Home Health & Hospice Week

Prepare now, or risk a chaotic flu season next year.

The ICD-10 implementation date may still seem far off, and getting ready for the change could be taking a back seat to other, more-pressing issues. But as Centers for Medicare & Medicaid Services representatives urged in the Jan. 29 Open Door Forum, you should be preparing now to make the leap -- particularly with your influenza coding and documentation.

ICD-9 Coding Rules: Under ICD-9, your influenza coding options are fairly straightforward, with 487.0 (Influenza with pneumonia) serving as the main influenza code when the patient has accompanying pneumonia, and 487.1 (Influenza with other respiratory manifestations) when the patient has other respiratory issues.

ICD-10 Changes: Effective Oct. 1, 2014, your influenza coding will expand dramatically. When you know the virus that caused your patient’s influenza, you’ll report a code from the following series:

• J10.00 (Influenza due to other identified influenza virus with unspecified type of pneumonia)

• J10.01 (Influenza due to other identified influenza virus with the same other identified influenza virus pneumonia)

• J10.08 (Influenza due to other identified influenza virus with other specified pneumonia)

• J10.1 (Influenza due to other identified virus with other respiratory manifestations)

Along with this code series, you’ll report a second diagnosis code to signify the cause of the disease. You’ll find this code in the B97 range (Bacterial and viral infectious agents) category--for instance, you might report B97.4 (Respiratory syncytial virus as the cause of diseases classified elsewhere).

ICD-10 will also include a separate series to report when you don’t know the virus that caused the patient’s influenza (J11.x, Influenza due to unidentified influenza virus…).

Documentation Will Require Details

One of the biggest influenza coding changes will require the physician to document not only the patient’s influenza complications, but also the cause of the illness. If you have identified the virus that caused the patient’s influenza, you must report the J10.x series, and if you haven’t, you’ll instead report the J11.x series. The simple documentation of the contributing virus could make all the difference in selecting the most accurate influenza diagnosis code, so documentation is critical.