Pediatric Coding Alert

2 Details are critical in selecting the correct influenza diagnosis.

Don't let rumors of few ICD-9 changes in prep for ICD-10 blindside you to the top pediatric diagnosis code change. Without the scoop on expansion to the 488 category, denials for invalid codes will derail your claims delaying your payments.

In ICD-9 2011, "Codes continue to become more and more specific necessitating a provider to document clearly and thoroughly to allow for selection of the most specific and accurate code," says Jennifer Swindle, RHIT, CCS-P, CEMC, CFPC, CCP-P, PCS, Director Coding & Compliance Division, PivotHealth, LLC.

Good news: Updating your ICD-9 coding by the Oct. 1, 2010, effective date doesn't have to be a chore. Start using your new choices following these guidelines.

Look at Manifestation When Assigning "Swine Flu" Dx

This fall when a patient has H1N1 ("swine flu") pay attention to two details. The medical record will have to identify the correct influenza and you will have to capture the appropriate manifestation to select the codes to the degree of specificity now required, Swindle points out With the change "category 488 (Influenza due to certain identified influenza viruses) would mirror the structure of category 487 (Influenza)," according to the Summary of March 2010 ICD-9-CM Coordination and Maintenance Committee Meeting. The current 488.x subcategory didn't provide the level of detail that category 487 (Influenza) does.

Change: There will be "tremendous expansion of the H1N1 category," Swindle explains. ICD-9 2011 deletes 488.0 and 488.1 and adds six new five-digit codes. New codes  88.0x (Influenza due to identified avian influenza virus) and 488.1x (Influenza due to identified novel H1N1 influenza virus) allow you "to uniquely capture pneumonia, other respiratory manifestations, and other manifestations occurring with these types of influenza," states the summary. Starting Oct. 1, you'll assign the correct 488.xx code based on the type of comorbid manifestation the avian or H1N1 influenza involves:

Don't forget: As with 487.0, when you code 488.01 or 488.11, you'll use an additional code to identify the type of pneumonia (480.0-480.9, 481, 482.0-482.9, 483.0-483.8, 485).