: Determine if the reaction is an allergic reaction, anaphylaxis, or another type of adverse reaction.
- Assess the severity: Evaluate the severity of the reaction, including any symptoms, such as rash, itching, swelling, or difficulty breathing.
- Review patient history: Consider the patient's medical history, including any previous reactions to ceftriaxone or other cephalosporins.
Relevant Studies
Studies have shown that:
- Ceftriaxone does not increase the risk of an allergic reaction among patients with penicillin allergy 2.
- The overall cross-reactivity rate between penicillins and cephalosporins is approximately 1% when using first-generation cephalosporins or cephalosporins with similar R1 side chains 3.
- The use of third- or fourth-generation cephalosporins, such as ceftriaxone, carries a negligible risk of cross-allergy in penicillin-allergic patients 3.
- Skin testing for cephalosporins has not been well validated, but appears to have a good negative predictive value for cephalosporins with disparate R1 side chains 4.
- A study on the effects of ceftriaxone by intravenous push found a low adverse reaction rate of 0.13% 5.
Coding Considerations
When coding a reaction to ceftriaxone, consider the following:
- Use specific codes for allergic reactions, anaphylaxis, or other adverse reactions.
- Include codes for any symptoms or conditions related to the reaction.
- Consider coding for any relevant patient history, such as penicillin allergy.
- Be aware of the low cross-reactivity rate between penicillins and cephalosporins, such as ceftriaxone 2, 3.