Cardiology Coding Alert

Confirmed Dx Is a Must Before Choosing 488.1

But 'confirmed' may not mean what you think it means.

Just because there's an H1N1 vaccine doesn't mean you won't see any cases of the flu, so you need to be prepared to fill in the proper diagnosis code.

ICD-9 2010 does provide a code for H1N1 (488.1,Influenza due to identified novel H1N1 influenza virus), but that doesn't mean you should use it automatically. The ICD-9 official guidelines instruct you to code only confirmed cases of novel H1N1 influenza virus using 488.1 (

Rule: Base your coding on the provider's diagnostic statement that the patient has novel H1N1 (H1N1 or swine flu) influenza. "In this context, 'confirmation' does not require documentation of positive laboratory testing specific for novel H1N1 influenza," according to the guidelines.

If the provider records suspected, possible, or probable H1N1 or swine flu, do not assign 488.1. Instead, you should use the appropriate influenza code from category 487.x (Influenza ...).

"In reality, to report a specific strain, one should have proof," says Philip Marcus, MD, at the St. Francis Hospital Heart Center in Roslyn, N.Y. "Otherwise, it's best to report influenza (487.x) and not speculate."

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