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Influenza Coding Guidelines: How to Code the Flu

Here are some helpful coding tips to guide you through flu season.

What’s the flu type?

  • J09 (Influenza due to identified novel influenza A virus) – this category covers the more exotic flu types, such as avian flu, swine flu or other flu viruses of animal origin. It is very unlikely that you will be able to assign a code from this category due to a lack of testing capability for these specific flu types.
  • J10 (Influenza due to other identified influenza virus) – this category is where most of your patients will fall. This is the average patient who tests positive for the seasonal type A or B flu.
  • J11 (Influenza due to unidentified influenza virus) – this category is to be used when the flu type is unknown. This would most likely be used when a patient fits the clinical presentation of influenza but testing is not performed.

What other conditions or symptoms are present?

Once you decide on the correct ICD-10 category, it’s time to break it down a little more. The following options are available in each flu type category.

  • Influenza with pneumonia
  • Influenza with other respiratory manifestations
  • Influenza with gastrointestinal manifestations
  • Influenza with otitis media
  • Influenza with other manifestations

When using combination codes such as the list above, it is not necessary to list the other condition (such as pneumonia) separately. It is also inappropriate to list all of the symptoms that the patient is experiencing (fever, cough, vomiting, etc). It is important to use the most specific ICD-10 code possible for each patient. This is not only essential information for the insurance company or patient but also assists in statistical data collection. Stay healthy and comment if you have any questions. Kelli Rain, CPC, CPMA Director of Coding WOWZA Management Services 3515 Richmond Rd Texarkana, TX 75503 903-831-7270, ext 1404

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