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ICD-10-CM contracts the flu

HCPRO Website, January 28, 2013

Cold and flu season is in full swing, so I thought it might be a good time to look at coding for influenza in ICD-10-CM.

If you look up influenza in the ICD-9-CM index, you might think we currently have a wide range of codes for influenza. Initial appearances may be deceiving. When you actually look at code in the 487 (influenza) and 488 (influenza due to certain identified influenza viruses), you find a grand total of 13 codes.

In ICD-10-CM, you’ll find 21 codes in several subcategories for influenza:

  • 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 is further broken down into more specific codes. For example, under J09, you’ll find these options:

  • J09.X1, influenza due to identified novel influenza A virus with pneumonia
  • J09.X2, influenza due to identified novel influenza A virus with other respiratory manifestations
  • J09.X3, influenza due to identified novel influenza A virus with gastrointestinal manifestations
  • J09.X9, influenza due to identified novel influenza A virus with other manifestations

Each of those four codes includes some type of instructional note that you need to follow as well. Code J09.X1 includes this note:

Code also, if applicable, associated:

  • lung abscess (J85.1)
  • other specified type of pneumonia

Make sure while you’re coding the condition, you’re also following the instructional notes.

And while we’re on the subject of instructional information, don’t forget to review the ICD-10-CM Official Guidelines for Coding and Reporting for iInfluenza due to certain identified influenza viruses.

The guidelines instruct coders to code only confirmed cases of influenza due to certain identified influenza viruses (category J09), and due to other identified influenza virus (category J10).

In this context, “confirmation” does not require documentation of positive laboratory testing specific for avian or other novel influenza A or other identified influenza virus. However, coding should be based on the provider’s diagnostic statement that the patient has:

  • Avian influenza, or other novel influenza A, for category J09
  • Another particular identified strain of influenza, such as H1N1 or H3N2, but not identified as novel or variant, for category J10

If the provider records “suspected” or “possible” or “probable” avian influenza, or novel influenza, or other identified influenza, coders should report the appropriate influenza code from category J11, (influenza due to unidentified influenza virus).

This article originally appeared on the ICD-10 Trainer blog.

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