ED Coding and Reimbursement Alert
Differentiate Flu From Flu-Like Symptoms
Question: We have had a record number of patients coming to the ED with flu-like symptoms, but only about half of them actually have the flu. Which diagnosis codes should we append to these visits? Codify Subscriber Answer: In cases when the patient doesn't actually have the flu, you'll link the visit to the symptoms. Symptoms that you will commonly see include fever (R50.9, Fever, unspecified) with chills, cough (R05, Cough); malaise (R53.81, Other malaise); headache (R51, Headache); nasal congestion (R09.81, Nasal congestion); and soreness of the throat (J02.9, Acute pharyngitis, unspecified). You might also see gastrointestinal symptoms such as nausea (R11.0, Nausea), vomiting (R11.1-, Vomiting), or both (R11.2, Nausea with vomiting, unspecified) and diarrhea (R19.7, Diarrhea, unspecified), although it is not found in all the cases. If the physician does diagnose the patient with influenza, you will need to begin your code selections by choosing from three broad code categories: J09 (Influenza due to certain identified influenza viruses), J10 (Influenza due to other identified influenza virus), and J11 (Influenza due to unidentified influenza virus). Careful provider documentation of the current patient presentation is especially important because of the various factors influencing a diagnosis of influenza. Category J09 contains four codes, as follows: Categories J10 and J11 further expand into a 4th digit classification based on the presence or absence of pneumonia, other respiratory manifestations (such as laryngitis, pharyngitis, and upper respiratory infections), gastrointestinal manifestations, or other manifestations such as encephalopathy, myocarditis, or otitis media. For example, J10 expands into the following codes using a fourth digit expansion: Keep in mind that J10.8 expands into a fifth character as well, so don't forget to add that to your code if you use it. Important: Select from the J10 series only when the physician has definitively identified the type of influenza virus. If no type of influenza virus is identified, use a code the J11 series instead, which includes the following codes, among others:
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Differentiate Flu From Flu-Like Symptoms
Question: We have had a record number of patients coming to the ED with flu-like symptoms, [...]
