As the flu season has begun, it is time for everyone to prepare for this highly contagious condition, which generally peaks between December and February. According to the Centers for Disease Control and Prevention (CDC), there were 80,000 deaths over the 2017-18 flu season, which is much higher than the average range that is between 12,000-56,000 deaths per year. CDC and the American Academy of Pediatrics also recommend October as the best time to get the flu vaccine. The CDC advises that anyone older than 6 months should be vaccinated. It is also time for medical coding companies and coding staff at hospitals and clinics to stay up-to-date with the latest coding updates to document flu accurately.
There are four types of influenza: types A, B, C, and D. Often the most frequently identified subtype of flu reported is influenza A. Along with taking vaccines, other steps that are recommended to stay healthy include wash your hands well and often, stay at home when sick, cover your nose and mouth when coughing or sneezing, and wipe down counters, desks, tables and other surfaces with disinfectant.
When documenting flu, you must include the signs and symptoms of flu, the actual disease condition, the vaccination as well as its complications.
Signs and Symptoms
The signs and symptoms of flu with the associated codes include:
- R50.9 – Fever, unspecified
- M79.1 – Myalgia (muscle pain)
- R53.83 – Other fatigue
- R05 – Cough
- R06.02 – Shortness of breath
- R06.7 – Sneezing
- R63.0 – Anorexia (loss of appetite)
- R51 – Headache
- R09.81 – Nasal congestion
- H92.0 – Otalgia (ear pain)
Complications
Flu can also result in life-threatening illnesses like pneumonia. These associated complications should also be included with the flu type code to demonstrate the severity of the patient’s illness.
- J10 Influenza due to other identified influenza virus
- J10.0 Influenza due to other identified influenza virus with pneumonia
- J10.1 Influenza due to other identified influenza virus with other respiratory manifestations
- J10.2 Influenza due to other identified influenza virus with gastrointestinal manifestations
- J10.8 Influenza due to other identified influenza virus with other manifestations
- J11 Influenza due to unidentified influenza virus
- J11.0 Influenza due to unidentified influenza virus with pneumonia
- J11.1 Influenza due to unidentified influenza virus with other respiratory manifestations
- J11.2 Influenza due to unidentified influenza virus with gastrointestinal manifestations
- J11.8 Influenza due to unidentified influenza virus with other manifestations
The most serious complication would be the development of sepsis.
- A41.9 Sepsis, unspecified organism
It is also recommended to note that type A influenza is not the same as novel influenza A.
Vaccination
The code representing the flu vaccination is Z23, which is the same for any immunization.
- Z23 Encounter for immunization
This diagnosis code can be used regardless of vaccine quantity or type. It can also be used with other vaccines too, not just flu shots.
An ICD-10-PCS code, “3E01340” was added to the list in October 2017 to report the administration of the influenza vaccine.
- 3E01340 Introduction of Influenza Vaccine into Subcutaneous Tissue, Percutaneous Approach
For more details on influenza vaccine administration guidance and coding, read our blog.
Medical billing and coding outsourcing is a great option to help providers ensure accurate medical coding, which is indispensable for on-time reimbursement for the services provided.
Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.