Q&A: Sequencing for influenza, pneumonia, and asthma

Q: I am never sure of correct sequencing when the admission is for flu, pneumonia, and asthma. Can you suggest proper sequencing, and if queries are needed?  

A: Per the Official Guidelines for Coding and Reporting, only confirmed cases of influenza are coded. No laboratory tests are required, just the diagnostic statement by the provider that the patient has influenza. In ICD-10, there are combination codes that represent both influenza and its manifestations, such as pneumonia.

Provider documentation linking the conditions is necessary to use these combination codes, so a query may be needed if the documentation is not present in the chart. When a patient has both influenza and pneumonia due to the influenza, per coding conventions, the influenza will be sequenced first, under code J14 Pneumonia due to H Flu. There is a “code first” note for associated influenza, if applicable. The influenza codes will map to different MS-DRGs depending on the combination code applied.

When pneumonia is documented, another reason for a query would be to identify the etiology of the pneumonia. Documented etiology could change the MS-DRG assignment. For example, if there is a bacterial organism causing the pneumonia, the identification of the organism could move a simple pneumonia to a complex pneumonia. 

The specificity needed with a diagnosis of asthma would be the frequency, severity, and any complications associated with it, such as an exacerbation or status asthmaticus. If any of these elements are missing, you would want to query the provider for the information. The documentation of asthma with acute exacerbation or status asthmaticus would give you a CC, and if both are present, per Coding Clinic, only the status asthmaticus would be coded.  

 Editor’s Note: Sharme Brodie, RN, CCDS, AHIMA-approved ICD-10-CM/PCS trainer, CDI education specialist and CDI Boot Camp instructor for HCPro in Danvers, Massachusetts, answered this question. For information, contact her at sbrodie@hcpro.com. For information regarding CDI Boot Camps offered by HCPro, visit www.hcprobootcamps.com/courses/10040/overview.