Health Information Management

Q&A: Sequencing for influenza, pneumonia, and asthma

CDI Strategies, March 24, 2016

Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!

Q: I am never sure of correct sequencing when the admission is for flu, pneumonia, and asthma. Can you suggest proper sequencing, and if queries are needed?  

A: Per the Official Guidelines for Coding and Reporting, only confirmed cases of influenza are coded. No laboratory tests are required, just the diagnostic statement by the provider that the patient has influenza. In ICD-10, there are combination codes that represent both influenza and its manifestations, such as pneumonia.

 

Provider documentation linking the conditions is necessary to use these combination codes, so a query may be needed if the documentation is not present in the chart. When a patient has both influenza and pneumonia due to the influenza, per coding conventions, the influenza will be sequenced first, under code J14 Pneumonia due to H Flu. There is a “code first” note for associated influenza, if applicable. The influenza codes will map to different MS-DRGs depending on the combination code applied.

 

When pneumonia is documented, another reason for a query would be to identify the etiology of the pneumonia. Documented etiology could change the MS-DRG assignment. For example, if there is a bacterial organism causing the pneumonia, the identification of the organism could move a simple pneumonia to a complex pneumonia. 

The specificity needed with a diagnosis of asthma would be the frequency, severity, and any complications associated with it, such as an exacerbation or status asthmaticus. If any of these elements are missing, you would want to query the provider for the information. The documentation of asthma with acute exacerbation or status asthmaticus would give you a CC, and if both are present, per Coding Cliniconly the status asthmaticus would be coded.  

 Editor’s Note: Sharme Brodie, RN, CCDS, AHIMA-approved ICD-10-CM/PCS trainer, CDI education specialist and CDI Boot Camp instructor for HCPro in Danvers, Massachusetts, answered this question. For information, contact her at sbrodie@hcpro.com. For information regarding CDI Boot Camps offered by HCPro, visit www.hcprobootcamps.com/courses/10040/overview.



Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular