Part B Insider (Multispecialty) Coding Alert

Flu season is busy now, but may be even more chaotic if you don’t know how to code this common dx.

The ICD-10 implementation date is right around the corner, and will impact your practice on Oct. 1, 2014. But as CMS representatives urged in the Jan. 29 Open Door Forum (see cover page for more), you should be preparing now to make the leap. With flu patients most likely taking up a good portion of your waiting room this month, it’s a good time to know how your influenza coding will change under ICD-10.

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 your 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.

Heed These Coder Tips

Gone are the days when your superbills will simply include one or two influenza codes. You and your physicians will have to review the entire J09-J11 series in ICD-10 and extract the most commonly-used diagnoses that your practice typically sees. Or, you can put abbreviated notes on your superbill, as follows:

J10.x Influenza due known to virus; Name virus
____________________________________________

J11.x Influenza due to unknown virus

List influenza manifestations (eg., pneumonia)
____________________________________________