Revenue Cycle

Understand the H1N1 Flu and how to code it

Coding Educator, June 15, 2009

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By Jennifer Avery, CCS, CPC, CPC-H, CPC-I

During recent months we have all heard the news reports about a growing outbreak of an illness currently referred to as H1N1 Flu. Originally known in the media as “Swine Flu,” the Novel influenza A is a new flu virus of swine origin that was first detected in April 2009.

The virus infects people and is spreading; as of June 3, 2009 there have been 11, 054 cases and 17 deaths across the United States, District of Columbia, and Puerto Rico. There have also been increasing reports of international cases as well.
 
Scientists believe that the H1N1 Flu spreads in the same way the regular seasonal flu viruses spread, through coughs and sneezes from people infected with the virus. It is uncertain as to how severe the H1N1 outbreak will be in terms of illnesses and deaths as compared to the other flu viruses. Because this is a new virus, most of the population will not have any immunity—meaning the virus may be more widespread.
 
There currently is no vaccine to protect against the novel H1N1 virus. The Center for Disease Control (CDC) anticipates that there will be additional cases, hospitalizations and deaths associated with the new virus in the coming days and weeks.
 
Currently the H1N1 virus is detected through the CDC’s routine influenza surveillance systems and reported weekly in Fluview, a publication in which the CDC tracks U.S influenza through multiple systems across five categories. The data demonstrates a higher level of influenza-like illnesses than normal for this time of year. Most of the influenza viruses currently being detected are the H1N1 viruses.
 
The CDC is taking an aggressive approach in regards to the H1N1 Flu. The goal is to reduce the spread and severity of the illness, and to provide information to help healthcare providers and public health officials. The CDC is issuing updates daily.
 
Healthcare professionals treat H1N1 influenza with antiviral drugs in the form of pills, liquid, and even inhalers in severe cases (e.g., for hospitalized patients or those considered at high risk of influenza-related complications).
 
The CDC continues to educate the public on what to do if they develop flu-like symptoms, and provides guidance for those caring for others with flu-like symptoms. Symptoms may include:
  • Fever
  • Cough
  • Sore throat
  • Body aches
  • Headache
  • Chills
  • Fatigue
  • Nausea, vomiting, and/or diarrhea
Public health officials remind Americans to avoid the spread of germs by frequently washing their hands, and to stay home and avoid contact with others if you become ill to limit further spread of the disease.
 
The CDC has developed a diagnostic test kit to detect the H1N1 influenza virus and has distributed it throughout the U.S., the District of Columbia, and Puerto Rico. Due to the increased testing, it is likely there will be an increase in the number of confirmed cases being reported. The increased testing combined with increased monitoring will provide the CDC with a fuller picture of the effects of the disease over time.
 
Official coding guidance for the H1N1 influenza doesn’t yet exist and there is no current ICD-9 code specifically for it. Until a more specific code is developed, coders should use the 487 influenza codes. For rapid nasal swab, report code 87804-QW (Infectious agent antigen detection by immunoassay with direct optical observation; Influenza). To code for the antiviral drugs, report either HCPCS G9019, Oseltamivir phosphate, oral, per 75 mg (Tamiflu®) or G9018 Zanamivir, inhalation powder, administered through inhaler, per 10 mg (Relenza®).
 
Over time, CMS and the AMA will may adopt changes and official guidance for both ICD-9 and CPT/HCPCS codes to account for H1N1. Currently there are no reports of new H1N1 ICD-9 codes, so it is perhaps more likely that code revisions may occur instead. Only time will tell, so stay tuned. This is definitely an area to watch for additional guidance.
 
To continue to watch for updates on the H1N1 Flu virus, you may find the following Web sites and e-mail alerts helpful:
In addition, see the CDC Web site for the latest number of confirmed H1N1 cases and deaths in the United States.
 
Editor's note: Jennifer Avery, CCS, CPC, CPC-H CPC-I, is a regulatory specialist for HCPro, Inc. You can e-mail her at javery@hcpro.com.



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