Autumn is a beautiful season but it also brings lower temperatures, which can cause a host of ailments. Physicians need to be ready with the ICD-10 codes for these common seasonal conditions and outsourcing medical coding to an experienced service provider is a reliable strategy to ensure this. Here are the common autumn ailments that physicians need to be ready to code:

Autumn Ailments
  • Influenza: Fall is flu season. An infection involving the respiratory tract, influenza is caused by a number of viruses. It causes inflammation of the nasal mucosa, the pharynx, and conjunctiva, as well as headache and severe, often generalized muscle pain or myalgia. Flu can pose serious risks for new born babies, elderly people, and people with certain chronic medical conditions. Besides fever and body aches, symptoms include cough, sore throat and headache.

    J11.1 Influenza due to unidentified influenza virus with other respiratory manifestations is the diagnosis code for influenza.

    ICD 10 codes adjacent to J11.1 include:

    • J11.2 Influenza due to unidentified influenza virus with gastrointestinal manifestations
    • J11.8 Influenza due to unidentified influenza virus with other manifestations
    • J11.81 Influenza due to unidentified influenza virus with encephalopathy
    • J11.82 Influenza due to unidentified influenza virus with myocarditis
    • J11.83 Influenza due to unidentified influenza virus with otitis media
    • J11.89 Influenza due to unidentified influenza virus with other manifestations

    When reporting J11.1, the instructions are to use additional codes for associated pleural effusion and sinusitis, if applicable. Also, flu with pneumonia is coded using a combination code, that is flu and pneumonia are not coded separately.

    A Kentucky RHIO report reminds that to code correctly for influenza, the clinician’s documentation should specify the type and manifestations of the virus (such as A, B, or C). Practices also need to be up to date on the vaccine administration codes for the current flu season.

  • Pharyngitis: Pharyngitisor sore throatis usually associated with colds or influenza. The condition can be acute or chronic and due to streptococcus, due to a known agent other than streptococcus, or unspecified. A chronic sore throat lasts much longer and should not be ignored as it is generally indicative of an unresolved underlying condition or disease. Viral and bacterial sore throats usually spread via cold sneezing, coughing, sharing drinking glasses, etc. Sore throats are caused by environmental factors or allergies cannot be passed from one person to another. The ICD-10 codes for pharyngitis are:
    • J02.0 Streptococcal pharyngitis
    • J02.8 Acute pharyngitis due to other specified organisms
    • J02.9 Acute pharyngitis, unspecified
    • J31.1 Chronic nasopharyngitis
    • J31.2 Chronic pharyngitis
  • Raynaud’s phenomenon/syndrome: When the temperatures decrease, a person with Raynaud’s syndrome experiences pain in the extremities, typically the fingers and toes. The condition is caused by the overreaction of the peripheral blood vessels to the cold. It affects 5 to 10 percent of Americans, and females are estimated to be nine times more susceptible to it than males. Signs and symptoms of Raynaud’s disease include: cold fingers or toes, changes in the color of the skin in response to cold or stress, and numbness or stinging pain upon warming or stress relief. A nail fold capillaroscopy can help Raynaud’s disease.

    The ICD 10 codes to report are:

    • I73.00 Raynaud’s syndrome without gangrene
    • 173.01 Raynaud’s syndrome with gangrene

    Associated diseases include scleroderma and lupus

  • Sinusitis: While sinusitis more commonly occurs in the fall season, the pain due to sinus headaches worsens in cold and damp weather. The condition is marked by inflammation, or swelling, of the tissue lining the sinuses. Codes for sinusitis are classified based on whether the documentation indicates an acute or a chronic condition. J00-J99, the ICD-10 code set for sinusitis covers acute, acute recurrent and chronic sinusitis codes for maxillary, frontal, ethmoidal, and sphenoidal and pansinusitis. For example:
    • J01.00 Acute maxillary sinusitis
    • J01.11 Acute recurrent frontal sinusitis
    • J32.2 Chronic ethmoidal sinusitis
    • J01.30 Acute sphenoidal sinusitis
    • J01.41 Acute recurrent pansinusitis sinusitis
    • J32.8 Other chronic sinusitis
    • J01.91 Acute recurrent sinusitis,unspecified

    If applicable, an additional code should be used to identify:

    • Exposure to environmental tobacco smoke
    • Exposure to tobacco smoke in the perinatal period
    • History of tobacco use
    • Occupational exposure to environmental tobacco smoke
    • Tobacco dependence
    • Tobacco use

    If the documentation indicates that the patient has chronic sinusitis, it should be coded in addition to the code for the acute condition.

  • Norovirus: Stomach flu or norovirus peaks during autumn and winter. The Centers for Disease Control and Prevention (CDC) estimates that this extremely contagious virus accounts for about 21 million illnesses each year. It is a major cause of acute gastroenteritis. According to Mayo Clinic, diarrhea, abdominal pain and vomiting typically begin 12 to 48 hours after exposure. Norovirus symptoms last one to three days and treatment is not required in most cases. However, severe vomiting and diarrhea can cause severe dehydration in infants, older adults and people, requiring immediate medical attention.

    The ICD-110 codes for the condition fall under A08 Viral and other specified intestinal infections, category A08, Viral and other specified intestinal infections contains codes for viral enteritis and gastroenteropathies:

    • A08.0 Rotaviral enteritis
    • A08.1 Acute gastroenteropathy due to Norwalk agent and other small round viruses
    • A08.11 Acute gastroenteropathy due to Norwalk agent
    • Acute gastroenteropathy due to Norovirus
    • Acute gastroenteropathy due to Norwalk-like agent

Bronchiolitis, asthma, heart disease, and outdoor allergies are also common medical conditions reported the fall. Partnering with an experienced medical coding company is the solution to accurate and compliant coding for maximum reimbursement.