Flu During Peak Season
It’s that time of year again—flu season. According to data from the Centers for Disease Control and Prevention (CDC), 43 states are experiencing high or widespread flu activity mostly due to the spread of the H3N2 virus. For the week ending December 27, 2014, visits for influenza-like illness accounted for 5.9% of all clinic visits. During this same week, overall flu-related hospitalizations were 12.6 per 100,000 people. In addition, six flu-associated pediatric deaths were reported.
Given the increased volume of flu-related cases, facilities and practices must ensure accurate documentation and coding. Coders must know how to code and sequence information gleaned from the diagnostic statement. In addition, they must be able to clarify documentation with physicians, when necessary.
Know How To Code Sepsis Due To Influenza
Sepsis is one of many complications that can occur when patients have influenza. When coders see ‘sepsis due to influenza,’ many pause to ask themselves the following: Should I report 079.99 (unspecified viral infection)? What about 038.9 (unspecified septicemia)? Or perhaps I should code 079.99 (unspecified viral infection) and 995.91 (sepsis)? What about 038.8 (other specified septicemias) or 487.8 (influenza with other manifestations)?
ICD-9-CM does not offer clear-cut guidance for coding sepsis due to influenza. Instead, coders should consider the following information to ensure compliant coding:
1. The Flu Patient Diagnosis
Identifying the patient’s actual diagnosis is critical. Ensure that physicians understand the differences between sepsis, systemic inflammatory response syndrome (SIRS), and septicemia—and that they document accordingly. The ICD-9-CM Official Guidelines for Coding and Reporting provide the following definitions:
- Septicemia: Generally refers to a systemic disease associated with the presence of pathological microorganisms or toxins in the blood, including bacteria, viruses, fungi, or other organisms
- SIRS: Generally refers to the systemic response to infection, trauma/burns, or other insult with symptoms including fever, tachycardia, tachypnea, and leukocytosis
- Sepsis: Generally refers to SIRS due to infection (Note: This definition states a blanket “infection” and does not exclude viral infection)
2. The ICD-9-CM Coding Book
Always reference the ICD-9 coding book and its indices when coding. When referencing septicemia and its subterm, virus, in the alphabetic index, coders are directed to code (079.99, unspecified viral infection). Note that the term sepsis does not include any subterms for virus/viral in the alphabetic index.
The tabular index states that codes from category 079 are used as an additional code to identify the viral agent in diseases classifiable elsewhere. This category also denotes the viral infection of unspecified nature or site.
The introduction section of Chapter 1, Infectious and Parasitic Diseases (001-139), also provides an excludes note for influenza (i.e., 487.0-487.8, 488.01-488.19).
3. Definitions in Dorland’s Illustrated Medical Dictionary
It’s important for coders keep the following definitions in mind. Physicians may use these definitions when documenting.
- Septicemia (category 038): A systemic disease associated with the presence and persistence of pathogenic microorganisms or their toxins in the blood.
- Microorganisms: Refers to microscopic organisms. Those of medical interest include bacteria, viruses, fungi, and protozoa.
4. Coding Clinic References
Coding Clinic references are also important. Coders should review these references and keep them in mind at all times when coding complications of the flu.
- Coding Clinic, 2nd quarter 2005, pp. 18-19: The scenario refers to an inpatient admitted with acute influenza who later deteriorates and develops septic shock and pneumonia. The coder is directed to code 487.0 (influenza with pneumonia), 038.9 (unspecified septicemia), and 995.92 (SIRS).
NOTE: This Coding Clinic reference appears to indicate sepsis due to influenza is coded to category 038.
- Coding Clinic, 3rd quarter 2012, pp. 11-12: This scenario pertains to a patient with sepsis due to urinary tract yeast (Candida) infection. The coder is directed to code 112.5 (disseminated Candidiasis). There is an additional notation that category 038 (septicemia) is meant to “classify bacterial infections; whereas candidiasis is a mycotic infection.”
NOTE: The reference states that category 038 is meant to classify bacterial infections. It does not specifically exclude viral infections. Viral infections are included in Dorland’s definition of septicemia. In addition, Candidiasis is not coded to 038 because a separate and established systemic infection code exists—i.e., code 112.5. A separate and established code for sepsis due to influenza does not exist.
Coding Clinic no longer accepts coding questions related to ICD-9-CM. This means that between now and October 1, 2015, coders must continue to use the resources and guidance that currently exist. However, as coders dual code and prepare for ICD-10, they should note any and all documentation and coding challenges that require official clarification and submit these questions directly to Coding Clinic.
What are your thoughts? What’s your interpretation of this coding dilemma?
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