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

Certified Emergency Department Coder CEDC

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.”

Treatment Options

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.

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20 Responses to “Swine Flu Prompts Coding Concerns”

  1. Francine says:

    Are there any ICD 9 diagnosis code that the CDC is recommending providers to use for screening of swine flu, with or without symptoms?

  2. Lisa says:

    I would think that ICD-9 code V73.89 would work for screening of swine flu.

  3. Erica says:

    Lisa, I would disagree with that. You don’t bill for a screening when patient presents with signs and symptoms. (See the official ICD-9 Coding Guidelines). If pt has symptoms of swine flu without a definitive diagnosis made during the encounter, code the symptoms. Thanks

  4. Scott says:

    I would state that you are both correct. The diagnosis for the presenting symptoms should be coded and even URI if the doctor gets more definitive, but when the additional work of testing for the strain is done you should report it and indicate the additional work. Show your screen code after and in addition to the primary codes listed.

  5. ann says:

    would any one be able to tell me a procedure code to use for the nasal swab testing

  6. Susan says:

    Hi Ann –

    You should find what you need under Influenza in CPT – the answers you need are the first listed codes under Influenza

  7. Renee White says:

    Hello Ann,

    When the test is performed in the physician’s office report 87804-QW for RAPID influenza A & B nasal swab and link the appropriate diagnoses for signs & symptoms. If the RAPID results are positive for influenza A and a second nasal is performed then check with your lab to see what code they what you to use and link it to ICD-9 code 487.1 influenza NOS.

  8. Susan Lippman says:

    there are 2 codes to use for billing the nasal swab for influenza the first on is 87276 & 87275 using mod 50. As far as ICD’s go you can use 079.99 for viral syndrome. Please remember to modify the E&M with a 25 first.

  9. Renee says:

    Hello Susan,

    CPT codes 87276 and 87275 are not CLIA waived so they cannot be perfomed in the physician’s office setting however they may be report by a “laboratory” please review CMS link below that instructs you to use CPT code 87804-QW for the RAPID influenza A&B nasal swab.

    http://www.cms.hhs.gov/CLIA/downloads/waivetbl.pdf

    What is a CLIA waiver?

    Every laboratory test has its own unique requirements. Certain tests can be highly complex and may require specialized equipment. If these tests satisfy certain conditions they can be exempt or waived from all regulatory procedures. In other words, these tests are cleared by FDA and can be performed at home. Most of these tests are very simple to carry out and use standardized equipment, which makes chances of an inaccuracy impossible. Such tests are referred to as a CLIA waived.

  10. Renee says:

    Hello Susan,

    CPT codes 87276 and 87275 are not CLIA waived so they cannot be performed in the physician’s office setting however they may be reported by a “laboratory” please review CMS link below that instructs you to use CPT code 87804-QW for the RAPID influenza A+B nasal swab.

    http://www.cms.hhs.gov/CLIA/downloads/waivetbl.pdf

  11. Brittany says:

    Okay, so have we come to a decision of what to code for?? It seems there is alot of contradicting suggestions. Can someone definitively tell me the CPT and Dx codes for the swine flu swab? please?

  12. linzsey says:

    Use the information you have in the documentation and then utilize all of your coding references to come of with the BEST codes for the situation. Each scenerio would be different, the setting, provider, patient symptoms or lack thereof – maybe the patient only suspects they have been exposed to a virus or some influenza. Fellow -coders, this is where YOUR PERSONAL EXPERTISE comes in. We are professionals, and we should not expect someone else to give us the answers to our coding quadries without having to research for yourself and working with your payor to make sure your services are captured as completely and truthfully as possible. Understand that all of the coding questions have not been asked yet, neither have all the answers been hashed out. This is a work in progress and we (CPCs, RHITs, CCPs and other coding professionals) are instrumental in the furtherment of our profession as medicine and technology progresses.

    The answer is, Brittany, make friends with your coding books and references and dig in there and increase your knowledge about this new medical occurance. Happy coding!!!!

  13. florence says:

    Effective 10/1/2009 there will be a specific diagnosis code for H1N1 “swine” flu – 488.1
    New ICD9 codes are available on the CMS web site.

  14. MIRTA BRADY says:

    would it be appropriate to code the V12.09 for a patient who was treated for the swine flu and recuperated?

  15. Connie Mitchell says:

    we are a Family Practice and will be administrating the Swine vaccine as soon as it is available. Would use of the CPT code 90663 be appropriate?

  16. Gerry Olenick says:

    Does any one have a CPT code for the collection of the nasal specimen “nasal swab” – not the testing for the flu just the collections of the specimen?

  17. Sheri Greeen says:

    I am also looking for a CPT code for the collection of the nasal specimen “nasal swab” – no test done in office, just collecting the specimen.

  18. Marie says:

    we are also needing assistance with CPT for nasal swab–not the rapid test–sending out to lab for testing –help !! thanks

  19. Jessica says:

    I am looking for clarification on diagnosis code. When we swab (87804) we are testing for Influenza A & B. When they are positive for A do we code for swine flu?

  20. Debbie says:

    I am looking for clarification on the diagnosis code that needs to be used. We perform the 87804 and 87804-59 for influenza A & B. When the flu A is positive, do we still use the 487.1 until we have a confirmation of swine flu? thanks!

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