As we are all well aware, getting an annual flu vaccine is the first and best way to protect yourself and your family from the flu. The flu vaccination can reduce flu illnesses, doctors’ visits, missed work and school due to flu, as well as prevent flu-related hospitalizations. The more people who get vaccinated, the more people are protected from flu including older people, very young children, pregnant women and people with certain health conditions who are more vulnerable to serious flu complications.
Now that fall is here, winter and the holidays are quickly approaching – and that means that flu season is upon us. Before it really begins, it’s a good idea to go over the basic guidelines for coding influenza. While it is not possible to predict what this flu season will be like, we can be prepared for good documentation and accurate submission of billing.
When coding correctly for influenza, the clinician should document the type and manifestations of the virus. There are three types of influenza virus: A, B, and C. Types A and B can cause seasonal epidemics in the United States, whereas type C causes mild respiratory illness and is not thought to cause epidemics, according to the Centers for Disease Control and Prevention.
Many of the ICD-10-CM diagnosis codes include the manifestation — for example, J09.X2 – Influenza due to identified novel influenza A virus with other respiratory manifestations. If the code does not include the manifestation, you will find an instructional note to “code also” or “use additional code” for reporting the manifestation(s) or associated complication(s). For example, J11.1 – Influenza due to unidentified influenza virus with other respiratory manifestations, instructs you to use additional codes for associated pleural effusion and sinusitis, if applicable.
Per the 2016 ICD-10 CM guidelines you are instructed to only code confirmed cases of influenza that are due to certain identified influenza viruses (category J09), and due to other identified influenza virus (category J10). Within this context “confirmation” doesn’t require documentation of positive laboratory testing specific for avian or other novel influenza based on the provider’s diagnostic statement that the patient has avian influenza, or other novel influenza A, for category J09 or has 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, then the appropriate influenza code code from Category J11, influenza due to unidentified influenza virus, should be assigned. A code from category J09, influenza due to certain identified influenza viruses, should not be assigned nor should a code from category J10, influenza due to other identified influenza virus.
Flu season is very unpredictable and can vary in different parts of the country and from season to season. Seasonal flu viruses can be detected year-round; however, seasonal flu activity can begin as early as October and continue to occur as late as May. Flu activity most commonly peaks in the United States between December and March. To avoid catching the flu yourself, the CDC recommends the following: cover your nose and mouth with a tissue when coughing or sneezing, throw the tissue in the trash after use, wash your hands often with soap and water or use an alcohol based hand rub, and avoid touching your eyes, nose and mouth.