With cold and flu season already upon us, you’re probably starting to see an increase in patient volume with people complaining of stuffy noses, coughs, sore throats, and more. Not only will you need enough staff to handle the uptick; you’ll also need strong financial management of patient accounts receivable (A/R).
The most effective strategy?
Take the time to review cold and flu-related billing codes to promote revenue integrity and reduce denials. The goal is to get clean claims out the door as quickly as possible and make sure those claims are paid accurately and in a timely manner.
Consider these five medical coding tips to keep your A/R on track during the 2022-2023 cold and flu season:
- Promote specific documentation. Is it the common cold or is it the flu? According to the Centers for Disease Control and Prevention, influenza and the common cold are both contagious respiratory illnesses. However, they are caused by different viruses and present differently in terms of symptoms. They also each have their own set of medical codes. Of course, physicians should document the specific diagnosis; however, in case they don’t, you’ll need to query. Even once you know whether it’s the flu or common cold, you may still need to query for additional information to ensure you pick the right code. Note that physicians should also document any environmental or occupational factors that may play a role (e.g., smoking history, second-hand smoke exposure, active smoking, COPD, or emphysema).
- If it’s a cold, choose ICD-10-CM code J00. This code denotes acute nasopharyngitis (i.e., the common cold). You can also report this code if the physician documents acute rhinitis, coryza (acute), infective nasopharyngitis not otherwise specified (NOS), infective rhinitis, acute nasal catarrh, or nasopharyngitis NOS.
However, note that there are certain codes you can’t ever report with J00. These include J02.- (acute pharyngitis); J02.9 (acute sore throat NOS and sore throat NOS); J09.X2, J10.1, and J11.1 (influenza virus with other respiratory manifestations); J02.9 (pharyngitis NOS); and J31.0 (rhinitis NOS).
- If it’s the flu, choose ICD-10-CM diagnosis code J09-, J10-, or J11-. The specific code you choose will depend on the cause of the influenza virus as well as any other manifestations that occur. For example, ICD-10-CM diagnosis code J09.X2 denotes influenza due to identified novel influenza A virus with other respiratory manifestations. ICD-10-CM diagnosis code J10.81 denotes influenza due to other identified influenza virus with encephalopathy.
- Pick the right ICD-10-CM diagnosis codes for other common conditions that occur during the winter months. The list is long, but we’ll share a few here:
- Acute sinusitis: J01-
- Acute pharyngitis: J02-
- Acute bronchitis: J20-
- Pneumonia: J12- through J18-
- Know what medical codes to report when administering the flu shot. The CDC recommends everyone six months of age and older be vaccinated against the flu ideally by the end of October. The good news that your medical practices will be paid more for giving these vaccinations this year. That’s because Medicare Part B payment allowances increased slightly for the 2022-2023 flu season. For Medicare and commercial patients, report ICD-10-CM code Z23 (encounter for immunization) on the claim along with the administration code G0008 (administration of influenza virus vaccine. For private payers, report 90460–90474 for the administration of the vaccine.
For more flu-related resources about Medicare frequency, coverage, billing, and coding, visit https://www.cms.gov/flu-provider.
Conclusion
As always, accurate coding requires careful attention to detail and monitoring of any denials. Providing proactive education is an essential part of ensuring a smooth A/R in your medical practice. Learn how Inbox Health can help at https://www.inboxhealth.com/.
Lisa A. Eramo, MA is a freelance healthcare writer who specializes in healthcare reimbursement, health information management, value-based care, and patient engagement. She contributes bylined articles to various healthcare trade publications and also assists clients with healthcare content marketing. You can reach her at lisa@lisaeramo.com or by visiting www.lisaeramo.com.