Pulmonology Coding Alert

Identify the causative influenza viruses first.

Influenza coding requires a lot of analysis and deep thought, given the vast variety of codes you have to choose from. The most common challenge while tackling influenza codes lies in “not factoring in all of the available information to be able to choose the correct code, considering the strain or the associated complications,” tells Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania.

To begin with, you have three broad code categories as a starting point:

• J09.~ — Influenza due to certain identified influenza viruses
• J10.~ — Influenza due to other identified influenza virus
• J11.~ — Influenza due to unidentified influenza virus.

Each of these categories then divides into multiple possibilities. Read on to find just the right code from amongst the many highly precise options available.

Confirm the Type of Influenza

Remember that you will need a confirmation of the type of influenza before you assign the patient to category J09 or J10. The physician’s statement in the record is the only confirmation needed to code for avian, other new strains of influenza A, or other identified influenza viruses. This includes strains we have seen recently, such as H1N1 or H3N2 influenza viruses.

Documentation is vital: Based on the various factors influencing a diagnosis of influenza, physician documentation will be even more important than before. He will need to first distinguish between influenza that is non-seasonal (i.e., avian and bird flu) or influenza that is seasonal (i.e., caused by another identified virus). That documentation starts narrowing your category choices:

• Seasonal influenza: J10.00, Influenza due to other identified influenza virus with unspecified type of pneumonia
• Non-seasonal influenza: J09.X1, Influenza due to identified novel influenza A virus with pneumonia (“code also” the type of pneumonia documented).

Plus: Apart from indicating the cause of the influenza, you should also check for any associated manifestations such as pneumonia, gastroenteritis, encephalopathy, etc., to figure out your fourth and fifth character choices.

No lab confirmation needed: According to ICD-10 Coding Principles, your physician will not need to have a positive lab result to diagnose certain identified influenza viruses like avian (J09) or those due to other identified influenza viruses (J10).

Heed the Guideline Notes

Throughout the influenza categories (J09-J11), you will find a lot of “code also” and “use additional code” notes. Read these carefully to help guide you in optimal code assignment for this commonly diagnosed condition.

Use J11 when not sure: When the provider documents avian or some other new strain of influenza as “suspected,” “possible,” or “probable,” then you will code these to category J11. For example, diagnoses like Influenza NOS, Influenzal laryngitis NOS, and Influenzal pharyngitis NOS may be coded with J11.1.

Also be aware of exclusion information about the influenza codes. In short, when you code for one category, beware of an Excludes1 for the other two categories. For example:

J09.~

• Excludes1:
• influenza due to other identified influenza virus (J10.-),
• influenza due to unidentified influenza virus (J11.-),
• seasonal influenza due to other identified influenza virus (J10.-),
• seasonal influenza due to unidentified influenza virus (J11.-)

J10.~

• Excludes1:
• influenza due to avian influenza virus (J09.X-),
• influenza due to swine flu (J09.X-),
• influenza due to unidentified influenza virus (J11.-)

Final takeaway: Go step-by-step, and you can be sure every time you code for influenza. “Make sure you have collected all of the pertinent information, and considered all associated factors before making your code selection,” reminds Pohlig.