Swine Flu Prompts Coding Concerns
In response to recent human infections of Swine influenza A (H1N1) (swine flu) virus, the Department of Health and Human Services (HHS) issued a nationwide public health emergency declaration on April 26. The Centers for Disease Control and Prevention (CDC) is conducting case investigations, monitoring for illness in swine flu patients’ contacts, and enhancing surveillance to determine the extent of the virus.
Coding Swine Flu
There is no ICD-9-CM code specific to swine flu. Sheri Poe Bernard, CPC,CPC-H, CPC-P, vice president of clinical coding content at American Academy of Professional Coders (AAPC) said, “The government is working on a new code for swine flu … everyone at the CDC is scrambling. At the very least, swine flu will be indexed to existing codes by October for the 2010 ICD-9-CM. There may be a new unique code for swine flu by then, too, if possible.” Until there is a more specific code for swine flu, you have the 487 Influenza codes to diagnose the condition.
Although there was no proposal for a code specific to swine flu during the Sept. 2008 or the March 2009 ICD-9-CM Coordination and Maintenance (C&M) Committee Meeting, The National Center for Health Statistics (NCHS) and Centers for Medicare & Medicaid Services (CMS) may rapidly advance its development in response to the current outbreak.
Bernard said, “Mechanisms for fast-tracking emerging conditions have been in place since 2002, when the events of Sept. 11, 2001 led to a fast-tracking of E codes that describe sources of injury due to terrorist acts. When there was a threat of avian influenza in 2005, the government discussed the issue at the September 2005 C&M meeting, and created 488 Influenza due to identified avian influenza virus; however, this code did not become effective until Oct. 1 2007.”
As for the CPT® code choice, Raemarie Jimenez, CPC, CPC-I, CANPC, CRHC, director of exam content at the AAPC said, “The office visit code would be the appropriate evaluation and management code based on the documentation and level of service performed by the physician.”
The swine flu virus is susceptible to the prescription antiviral drugs oseltamivir (brand name Tamiflu®) G9019 Oseltamivir phosphate, oral, per 75 mg (for use in a Medicare-approved demonstration project) and zanamivir (brand name Relenza®) G9018 Zanamivir, inhalation powder, administered through inhaler, per 10 mg (for use in a Medicare-approved demonstration project). CDC has issued interim guidance for the use of these drugs to treat and prevent infection with swine influenza viruses. Interim guidance on infection control, treatment, and chemoprophylaxis for swine influenza is available on the CDC Web site.
U.S. clinicians should consider the possibility of swine flu infection in patients presenting with febrile respiratory illness so further investigations may be prompted.
If a patient is suspect of influenza that cannot be subtyped and meet the aforementioned criteria, the CDC requests clinicians to test for influenza and send positive influenza specimens to public health laboratories for further characterization. For testing, clinicians should:
- Obtain a nasopharyngeal swab from the patient;
- Place the swab in a viral transport medium;
- Refrigerate the specimen (do not freeze); and then
- Contact their state or local health department to facilitate transport and a timely diagnosis at a state public health laboratory.
State public health laboratories should promptly send all influenza A specimens that cannot be subtyped to the CDC, Influenza Division, Virus Surveillance and Diagnostics Branch Laboratory. The CDC is working with other partners to develop a vaccine seed strain specific to the recent human swine flu viruses.
This is a rapidly evolving situation and the CDC says it will provide new information as it becomes available. Additional information about swine influenza is available on the CDC Web site.