ED Coding and Reimbursement Alert

Question: A patient with congestion, thick nasal drainage, facial pain, and a headache presented to the ED, and our physician documented diagnoses of the flu and acute maxillary and frontal sinusitis due to the infection. However, the physician didn’t specify the type of influenza virus.

Which ICD-10 codes should I report for this encounter?

Maryland Subscriber

Answer: You’ll assign code J11.1 (Influenza due to unidentified influenza virus with other respiratory manifestations) to report the patient’s diagnosis. Code J11.1 features an additional synonym of “Influenza NOS,” which allows you to report this code when the provider doesn’t give you any specifics beyond the general diagnosis of influenza.

To locate this code, turn to the Alphabetic Index and look for Influenza (bronchial) (epidemic) (respiratory (upper)) (unidentified influenza virus). Then follow the indentations to with/ respiratory manifestations NEC, which directs you to code J11.1. You’ll then verify the code in the Tabular List.

The physician also diagnosed the patient with acute maxillary and frontal sinusitis caused by the flu. When you look under J11.1, you’ll see a note directing you to use an additional code to report an associated sinusitis condition, if applicable, from the J01.- (Acute sinusitis) code category.

Anatomy review: Sinuses are air-filled spaces located within the bones of the skull and face centered on the nasal cavity. There are four pairs of paranasal sinuses, each named after the bones that contain them: frontal (lower forehead), maxillary (cheekbones), ethmoid (beside the upper nose), and sphenoid (behind the nose).

You’ll find the J01.- code subcategories are differentiated by which sinuses are affected. When there is inflammation in only one of the four paranasal sinuses, you’ll use the appropriate code from the J01.0-J01.3- group. When all of the sinuses in the head become infected or inflamed, you’ll turn to code J01.4- (Acute pansinusitis). In cases of acute sinusitis involving more than one sinus, but not all of them, ICD-10 instructs you to report J01.8- (Other acute sinusitis).

Since the physician diagnosed the patient with both maxillary and frontal sinusitis, you’ll start with J01.8-, but a 5th character is required to complete the code. The physician didn’t specify whether the patient experiences maxillary and frontal sinusitis repeatedly, so you’ll assign J01.80 (Other acute sinusitis).

Wrap up the claim: For this encounter, you’ll assign J11.1 and J01.80 to report unspecified influenza with acute maxillary and frontal sinusitis.