Hospital-acquired pneumonia (HAP) in ICD10: Difference between revisions
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{{ICD10 coding guideline}} | {{ICD10 coding guideline}} | ||
== Coding instructions == | == Coding instructions == | ||
* HAP is | *HAP, Hospital-acquired pneumonia, is a category of nosocomial pneumonia that is contracted by a '''non-ventilated''' patient after at least 48 hours of being admitted to a hospital. | ||
*To code HAP, you must [[Combined ICD10 codes | combined coding]] 3 separate ICD10 codes: | |||
** (1) '''[[Iatrogenic, complication of medical or surgical care NOS]]''' ''PLUS'' | ** (1) '''[[Iatrogenic, complication of medical or surgical care NOS]]''' ''PLUS'' | ||
** (2) One of the codes for | ** (2) One of the codes for SPECIFIC TYPES OF PNEUMONIAS: | ||
***[[Pneumonia, bacterial]] | ***[[Pneumonia, bacterial]] | ||
***[[Pneumonia, fungal/yeast]] | ***[[Pneumonia, fungal/yeast]] | ||
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***[[Pneumonia, NOS]] | ***[[Pneumonia, NOS]] | ||
** (3) relevant [[Pathogens]], possibly [[Infectious organism, unknown]] or an NOS | ** (3) relevant [[Pathogens]], possibly [[Infectious organism, unknown]] or an NOS | ||
*The concept of "early onset" HAP is not an accepted one (and not one we will use), because BY DEFINITION, to be HAP the patient must have been in hospital >48 hours and THEN developed the clinical signs/symptoms of pneumonia. | |||
*To decide about whether a HAP (or a CAP) has occurred, requires clinical correlation. | |||
**For example, sputum is 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== | ||
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* Patients from [[Grace Nursing Home Ward]] - even though this is considered a nursing home type ward, for patients who acquire a pneumonia and meet the HAP criteria '''code HAP'''. | * Patients from [[Grace Nursing Home Ward]] - even though this is considered a nursing home type ward, for patients who acquire a pneumonia and meet the HAP criteria '''code HAP'''. | ||
==Pneumonia develops less than 48 hours of receiving patient to your unit from another inpatient unit== | ==Pneumonia develops less than 48 hours of receiving patient to your unit from another inpatient unit== | ||
Revision as of 09:35, 2018 July 12
| This page contains an ICD10 Coding Guideline for ICD10 collection. See ICD10 coding guidelines for similar pages. |
Coding instructions
- HAP, Hospital-acquired pneumonia, is a category of nosocomial pneumonia that is contracted by a non-ventilated patient after at least 48 hours of being admitted to a hospital.
- To code HAP, you must combined coding 3 separate ICD10 codes:
- (1) Iatrogenic, complication of medical or surgical care NOS PLUS
- (2) One of the codes for SPECIFIC TYPES OF PNEUMONIAS:
- (3) relevant Pathogens, possibly Infectious organism, unknown or an NOS
- The concept of "early onset" HAP is not an accepted one (and not one we will use), because BY DEFINITION, to be HAP the patient must have been in hospital >48 hours and THEN developed the clinical signs/symptoms of pneumonia.
- To decide about whether a HAP (or a CAP) has occurred, requires clinical correlation.
- For example, sputum is 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
Additional Info
- If there is insufficient criteria for a Pneumonia, ventilator-associated (VAP) in ventilated patients with positive cultures, the patient may still have HAP.
- Patients from Grace Nursing Home Ward - even though this is considered a nursing home type ward, for patients who acquire a pneumonia and meet the HAP criteria code HAP.
Pneumonia develops less than 48 hours of receiving patient to your unit from another inpatient unit
- If a patient is transfered from another ward and develops HAP positive culture within 48 hours of tranfer to your unit then the HAP belongs to the sending facility/ward/ICU and should be in your admit diagnosis not acquired? Please give direction.