ED Coding and Reimbursement Alert

The AMA is scrambling to address diagnosis coding issues surrounding the outbreak of the H1N1 flu virus.

There will be a definitive code for the so-called swine flu -- beginning with ICD-9 2010.

Get the scoop on the ICD-9 insights you'll need to know now, and how to adjust coding once your swine flu diagnoses fly over to the bird category 488 (Influenza due to identified avian influenza virus).

Provided you're up to date with the latest ICD-9 coding expert recommendations, your coding for confirmed cases should be on track. "Given the current coding constraints, 487.x (Influenza) is the best choice for the interim period," says Kathy Giannangelo, MA, RHIA, CCS, CPHIMS, FAHIMA, an independent consultant in Springfield, Ill.

Reason: The current code 488 is specific for avian flu.

The National Center for Health Statistics (NCHS) has indicated they feel under the current code titles that 487 is the appropriate code, reports Jeffrey F. Linzer Sr., MD, MICP, FAAP, FACEP, associate medical director of compliance and business affairs for the Emergency Pediatric Group at Children's Healthcare of Atlanta at Egleston.

The 847 code is a good way to report the H1N1 virus -- for now, agrees Michael Granovsky, MD, CPC, FACEP, president of Medical Reimbursement Systems Inc. (MRSI), an ED billing company in Woburn, Mass.

This fall, you'll turn to a new code in an expanded category. In ICD-9 2010, the 488 category covers a broader group of "certain identified influenza viruses," rather than the 2009 limited title "Influenza due to identified avian influenza."

Speed tip: If you look up "swine flu" in the ICD-9- CM 2010 tabular list, the entry will direct you to 488.1 (Influenza due to identified novel H1N1 influenza virus).

"It will be appropriate to use the new code starting Oct.1," Linzer says.

The new code has "been created to provide data capture for the novel H1N1 influenza virus (swine flu virus), which was first identified in April, after the March 2009 ICD-9-CM Coordination and Maintenance Committee meeting," according to the NCHS (www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/ftpicd9.htm).