Pediatric Coding Alert

Question: Our pediatrician recently diagnosed a patient with bronchopneumonia and influenza A virus. The patient lives with a smoker. How do I report this?

Illinois Subscriber

Answer: In this scenario, there are two distinct diagnoses to code, and instructions on which order to report them in can be found right in ICD-10. When you find J18.0 (Bronchopneumonia, unspecified organism), you’ll notice a Code first alert under the main category that tells you to code the influenza first. The chapter guidelines also list several applicable options in the Use additional code note, which you’ll code second when documentation supports doing so.

ICD-10-CM Official Guidelines, Section 1.A.13, states “ICD-10-CM has a coding convention that requires the underlying condition be sequenced first, if applicable, followed by the manifestation. Wherever such a combination exists, there is a ‘use additional code’ note at the etiology code, and a ‘code first’ note at the manifestation code.”

Therefore, code first J09.X1 (Influenza due to identified novel influenza A virus with pneumonia), followed by J18.0. You’ll also need to code Z77.22 (Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic)) to complete the claim for this patient.