Primary Care Coding Alert

Question: A college student traveling through Texas two days prior returned home with fever of 102.4 F, cough, sore throat, and fatigue. Concerned, the patient sees an FP. A lab test confirms that the patient has swine flu. What diagnosis should I use for this case?

New York Subscriber

Answer: You should use the ICD-9 code for influenza that will apply to this case. Since the patient has respiratory symptoms, report 487.1 (Influenza with other respiratory manifestations).

Presently, ICD -9 does not have a specific code for H1N1 influenza (for example, "swine flu"). ICD-9 guidelines call for you to code the diagnosis known at the end of the encounter. In this instance, only influenza is applicable since swine flu is a form of influenza (H1N1 Influenza A).

Influenzal respiratory infection (cough) and influenzal pharyngitis (sore throat) all fall under 487.1.

Even for confirmed cases of swine flu, you will still use the codes for influenza:

• 487.0 -- Influenza with pneumonia

• 487.1 -- Influenza with other respiratory manifestations

• 487.8 -- Influenza with other manifestations.

Future: Effective Oct. 1, 2009, an ICD-9 code specific to swine flu will exist. That code and its descriptor are 488.1 (Influenza due to certain identified influenza viruses; influenza due to identified novel H1N1 influenza virus). The Centers for Disease Control and Prevention created the new code to better capture H1N1 flu cases in response to the recent flu outbreak.