Oncology & Hematology Coding Alert

Question: How can we report the diagnosis of swine flu influenza in ICD-10-CM?

Ohio Subscriber

Answer: For swine flu influenza, look to ICD-10-CM code category

J09 (Influenza due to certain identified influenza viruses). Influenza due to identified novel influenza A virus is reported with code set (J09._) and requires 5 characters to further identify the manafestations present. This subcategory of codes includes avian influenza, bird influenza, influenza of other animal origin, and swine influenza.

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

Check these three code sets for influenza:

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

Look for related conditions: ICD-10-CM introduces codes with increased specificity for many conditions including influenza. Influenza is defined by type along with manifestations. In addition, you should look for related conditions that are documented and should be reported.

Each of the code subsets 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.

For example, under J09, you will 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 is used when the influenza type is unknown.

Follow the instructional notes: 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, novel influenza, or other identified influenza, coders should report the appropriate influenza code from category J11 (Influenza due to unidentified influenza virus).