How to Code Flu – from Prevention to Care

How to Code Flu – from Prevention to Care

Flu season is here, prompting a great deal of confusion about how to code.  I decided to spend some time on the  Centers for Disease Control and Prevention (CDC) website and other resources to try to clarify the murky in this very sick flu season.
Caring for the flu is divided into different parts. It includes the prophylactic, providing immunization for the population and, in particular, the high-risk population. Then it includes the caring for flu patients.

Coding Prophylactic Care for Flu

The Centers for Disease Control and Prevention (CDC) reminds providers  children ages 6 months through 8 years who have never been vaccinated or for whom the vaccination history is unknown will require two doses of the flu vaccine. The two vaccinations should be at least 4 weeks apart for full protection. If a child has received two or more doses of a trivalent or quadrivalent flu vaccine before 7/1/2017, only one dose of the 2017-2018 is recommended by the CDC.
ACIP removed the recommendations for flu vaccines for patients with egg allergies last season. That has not changed for this season. Patients with egg allergies should be observed for 30 minutes following vaccination for signs and symptoms of an allergic reaction. It is recommended that all patient be observed for at least 15 minutes following administration of the vaccine.
Keep in mind that we now have one diagnosis for all immunizations. ICD-10-CM code Z23 Encounter for immunization should be used with all CPT® codes involved with the administration of the vaccine and the actual vaccine itself. Depending on the third-party payer, you may need to add another diagnosis to show how the patient might be a high-risk patient when you are administering the vaccine to a population outside the payer’s guidelines.
CPT® coding for vaccinations involve two CPT® codes, one for the administration of the vaccine (actually giving the vaccine) and one for the vaccine material. The more difficult to select is the code for the vaccine material because there are so many different CPT® codes for the flu vaccine.
The administration of the flu vaccine via an IM injection is coded:
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) for non-Medicare payers
G0008 Administration of influenza virus vaccine for Medicare
The vaccine
The CDC recommended either trivalent or quadrivalent vaccines for the 2017-2018 flu season as of September of 2017. They had no idea how bad the flu season we would be experiencing at that time. Given how the flu has come so heavy and strong, the recommendations are to use only the quadrivalent vaccines at this point. That narrows down the options that we have from the many available in CPT® to select from.
CPT® Coding of the Flu Quadrivalent Vaccines: (clip and save)

Manufacturer Trade Name How Supplied Age Group CPT® Medicare
Astra Zeneca FluMist Quadrivalent .2ml (single dose nasal spray) 2 years through 49 years 90672 90672
GlaxoSmithKline Fluarix Quadrivalent .5ml (single dose syringe) 3 years & older 90686 90686
ID Biomedical Corp of Quebec Div of GlaxoSmithKline FluLaval Quadrivalent .5ml (single dose syringe) 6 months & older 90686 90686
5.0 ml (multi dose vial) 6 months & older 90688 90688
Protein Sciences Corp. Flublok Quadrivalent .5ml (single dose syringe) 18 years & older 90682 90682
Sanofi Pasteur, Inc. Fluzone Quadrivalent .25ml (single dose syringe) 6-35 months 90685 90685
.5ml (single dose syringe) 3 years & older 90686 90686
.5ml (single dose vial) 3 years & older 90686 90686
5ml (multi dose vial) 6-35 months 90687 90687
5ml (multi dose vial) 3 years & older 90688 90688
Fluzone Intradermal Quadrivalent .1ml (single dose microinjection system) 18-64 years 90630 90630
Seqirus Afluria Quadrivalent .5ml (single dose syringe) 5 years or older 90686 90686
5ml (multi dose vial) 65 years & older 90653 90653
Flucelvax Quadrivalent .5ml (single dose syringe) 4 years & older 90674 90674
5ml (multi dose vial) 4 years and older 90756 90756

You can learn more about Medicare immunization rules at their MLM article.

Coding Care for the Flu Patient

Not all patients chose to receive a vaccination for the flu, and this year a lot of patients who did get vaccinated are still coming down with the flu. That means offices and emergency departments are filled with patients.Patients have gotten so sick that they have required admission and there have been more deaths than expected from the flu. Patients who have the flu do not just have a bad cold and their symptoms need to be taken seriously. Drugs like Tamiflu count on early intervention as they are not very effective if the patient has had symptoms for more than 2 days. Tamiflu is a prescription medication used to treat the flu virus from 2 weeks of age and older who have had flu symptoms no more than 2 days. It claims that it can reduce the chance of getting the flu in people 1 year or older. Tamiflu does not prevent common bacterial infections that may happen with the flu. Tamiflu stresses in its literature that it is not a substitute for immunization against the flu. Interestingly, the prescribing instructions from Tamiflu is based on the onset of flu symptoms, not the receipt of a positive lab test indicating that the patient has the flu.
CPT® coding for patients with the flu is going to include an E/M and possibly a blood test, if the organization has a lab. The CPT® codes for the tests include:
87275  Infectious agent antigen detection by immunofluorescent technique; influenza B virus
87276  Infectious agent antigen detection by immunofluorescent technique; influenza A virus
The signs and symptoms should be coded when ordering these tests. If the provider indicates “probable flu” or “likely flu”, the flu cannot be coded because the provider is not documenting a definitive diagnosis. But, when the provider makes a determination that the patient has the flu in the chart, the flu can be coded.

Flu with Acute COPD

Coding Clinic Third Quarter 2016 Page 16 and Fourth Quarter 2017, Page 96 addresses the coding of the flu with COPD. It asks if J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection can be used for the flu with COPD. Coding Clinic states that since the flu is both an upper and lower respiratory infection, J44.0 should not be used. When present, both the flu and Acute COPD should be coded. You would code J11.1 Influenza due to unidentified influenza virus with other respiratory manifestations and J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation.

Flu with Pneumonia

Flu with pneumonia is coded using a combination code. You do not code the flu and the pneumonia separately.
When you know your flu virus, you can code the flu with pneumonia:

J09.X1  Influenza due to identified novel influenza A virus with pneumonia

J10.00  Influenza due to other identified influenza virus with unspecified type of pneumonia

J10.01  Influenza due to other identified influenza virus with the same other identified influenza virus pneumonia

J10.08  Influenza due to other identified influenza virus with other specified pneumonia

J11.00  Influenza due to unidentified influenza virus with unspecified type of pneumonia

J11.08  Influenza due to unidentified influenza virus with specified pneumonia

There are other options within the J09, J10, and J11, which support coding for flu with other respiratory infections as well as gastrointestinal infections. Be sure to us the combination codes when coding the flu with these other problems found in patients with the flu.


Barbara Cobuzzi

About Has 99 Posts

Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, AAPC Fellow, is an independent consultant, CRN Healthcare Solution, Tinton Falls, N.J. She is consulting editor for Otolaryngology Coding Alert and has spoken, taught, and consulted widely on coding, reimbursement, compliance, and healthcare-related topics nationally. Barbara also provides litigation support as an expert witness for providers and payers. Cobuzzi is a member of the Monmouth, N.J., AAPC local chapter.

7 Responses to “How to Code Flu – from Prevention to Care”

  1. Maniknata says:

    what is code for influenza “A” can you please suggest me.

  2. Esther Rachel Jones says:

    Thank you! That was very clear and informative.

  3. Sathish says:

    Yes makes sense. I hope this will be useful for us. I learned cold symptoms severity when I was working as a clinical documentation specialist. Please share this kinds of information.

  4. Martha Johnson says:

    Thank you for enlightening me with this excellent article. Regarding “likely flu” please refer to ICD-10-CM Index — Flu (see Influenza) – Influenza-like Disease – see influenza, therefore according to Appendix A to Correct Coding, it appears to me that “likely flu” should be coded as J11.1. Please correct me if I am wrong.

  5. Lisa Bethea says:

    There are medical coding of lots of flu coding principles. For the use of educational knowledge. It means to really apply your coding materials. The real documentation of just knowing more of how to instill yourselves with these opportunities. These updates are perfection in ones, but i feel the spirit. yes certification is my goal and oi know how to code flu shots and keep it p to date. The code to medicare for payment is the second step to code vaccinations.
    coding up to 10 flu seasons. coding up age and acceptable. These options are great.

  6. Michael Johnson says:

    When are the codes 4037F and/or 4274F used? For example, a patient is new to Medicare Advantage this year (1/1/18) but had the vaccine in November 2017. Would I submit one of the codes above to meet teh quality measure?

  7. Karina Felizola says:

    Thank you for sharing this great article. Highly recommended for this season