ED Coding and Reimbursement Alert

If the physician is presuming H1N1, leave 488.1 off the claim. Diagnosis coding for patients who definitely have H1N1 influenza is easy enough: You now have 488.1 to represent patients with the condition. Problem: A patient is diagnosed with "possible H1N1," but the ED does not have the lab work to confirm it. Should the coder use 488.1 (Influenza due to identified novel H1N1 influenza)? Not necessarily. The 2010 ICD-9 coding guidelines instruct you to code only confirmed cases of novel H1N1 influenza virus (H1N1 or swine flu, code 488.1). "This is an exception to the hospital inpatient guidelines (Section II, H) (Uncertain Diagnosis)," states the 2009 ICDCM Official Guidelines for Coding and Reporting (www.cdc.gov/nchs/data/icd9/icdguide09.pdf). In cases where the diagnosis has not been confirmed by either laboratory testing or the physician's clinical certainty, then a code from the 487.x series is more appropriate. Rule: Coding should be based on [...]