Pneumonia, NOS: Difference between revisions
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*The diagnosis of VAP '''[[Pneumonia, ventilator-associated (VAP)]]''' supercedes this code. | *The diagnosis of VAP '''[[Pneumonia, ventilator-associated (VAP)]]''' supercedes this code. | ||
*To code hospital-acquired pneumonia NOS, link this code with '''[[Iatrogenic, complication of medical or surgical care NOS]]''' | *To code hospital-acquired pneumonia NOS, link this code with '''[[Iatrogenic, complication of medical or surgical care NOS]]''' | ||
**Without that other code, it represents a CAP. | **Without that other code, it represents a CAP. | ||
*To decide about whether a CAP or HAP has occurred, requires clinical correlation. | |||
**For example, sputum is almost never sterile -- bug will always grow from it. It's even true that bronchoscopic lower respiratory samples are almost never sterile, which is why quantitative culture is used to interpet them. THUS, respiratory fluid that grows bugs cannot by itself be used to interpret the presence of pneumonia EXCEPT in the rare cases of bugs that are NEVER pathogens in the respiratory system -- that list is mainly limited to: TB, Legionella, and Pneumocystis jiroveci. Thus, a (+) sputum culture can almost never by itself be used to identify the presence of a pneumonia. Instead, it's a combination of clinical signs such as fever, leukocytosis and new (or presumed new) CXR changes that helps to figure it out. Indeed, one can diagnose CAP or VAP in the absence of a (+)sputum culture in the right situation (e.g. patient has been on antibiotics for some reason prior). | |||
== Alternate ICD10s to consider coding instead or in addition == | == Alternate ICD10s to consider coding instead or in addition == | ||
Revision as of 10:37, 2018 July 12
| ICD10 Diagnosis | |
| Dx: | Pneumonia, NOS |
| ICD10 code: | J18 |
| Pre-ICD10 counterpart: | CAP-Community Acquired Pneumonia, HAP-Hospital Acquired Pneumonia, VAP - Ventilator Associated Pneumonia |
| Charlson/ALERT Scale: | none |
| APACHE Como Component: | none |
| APACHE Acute Component: | 2019-0: Respiratory Infection |
| Start Date: | |
| Stop Date: | |
| External ICD10 Documentation | |
This diagnosis is a part of ICD10 collection.
Additional Info
- Mainly, this code is used when it's believed an infectious pneumonia is present, but even the type of organism is not known.
- The diagnosis of VAP Pneumonia, ventilator-associated (VAP) supercedes this code.
- To code hospital-acquired pneumonia NOS, link this code with Iatrogenic, complication of medical or surgical care NOS
- Without that other code, it represents a CAP.
- To decide about whether a CAP or HAP has occurred, requires clinical correlation.
- For example, sputum is almost never sterile -- bug will always grow from it. It's even true that bronchoscopic lower respiratory samples are almost never sterile, which is why quantitative culture is used to interpet them. THUS, respiratory fluid that grows bugs cannot by itself be used to interpret the presence of pneumonia EXCEPT in the rare cases of bugs that are NEVER pathogens in the respiratory system -- that list is mainly limited to: TB, Legionella, and Pneumocystis jiroveci. Thus, a (+) sputum culture can almost never by itself be used to identify the presence of a pneumonia. Instead, it's a combination of clinical signs such as fever, leukocytosis and new (or presumed new) CXR changes that helps to figure it out. Indeed, one can diagnose CAP or VAP in the absence of a (+)sputum culture in the right situation (e.g. patient has been on antibiotics for some reason prior).
Alternate ICD10s to consider coding instead or in addition
| Pneumonia codes: |
Candidate Combined ICD10 codes
- Add Iatrogenic, complication of medical or surgical care NOS to make viral hospital-acquired pneumonia
Infections
Infections in ICD10 have combined coding requirements for some of their pathogens. Any that have antibiotic resistances would store those as Combined ICD10 codes as well. If the infection is acquired in the hospital, see Nosocomial infection, NOS. See Lab and culture reports for confirmation and details about tests. See Infections in ICD10 for more general info.
Possible Simultaneous Presence of Multiple Different Types of Infection in a Single Site
- This refers to the situation where there may be simultaneous infection with multiple types of organisms -- e.g. 2 of bacteria, virus, fungus. While a classic example is a proven viral pneumonia (e.g. influenza) with a suspected/possible bacterial pneumonia superimposed, this kind of thing can occur in places other than the lungs, e.g. meningitis.
- The "signature" of this is typically the patient being treated simultaneously with antimicrobial agents for multiple types of organisms. BUT don't confuse this with there being infections at DIFFERENT body sites.
- As per our usual practice, we will consider a diagnosis as present if the clinical team thinks it's present and are treating it, with the exception that the team initially treated for the possible 2nd type of infection but then decided it likely was NOT present and stopped those agents.
- And remember that Infectious organism, unknown is used when the the specific organism is unknown (this could be not knowing the TYPE of organism, or suspecting the type but not having identified the specific organism of that type), while when the organism has been identified but it's not in our bug list, THEN use Bacteria, NOS, Virus, NOS or Fungus or yeast, NOS.
Attribution of infections
Related CCI Codes
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