Pulmonology Coding Alert

Question: A 50-year-old female patient complains of flu-like symptoms. The provider examines her and suspects avian influenza. As the provider has not yet confirmed the diagnosis, is it possible to report codes for this scenario?

Arizona Subscriber

Answer: ICD-10 chapter specific guidelines require you to “Code only confirmed cases of influenza due to certain identified influenza viruses (category J09), and due to other identified influenza virus (category J10).” However, you do not need any laboratory investigation to be able to do that. You would code the case based on the provider’s diagnosis of the case.

In your case, the provider suspects avian influenza. The guidelines state that if the provider records “suspected” or “possible” or “probable” avian influenza, or novel influenza, or other identified influenza, then you may assign the appropriate influenza code from category J11 (Influenza due to unidentified influenza virus).

Do not assign a code from category J09 (Influenza due to certain identified influenza viruses), or a code from category J10 (Influenza due to other identified influenza virus).

However, you should base your coding decision on the provider’s diagnostic statement that the patient has avian influenza, or other novel influenza A, for category J09, or has another particular identified strain of influenza, such as H1N1 or H3N2, but not identified as novel or variant, for category J10.