Coding, Classification & Reimbursement

Influenza A

  • 1.  Influenza A

    Posted 03-13-2019 20:55
    Hello,

    I have a patient that has been diagnosed with influenza A. I’m confused if I should assign J111 or J101 when the physician has not documented a subtype of influenza A (H3N2). The test being performed at my facility are the rapid test- nasal swab. Coding clinic 4th quarter 2011 pages 110-114 appears that in order to use code J10x a specific type of influenza should be documented. Or since we have ICD 10 if the physician document A it Will always code to other (J10x).

    Thanks,

    Anthony Neal


  • 2.  RE: Influenza A

    Posted 03-14-2019 00:32
    Anthony, I would assign the J11.1.  You really cannot assign J09.X2.  

    Elizabeth





  • 3.  RE: Influenza A

    Posted 03-14-2019 12:01
    We code it to J101.
    Coding path is ; influnza, due to identified influenza virus, then other/unspecified

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    Barbara McClevarty
    His Coding Technician
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  • 4.  RE: Influenza A

    Posted 03-14-2019 20:10
    I would assign J10.1, Influenza due to other identified influenza virus with other respiratory manifestations.  Coding Clinic 3Q 2016 pg 10-11 advises assigning J10.1 for influenza A and Coding Clinic 3Q 2016 pg 11 advises assigning J10.1 for Influennza B.

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    Karen Neal, RHIA, CCS
    APPROVED I10 CM/PCS
    Coding Quality Auditor
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  • 5.  RE: Influenza A

    Posted 03-15-2019 08:52
    We had this discussion at our facility earlier this year based on the following information received from Barry Libman in a "Coder's Corner" newsletter, which helps distinguish why Influenza A is coded to the J10 series.


    by Barry Libman, MS, RHIA, CDIP, CCS
    Now that flu season is upon us I would like to offer a friendly reminder as to how to code flu. Remember: Influenza A is not the same as Novel Influenza A.

    Influenza A is just plain old influenza and coded to the J10 category, Influenza due to identified influenza virus or the J11 category, Influenza due to unidentified influenza virus. Influenza A is often documented as being diagnosed on the basis of a nasal swab.

    Novel Influenza A is either H1N1 or H5N1 which are both animal-born influenzas (either swine or bird in origin) and are coded to the J09 category. A diagnosis of either H1N1 or H5N1 would likely generate a lot of interest in your facility (and your community).

    The ICD-10 index can be a little confusing in this area. The entire phrase "Novel Influenza A H1N1 (or H5N1)" must be documented in the medical record before you proceed to using the J09- codes.

    Check the ICD-10-CM Official Guidelines for Coding and Reporting FY 2019 pages 53-54 for Influenza coding guidelines. Also note that AHA Coding Clinic for ICD-10-CM/PCS Q3 2016 addresses this issue on page 11 in the second paragraph: "Codes from subcategory J09.X-, Influenza due to identified novel influenza A virus, are intended for a specific strain of influenza A, such as "novel" influenza A, and not the ordinary seasonal influenza A."

    Bottom line – If you find yourself wanting to use a code from the J09- range, please get a second opinion!

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    Barbara Tucker
    Medical Records Technician/Coder
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  • 6.  RE: Influenza A

    Posted 03-15-2019 12:17
    J101 takes it to a simple pneumonia DRG and J111 takes it to an otitis media DRG which is the next concerning part.

    I wish a distinctive code for influenza A created, that way the DRG would make since I’m the absence of any type of manifestations.



    Anthony Neal




  • 7.  RE: Influenza A

    Posted 03-15-2019 09:12
    Anthony, there is a Coding Clinic from 2016, Q3 that addresses the diagnostic statement, "Viral sepsis due to acute viral bronchitis due to influenza A."  The bottom line is if you have either influenza A or influenza B, you have an identified type, but not a "novel" flu strain, you would use category J10.x. When the diagnostic statement does NOT include either A or B as the type, then you would code a code from category J11.x.

    Question: 
    What are the correct ICD-10 CM codes for a provider's diagnostic statement of "viral sepsis due to acute viral bronchitis due to influenza A?" The sepsis was present on admission.

    Answer: 
    Assign code A41.89, Other specified sepsis, for a diagnosis of sepsis due to influenza A. Although codes A30-A49 classify bacterial illnesses, there is no specific code for viral sepsis. Code A41.89 is the best available option to capture the concept of sepsis when no specific code exists. "Sepsis, specified organism NEC" is indexed to code A41.89. Assign also code J10.1, Influenza due to other identified influenza virus with other respiratory manifestations, and code J20.8, Acute bronchitis due to other specified organisms.

    Codes from subcategory J09.X-, Influenza due to identified novel influenza A virus, are intended for a specific strain of influenza A, such as "novel" influenza A, and not the ordinary seasonal influenza A.

    © Copyright 1984-2019, American Hospital Association ("AHA"), Chicago, Illinois. Reproduced with permission. No portion of this publication may be copied without the express, written consent of AHA. 


    Here is another CC from 2016 Q3, addressing the diagnosis of, "Sepsis secondary to influenza B."

    Question: 
    What are the appropriate ICD-10-CM codes for a diagnosis of sepsis secondary to influenza B?

    Answer: 
    Assign code A41.89, Other specified sepsis, for a diagnosis of sepsis due to influenza B. Although codes A30-A49 classify bacterial illnesses, there is no specific code for viral sepsis. Code A41.89 is the best available option to capture the concept of sepsis when no specific code exists. "Sepsis, specified organism NEC" is indexed to code A41.89. Assign also code J10.1, Influenza due to other identified influenza virus with other respiratory manifestations, for the influenza B. 

     © Copyright 1984-2019, American Hospital Association ("AHA"), Chicago, Illinois. Reproduced with permission. No portion of this publication may be copied without the express, written consent of AHA. 

    Regina Sanders RHIT, CCS