Pathology/Lab Coding Alert

If you're one of the many labs performing influenza testing spurred by the World Health Organization's (WHO) June 11 pandemic declaration for novel influenza A (H1N1), you need to read this.

Despite the Centers for Disease Control and Prevention (CDC) guidelines that involve fee-exempt testing for surveillance purposes, your lab can expect to see increased billable flu testing. That's why you need to bone up on how to code tests your lab might perform.

If your lab processes specimens for suspected swine flu cases by performing existing lab tests and panels, your procedure coding and billing will remain the same.

Example: "Our lab performs a respiratory viral panel that physicians may order for patients with certain flu-like symptoms," says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha. "We bill for the panel using three codes that describe the test processes:"

• 87252 -- Virus isolation; tissue culture inoculation, observation, and presumptive identification by cytopathic effect

• 87253 -- ... tissue culture, additional studies or definitive identification (e.g., hemabsorption, neutralization, immunofluorescence stain), each isolate

• 87798 x 8 -- Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism.

"If the panel is positive for influenza A and the polymerase chain reaction (PCR) nucleic acid tests indicate a possible H1N1 infection, then we send the specimen on to the Nebraska Public Health Lab for confirmatory testing," Slagle says.

If your lab performs different influenza A or B tests from respiratory specimens, you should use the appropriate code based on the lab method, such as:

• 87276 -- Infectious agent antigen detection by immunofluorescent technique; influenza A virus

• 87400 -- Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; influenza, A or B, each

• 87804 -- Infectious agent antigen detection by immunoassay with direct optical observation; influenza.

To identify and track confirmed cases of swine flu infection for surveillance purposes, the CDC developed a new test to confirm specific infection with novel influenza A (H1N1). Even if a patient doesn't meet the criteria for public-health testing, a physician may choose to order a test for swine flu. Labs may perform a fee-for service test in these cases.

For instance: Quest Diagnostics, through its Focus Diagnostics infectious disease reference laboratory, offers commercial laboratory testing for novel influenza A (H1N1). The CPT coding for the test is 87798 x 2.

If the test confirms a case of novel influenza A (H1N1), the lab must submit test specimens and/or results to the appropriate public health authority for confirmatory testing and reporting. Read "Differentiate Swine Flu

Confirmatory Tests by Focusing on Method" on page 67 to make sure your lab complies with public health guidelines.

Because ICD-9 2009 doesn't contain a specific code for confirmed cases of flu caused by the H1N1 organism, you'll have to stick with general influenza codes until expected changes come in ICD-9 2010.

"Given the current coding constraints, 487.x (Influenza) is the best choice for the interim period," says Kathy Giannangelo, MA, RHIA, CCS, CPHIMS, FAHIMA, an independent consultant in Springfield, Ill.

That's because the current code 488 as defined in ICD-9 2009 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 for novel influenza A (H1N1).

Beginning Oct.1, you'll turn to a new code in an expanded category to report confirmed novel influenza A (H1N1) cases. ICD-9 2010 expands the 488 category to cover a broader group of "certain identified influenza viruses." The current 488 definition is specific for "Influenza due to identified avian influenza virus."

Speed tip: If you look up "swine flu" in the ICD-9- CM 2010 tabular list, the entry will direct you to the new code, 488.1 (Influenza due to identified novel H1N1 influenza virus).

Don't miss: According to the ICD-9 update for Oct. 1, 488.1's descriptor will include:

• 2009 H1N1 [swine] influenza virus

• novel 2009 influenza H1N1

• novel H1N1 influenza

• novel influenza A/H1N1

• swine flu.

You can find the update at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdtab10add.pdf.