Health Information Management

Coding for H1N1

HIM-HIPAA Insider, December 29, 2009

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Q: How should we code H1N1?
A: Effective October 1, 2009, report ICD-9 code 488.1(influenza due to identified novel H1N1 influenza virus) for all identified and confirmed cases of H1N1, also referred to as swine flu or novel influenza A/H1N1.
Note that the ICD-9-CM Official Guidelines for Coding and Reporting instructs coders to report this code only for confirmed cases. The only exception is “suspected, possible, and probable” diagnoses, according to Section II, H Uncertain Diagnoses, of the guidelines, which states: 
Section I, Chapter 8, d. Influenza due to certain identified Viruses Code only confirmed cases of avian influenza (code 488.0, Influenza due to identified avian influenza virus) or novel H1N1 influenza virus (H1N1 or swine flu, code 488.1). In this context, ‘confirmation’ does not require documentation of positive laboratory testing specific for avian or novel H1N1 influenza.
However, coding should be based on the provider’s diagnostic statement that the patient has avian or novel H1N1 (H1N1 or swine flu) influenza. If the provider records ‘suspected or possible or probable avian or novel H1N1 influenza (H1N1 or swine flu),’ the appropriate influenza code from category 487 should be assigned. A code from category 488, Influenza due to certain identified influenza viruses, should not be assigned.
DeAnne W. Bloomquist, RHIT, CCS, president and chief consultant of Mid-Continent Coding, Inc., in Overland Park, KS, answered this question in the December issue of Briefings on Coding Compliance.

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