Otolaryngology Coding Alert

Before you start using new code 488.1 for the swine flu, get the facts you need to adhere to ICD-9 coding guidelines.

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" until ICD-9 2010 goes into effect," says Kathy Giannangelo, MA, RHIA, CCS, CPHIMS, FAHIMA, an independent consultant in Springfield, Ill.

Reason: The ICD-9 2009 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.

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 "influenza, novel" in ICD-9-CM's Alphabetic Index, you'll be directed 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.

"I'm glad to see that the NCHS published a new code after the proposed rule was already out," Giannangelo 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/icd.htm).

Don't miss: Two inclusions entries confirm swine flu's migration from 487.x to 488.1. According to ICD-9-CM's Tabular Addenda (www.cdc.gov/nchs/data/icd9/icdtab10add.pdf), 488.1's descriptor will include:

• 2009 H1N1 [swine] influenza virus

• novel 2009 influenza H1N1

• novel H1N1 influenza

• novel influenza A/H1N1

• swine flu.

Just because ICD-9 2010 provides a code for H1N1 doesn't mean you should automatically use it. The 2009 coding guidelines instruct you to code only confirmed cases of novel H1N1 influenza virus (H1N1 or swine flu, code 488.1). "This is an exception to the hospital inpatient guidelines (Section II, H) (Uncertain Diagnosis)," state the 2009 ICD-CM Official Guidelines for Coding and Reporting (www.cdc.gov/nchs/data/icd9/icdguide09.pdf).

"In this context, 'confirmation' does not require documentation of positive laboratory testing specific for novel H1N1 influenza," according to the guidelines. However, coding should be based on the provider's diagnostic statement that the patient has novel H1N1 (H1N1 or swine flu) influenza.

Warning: If the provider records "suspected or possible or probable novel H1N1 influenza (H1N1 or swine flu)," do not assign 488.1. Instead, you should use the appropriate influenza code from category 487.

"In reality, to report a specific strain, one should have proof," says Philip Marcus, MD, at the St. Francis Hospital Heart Center in Roslyn, N.Y. "Otherwise, it's best to report influenza (487.x) and not speculate."

Do this: Since influenza A and B symptoms are nearly identical to the H1N1 influenza strain, consider a diagnosis of H1N1 only when other cases have been diagnosed in the area, Marcus suggests. "At the present time, there are no easy ways to decide which strain of influenza is responsible for an individual infection. In fact, with the recent outbreak of H1N1 infection, most of the presumed cases were indeed negative when specifically tested for H1N1 antigen," he says.