Pulmonology Coding Alert

Question: How do we get to know the accurate code for influenza in ICD-10-CM?

Mississippi Subscriber

Answer: Coding for influenza might get tricky when you are faced with around 20 options to choose from. Luckily, influenza is one of those conditions for which you will find a few guidelines in ICD-10-CM. Remember that you will need a confirmation of the type of influenza before you assign them to the category J09 or J10. The physician’s statement in the record is the only confirmation needed to code for avian, or 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.

Further, 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). When the provider documents avian, or some other new strain of influenza as “suspected,” “possible,” or “probable,” then you will code these to the category, influenza due to unidentified influenza virus (J11).

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.

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). He will also need to indicate the cause of the influenza, as well as any associated manifestations such as pneumonia, gastroenteritis, encephalopathy, etc. Here are the relevant codes that you may need to use:

• Non-seasonal Influenza: J09.X1 (Influenza due to identified novel influenza A virus with pneumonia [code also, if applicable, other specified type of pneumonia)
• Seasonal Influenza: J10.00 (Influenza due to other identified influenza virus with unspecified type of pneumonia) 
• B97.0 (Adenovirus as the cause of diseases classified elsewhere).