Pediatric Coding Alert

Question: A parent brings in a child with fever of 102.2°F, diarrhea, sore throat, chest pain, loss of appetite, stomach pain, and fatigue for two plus days.

The mother is concerned that the child may have contracted swine influenza. The physician coded influenza and sent a nasal swab sample to our state health department. What influenza diagnosis should I use with the level-three established patient visit?

Florida Subscriber

Answer: You should use the ICD-9 code for influenza (487.1, Influenza; with other respiratory manifestations). Influenzal pharyngitis (sore throat) and influenzal respiratory infection (upper) (acute) fall under 487.1. For influenza with involvement of gastrointestinal tract other than viral gastroenteritis (008.8), you would instead use a fourth digit of 8 to indicate influenza with other manifestations.

Your diagnosis would be the same, regardless of whether you had a confirmed diagnosis of swine flu (H1N1 flu) at the time you filed the claim with the insurer. ICD-9 guidelines call for you to code the diagnosis that is known at the end of the encounter:

influenza. ICD-9 2009 does not contain a specific diagnosis for swine flu. A confirmed diagnosis goes to the regular 487.x flu codes.