Pulmonology Coding Alert

Question: I have a report diagnosing the patient with the flu and acute maxillary sinusitis due to the infection. However, the physician didn’t specify the type of influenza virus.

How should I code this encounter?

West Virginia Subscriber

Answer: You’ll assign code J11.1 (Influenza due to unidentified influenza virus with other respiratory manifestations) to report the patient’s diagnosis. Code J11.1 features an additional synonym of “Influenza NOS,” which allows you to report this code for an influenza infection that the provider didn’t specify.

To locate this code, turn to the Alphabetic Index and look for Influenza (bronchial) (epidemic) (respiratory (upper)) (unidentified influenza virus). Then follow the indentations to with > respiratory manifestations NEC J11.1. You’ll then verify the code in the tabular list.

The physician also diagnosed the patient with acute maxillary sinusitis caused by the flu. When you look under J11.1, you’ll notice a note directing you to use an additional code to report an associated sinusitis condition, if applicable, from the J01.- (Acute sinusitis) code category.

The J01.- code subcategories are separated by which sinuses are affected. You’ll start with J01.0 (Acute maxillary sinusitis) since the physician diagnosed the patient with an inflammation of the maxillary sinuses. A 5th character is required to complete the code. The provider didn’t specify whether the patient experiences maxillary sinusitis repeatedly, so you’ll assign J01.00 (Acute maxillary sinusitis, unspecified).

Wrap up the claim: For this encounter, you’ll assign J11.1 and J01.00 to report unspecified influenza with acute maxillary sinusitis.