2025 ICD-10-CM code J11.8
(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 unidentified influenza virus with other manifestations.
Medical necessity for the use of J11.8 is established by the physician's clinical judgment that the patient's symptoms and presentation are consistent with influenza, even in the absence of a positive test for a specific virus.The documentation should support this diagnosis.
The physician is responsible for diagnosing influenza based on the patient's symptoms and clinical presentation, along with ruling out other potential causes.They are also responsible for appropriate management, which can include antiviral medications, supportive care, and monitoring for complications.
- Diseases of the respiratory system (J00-J99)
- J11 - Influenza, virus not identified J11.0 - Influenza with pneumonia, virus not identified J11.1 - Influenza with other respiratory manifestations, virus not identified J11.8 - Influenza with other manifestations, virus not identified
In simple words: This code indicates the flu caused by an unknown flu virus, with symptoms beyond typical respiratory issues like cough or pneumonia.
This code represents influenza caused by an unspecified influenza virus, presenting with manifestations other than pneumonia or other respiratory symptoms.
Example 1: A patient presents with fever, myalgia, fatigue, and gastrointestinal symptoms like nausea and vomiting.Respiratory symptoms are mild.Testing for specific influenza viruses is negative. The physician diagnoses influenza with other manifestations, virus not identified (J11.8)., A child presents with high fever, seizures (febrile convulsions), and lethargy.Respiratory symptoms are absent. Influenza tests are negative. J11.8 is used to code the influenza diagnosis with other (neurological) manifestations., An elderly patient with a history of heart disease experiences worsening heart failure symptoms during a period of influenza-like illness.Respiratory symptoms are not prominent. Influenza tests are inconclusive. J11.8 may be used in conjunction with the heart failure code, recognizing the influenza's contribution to the exacerbation.
Documentation should include the patient's symptoms, history of present illness, relevant physical exam findings, and results of any influenza testing.If other organ systems are involved, these findings should also be clearly documented.
** For cases where a specific influenza virus is identified, use the appropriate code under J09-J11. Consider using additional codes (such as Z77.22 for exposure to environmental tobacco smoke) if relevant to capture the patient's complete clinical picture.
- Payment Status: Active
- Specialties:Internal Medicine, Family Medicine, Pediatrics, Infectious Disease, Emergency Medicine, Geriatrics
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Emergency Room - Hospital, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home