Pulmonology Coding Alert

Do you code bronchitis separately? Find out.

As flu season quickly approaches, now is the time to give your coding skills a booster shot. See if you can correctly code the flu diagnoses and manifestations in the following three scenarios.

Refresh Your Influenza Guidelines Comprehension

The ICD-10-CM code set includes specific guidelines for coding the flu caused by identified flu viruses. Under section I.C.10, “Chapter 10: Diseases of the Respiratory System (J00-J99), U07.0,” you’ll find section c, “Influenza due to certain identified influenza viruses.” These guidelines describe which code categories you’ll use depending on your provider’s influenza virus diagnosis:

• Category J09: “Code only confirmed cases of influenza due to certain identified influenza viruses”
• Category J10: “[Code only confirmed cases of influenza] due to other identified influenza virus”
• Category J11: “If the provider records “suspected” or “possible” or “probable” avian influenza, or novel influenza, or other identified influenza,” then use the appropriate code.

Remember: the use of “confirmed” in categories J09 (Influenza due to certain identified influenza viruses) and J10 (Influenza due to other identified influenza virus) doesn’t need positive laboratory testing documentation for avian or novel influenza A or other identified influenza virus. You can use the provider’s report to code the diagnosis.

Nail Down Influenza with Pneumonia Coding

Scenario: A general physician (GP) refers their 35-year-old patient to your pulmonology practice after complaining of flu-like symptoms that have persisted for two to three weeks. The patient is experiencing a harsh cough with greenish-yellow mucus, shortness of breath, and a sharp pain when breathing deeply. While giving their history, the patient mentioned they had the flu earlier in the month. The pulmonologist listened to the patient’s lungs and documented they heard bubbling sounds during inhalation. The physician ordered pulse oximetry and a sputum test, after which they diagnosed the patient with pneumonia due to the flu.

In this scenario, you can use code J10.00 (Influenza due to other identified influenza virus with unspecified type of pneumonia) to document this diagnosis since the physician diagnosed the patient with pneumonia due to the flu, but they did not specify the influenza type.

Report Other Identified Symptoms with Certain Flu Dx Codes

Scenario: Your pulmonologist sees a 63-year-old patient who claims they had the flu a couple weeks ago but is still experiencing exhaustion, a cough with yellowish-green mucus, and nagging chest congestion. The physician asks if the patient has a fever as well, but they reply they do not. The pulmonologist diagnoses the patient with acute bronchitis due to the flu.

In this scenario, the patient claims to be experiencing symptoms that are commonly associated with bronchitis, but since the patient claims they recently recovered from the flu, you’ll need to code that as well. The pulmonologist didn’t identify the type of flu virus the patient experienced, so you can use J11.89 (Influenza due to unidentified influenza virus with other manifestations). When you find J11.89 in the ICD-10-CM code set, you’ll see a note under the code and descriptor that reads, “Use additional codes to identify the manifestations.” This means you need to separately code any additional symptoms or conditions the patient is experiencing. In this case, you’ll use J20.8 (Acute bronchitis due to other specified organisms) with J11.89 to code the diagnoses.

Stretch Your Wings for H5N1 Coding

Scenario: A 43-year-old patient comes into your pulmonology practice experiencing a cough with yellow mucus, chills, shortness of breath, and pain when breathing deeply. The patient explains they were battling the flu two to three weeks ago, but the symptoms have resurfaced. During the visit, the pulmonologist asks what the patient does for a living, and they reply they work in the aviary of the local zoo. After a blood test, chest X-rays, pulse oximetry, and sputum test, the physician diagnoses the patient with Type A/H5N1 influenza with pneumonia.

In this scenario, the physician clearly diagnoses the patient with H5N1 influenza with pneumonia. In the Alphabetical Index of the ICD-10-CM code set, under Influenza (bronchial) (epidemic) (respiratory (upper)) (unidentified influenza virus), you’ll find A/H5N1, which directs you to Influenza > due to > identified novel influenza A virus. After finding identified novel influenza A virus, follow the indents with > pneumonia, which provides you with code J09.X1. When you turn to the tabular list, you’ll find J09.X1 (Influenza due to identified novel influenza A virus with pneumonia), which you will use to code the patient’s diagnosis.

Code Also note: Code J09.X1 features a note to add applicable codes that may be associated with the patient’s condition. These codes include J85.1 (Abscess of lung with pneumonia) or other specified type of pneumonia, so make sure to carefully check the provider’s documentation to ensure you’re telling the patient’s complete clinical story.