ED Coding and Reimbursement Alert

Check out these tips on coding those influenza presentations in the ED

Now that the implementation date has passed, ICD-10 has given us codes for increased specificity for many conditions.  Influenza is further defined by type along with manifestations. Additional related conditions should also be reported. The types may lead to some confusion, says Sarah Todt, RN, CPMA, CPC, CEDC, Director, Provider Education & Audit for LogixHealth in Bedford, MA.

There are 21 codes in several subcategories for influenza included in ICD-10 within the section for influenza pneumonia (J09-J18).

 The relevant influenza code sets include:

J09 (Influenza due to certain identified influenza viruses), J10 (Influenza due to other identified influenza virus), and J11 (Influenza due to unidentified influenza virus)

In ICD-10, Influenza due to identified novel influenza A virus is reported with code set (J09._) and will include Avian influenza, Bird influenza, Influenza of other animal origin, and Swine influenza, she adds.

Each of the code sets mentioned are further defined by the associated manifestations including: with pneumonia, with other respiratory manifestations, with gastrointestinal manifestations and with other manifestations. Documentation should include the manifestations associated with the influenza, says Todt.

• For example, under J09, you’ll find the following more specific codes:
• J09.X1, Influenza due to identified novel influenza A virus with pneumonia
• J09.X2, Influenza due to identified novel influenza A virus with other respiratory manifestations
• J09.X3, Influenza due to identified novel influenza A virus with gastrointestinal manifestations
• J09.X9, Influenza due to identified novel influenza A virus with other manifestations

Also, related conditions should be reported in addition to the influenza such as otitis media or lung abscess.

Example: Code J09.X1 includes this note:

Code also, if applicable, associated:

• lung abscess (J85.1)
• other specified type of pneumonia

The J10 code set (J10._) includes other identified viruses, such as H1N1 not identified as “Novel” along with influenza B and C types.

There is an additional code set for unidentified influenza (J11._) which would be used when the influenza type is unknown.

Is That Flu Diagnosis Confirmed?

Make sure while you’re coding the condition, you’re also following the instructional notes, Todt warns. The ICD-10-CM Official Guidelines for Coding and Reporting for influenza instruct coders to code only confirmed cases of influenza due to certain identified influenza viruses (category J09), and due to other identified influenza virus (category J10).

In this context, “confirmation” does not require documentation of positive laboratory testing specific for avian or other novel influenza A or other identified influenza virus. However, coding should be based on the provider’s diagnostic statement of what strain of influenza the patient has. If the provider records “suspected” or “possible” or “probable” avian influenza, or novel influenza, or other identified influenza, coders should report the appropriate influenza code from category J11, (influenza due to unidentified influenza virus), Todt explains.