A patient was seen in the provider’s office and diagnosed with influenza with pneumonia. The provider selected J18.9. Refer to the Tabular List to verify code J18.9. Is it correct to report code 118.9? Why?
a. Yes, code 118.9 is a combination code assigned to influenza with pneumonia.
b. No, there is a combination code J11.00 includes influenza with pneumonia.
c. Yes, because the provider selected 118.9, it must be reported.
d. No, the influenza code, J11.1 also needs to be reported on the claim.
The correct answer and explanation is:
The correct answer is: b. No, there is a combination code J11.00 includes influenza with pneumonia.
Explanation:
The ICD-10 code J18.9 refers to pneumonia, unspecified, which does not specify the cause of the pneumonia, such as influenza. However, the code J11.00 is the correct combination code for influenza with pneumonia, specifically caused by the influenza virus. It is important to use the most specific code to accurately reflect the patient’s condition.
Reasoning:
- Combination Codes: Combination codes are used to capture multiple conditions that are typically seen together. For influenza with pneumonia, the ICD-10 code J11.00 is a combination code that accounts for both the influenza virus infection and the pneumonia caused by it. This allows for more accurate reporting of the patient’s condition, as it combines both the viral infection and the resulting complication (pneumonia) into a single code.
- Correct Coding Practice: Reporting J18.9 alone is incorrect in this scenario because it only refers to pneumonia without specifying the underlying cause. In the case of a patient with both influenza and pneumonia, the influenza virus (J11.00) must be documented as the cause of pneumonia. This ensures that both the infection and its complication are correctly identified.
- Provider’s Selection: While the provider may have selected J18.9, it is important for coders to verify that the selected code accurately represents the diagnosis. If influenza is identified as the cause of the pneumonia, the coder should choose J11.00 instead of J18.9.
In summary, code J11.00 is the appropriate choice for a diagnosis of influenza with pneumonia. Reporting J18.9 would miss the underlying cause, potentially leading to inaccurate billing or a lack of specificity in the medical record.