2025 ICD-10-CM code J11.1
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Diseases of the respiratory system - Influenza and pneumonia (J09-J18) Diseases of the respiratory system (J00-J99) Feed
Influenza due to unidentified influenza virus with other respiratory manifestations.This code also encompasses influenza NOS, influenzal laryngitis NOS, influenzal pharyngitis NOS, and influenza with upper respiratory symptoms NOS.
The medical necessity for coding J11.1 is based on the clinical presentation consistent with influenza and the presence of other respiratory symptoms.Documentation should clearly support the clinical diagnosis and justify the use of this code.
Diagnosis and management of influenza and associated respiratory symptoms.This includes taking a thorough history, performing a physical examination, ordering appropriate laboratory tests (if necessary) to confirm diagnosis, and prescribing treatment based on the patient's clinical presentation and response to treatment.
In simple words: This code is for the flu when doctors can't tell exactly which type of flu virus it is, and the patient also has other breathing problems.It covers different flu types and related symptoms.
Influenza due to unidentified influenza virus with other respiratory manifestations. This ICD-10-CM code is used when influenza is present with other respiratory symptoms but the specific influenza virus type cannot be identified.It includes cases of influenza not otherwise specified (NOS), influenzal laryngitis NOS, influenzal pharyngitis NOS, and influenza with unspecified upper respiratory symptoms.Additional codes should be used to specify associated conditions like pleural effusion (J91.8) or sinusitis (J01.-).
Example 1: A 35-year-old presents with fever, cough, body aches, and a sore throat.The rapid influenza test is negative, but the clinical presentation strongly suggests influenza.J11.1 is used in this scenario since the specific viral strain is not identified., A 60-year-old with a history of COPD presents with worsening cough, shortness of breath, and increased sputum production. Influenza is suspected as a contributing factor to the exacerbation. J11.1 is coded along with codes for COPD exacerbation and any identified bacterial pneumonia., A 10-year-old child presents with fever, runny nose, cough, and hoarseness. The rapid influenza test is negative but the clinical picture is highly suggestive of influenza. J11.1 is assigned, acknowledging the presence of other upper respiratory symptoms.
Detailed history of present illness, including onset, duration, and character of symptoms. Physical examination findings documenting respiratory symptoms.Results of rapid influenza tests and any other relevant lab results. Treatment plan including medication, and any supportive care provided.
** This code should be used cautiously and only when the specific type of influenza virus cannot be determined.Ensure proper documentation to support the diagnosis.
- Payment Status: Active
- Specialties:Internal Medicine, Family Medicine, Pediatrics, Pulmonology, Infectious Diseases
- Place of Service:Office, Urgent Care Facility, Hospital Inpatient, Hospital Outpatient