Template:ICD10 Guideline Pneumonia: Difference between revisions

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=== HAP vs CAP ===

*To code hospital-acquired {{PAGENAME}}, link this code with '''[[Iatrogenic, complication of medical or surgical care NOS]]'''

** This contradicts the information given on the page[[Hospital-acquired pneumonia (HAP) in ICD10]], which states we are supposed to combine pneumonia with the code "Nosocomial infection, NOS". We need to delete or clarify these instructions

** {{Discuss | who = Allan | question =

*This contradicts the information given on the page[[Hospital-acquired pneumonia (HAP) in ICD10]], which states we are supposed to combine pneumonia with the code "Nosocomial infection, NOS". We need to delete or clarify these instructions --Michelle Lagadi, March 7.19}}

**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 -- bugs 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 interpret 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).

@@ Line 15: / Line 15: @@
 === HAP vs CAP ===
 *To code hospital-acquired {{PAGENAME}}, link this code with '''[[Iatrogenic, complication of medical or surgical care NOS]]'''
-** This contradicts the information given on the page[[Hospital-acquired pneumonia (HAP) in ICD10]], which states we are supposed to combine pneumonia with the code "Nosocomial infection, NOS". We need to delete or clarify these instructions
+** {{Discuss | who = Allan | question =
+*This contradicts the information given on the page[[Hospital-acquired pneumonia (HAP) in ICD10]], which states we are supposed to combine pneumonia with the code "Nosocomial infection, NOS". We need to delete or clarify these instructions --Michelle Lagadi, March 7.19}}
 **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 -- bugs 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 interpret 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).