Wash Your Hands!

First it was Covid 19 then murder hornets and now it’s flu season. Thankfully, flu activity for the 2020-2021 season is low according to the CDC.

Regardless of how active the flu season, it is important for the CDI professional to understand the flu and its complications in order to ensure that it is correctly coded.

J09.- through J11.- are the group of ICD-10CM codes used to capture influenza and its manifestations.

The first step to ensuring proper code selection is an understanding of the nomenclature of the influenza strains. The influenza strains seen most with the seasonal flu are influenza A and B. Influenza due to other identified influenza virus, J10, would be used to capture seasonal flu strains. For example, Type A/H1N1 and Influenza B would be coded under J10.

Novel influenza A, which includes the less common influenza strains such as avian flu, bird flu and swine flu would be captured using the code J09, Influenza due to novel influenza A virus. Novel influenza viruses are strains that typically circulate among animals and occasionally infect people. Coder beware; A common coding mistake is using J09 when influenza A is documented. Influenza A (J10) is not the same strain as novel influenza A (J09).

Finally, if the strain of influenza has not been identified in the documentation then the correct code category would be J11, Influenza due to unidentified influenza virus.

2021 Official Coding Guidelines regarding  terms linked by “with” state that  “These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated or when another guideline exists that specifically requires a documented linkage between two conditions (e.g., sepsis guideline for “acute organ dysfunction that is not clearly associated with the sepsis”).

For influenza there are many terms linked by the term “with”:

• Pneumonia (unspecified, viral and other specified)
  • Lung abscess, if applicable, would also be coded
  • If other pneumonia is specified, then code also the type of pneumonia
• Other respiratory manifestations (laryngitis, pharyngitis, upper respiratory symptoms)
  • Pleural effusion and sinusitis, if applicable, would also be coded
• Gastrointestinal manifestations (nausea, vomiting, diarrhea etc.)
• Encephalopathy
• Myocarditis
• Otitis media
  • Perforated tympanic membrane, if applicable, would also be coded
• Other manifestations
  • Use additional code to identify the manifestations

Keeping the above guidance in mind will keep you from having any flu coding complications. Washing your hands will, hopefully, keep you from having any real-life flu issues.