2025 ICD-10-CM code J11
(Active) Effective Date: N/A Diseases of the respiratory system - Influenza and pneumonia (J09-J18) Diseases of the respiratory system (J00-J99) Feed
Influenza due to an unidentified influenza virus.
Medical necessity for this diagnosis is established by the presence of signs and symptoms consistent with influenza.The lack of virus identification does not negate the medical necessity of treating the patient for influenza.
Clinicians diagnosing and treating patients presenting with influenza symptoms are responsible for accurately documenting the clinical findings and, if necessary, ordering appropriate tests to identify the causative agent.
In simple words: This code represents a diagnosis of the flu, caused by an influenza virus, but the specific type is unknown.
This code signifies an infection caused by an influenza virus where the specific type of virus has not been identified.
Example 1: A patient presents with fever, cough, muscle aches, and fatigue.The physician diagnoses influenza, but the specific virus is not identified through testing. J11 is used., A patient with a history of asthma experiences an exacerbation of symptoms, including wheezing and shortness of breath, along with fever and cough. The physician suspects influenza as a contributing factor but does not perform viral testing. J11 is appropriate., A child develops a sudden onset of fever, chills, and a runny nose. The pediatrician diagnoses influenza based on clinical presentation, but further testing to subtype the virus is not deemed necessary.J11 is assigned.
Documentation should include the patient's signs and symptoms, such as fever, cough, body aches, and fatigue.If any tests were performed to identify the influenza virus, the results should be documented.If testing was not performed, the rationale for not testing should also be included.
** For cases where influenza is identified as due to a specific virus, use codes J09-J10.Consider additional codes to identify exposure to tobacco smoke (Z77.22), history of tobacco dependence (Z87.891), or tobacco use (Z72.0) if relevant.
- Specialties:Internal Medicine, Family Medicine, Pediatrics, Infectious Disease
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Emergency Room - Hospital, Urgent Care Facility, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home