Template:ICD10 Recent Previous Pneumonia

This template provides guidance on how to code any type of pneumonia

To use: {{ICD10 Recent Previous Pneumonia}}

.

---

Guidelines for Recent Previous Pneumonia

• We have been reviewing our adjudication of VAP's using the CDC criteria. As a result we have tweaked some of our definitions and rules surrounding the coding of a PNA

• An important CDC guideline (Chapter 2 - Repeat Infection Timeframe (RIT)) is that if a pneumonia episode of any type is adjudicated to be present, then at least 14 days RIT must pass from its date of onset before another/different pneumonia episode (ie. VAP or HAP) can be identified as being present. This is the 14-day RIT and applies to both pneumonias present on infection AND hospital acquired pneumonias.
  • This holds even if the pathogens are different, including viral infections
  • This holds even if chest imaging shows infiltrates in different areas of the lungs
  • A relevant manifestation of this is if a patient is admitted with a pneumonia (so it's a CAP), and is intubated, the earliest a VAP may occur is on hospital day#14.
  • Day 1 of the RIT is the date of onset of the pneumonia.
  • The 14-day RIT does NOT re-start if a second pathogen is cultured during the RIT.

• If a patient had any pneumonia previously during the same admission and then develops pneumonia again, meeting the VAP criteria, it is only a VAP if:
  • (i) onset was at least 14 days after onset of the previous pneumonia, and
  • (ii) has new and persistent OR progressive and persistent infiltrates. and
  • (iii) there has been clinical resolution from the first episode, determined using best clinical judgement.

• • It is possible to have subsequent pneumonia episodes with the same organism as the prior pneumonia. This can occur due to colonization of the airways with pathogens. If the same original organism is cultured with the subsequent pneumonia episode BUT after the 14-day RIT, then clinical judgement must be used to determine that the first pneumonia episode has clinically improved/resolved prior to the second subsequent episode. If the first pneumonia has not completely been resolved clinically, then you should NOT code it as a VAP.
  • The same rules should apply for culture negative pneumonias. Clinical judgement will need to be used to ensure that the first pneumonia episode has resolved AND the VAP/HAP criteria are met AND the 14-day RIT has passed before a patient can have a subsequent pneumonia episode.

Example 1 - A patient is admitted with Strep pneumoniae pneumonia and intubated. On hospital day #7 (which is within the 14-day RIT) while intubated, there are clinical features of pneumonia and E. coli is cultured. This would be a single pneumonia episode with 2 pathogens - S. pneumoniae and E. coli, because the 14-day RIT has not passed.

Example 2 - An intubated patient develops a VAP with Stenotrophomonas maltophilia on hospital day 7. The patient is treated and clinically VAP resolves on hospital day 14. On hospital day 30 (which is past the 14-day RIT), the patient develops another VAP with new infiltrates, new clinical symptoms (which meet the pneumonia criteria) and Stenotrophomonas maltophilia is cultured again. This IS 2 separate VAP episodes, with the same organism.

Example 3 - An intubated patient is admitted and intubated with Strep pneumoniae pneumonia. Using best clinical judgement, the patient does NOT have clinical resolution of the first pneumonia, and has persistent infiltrates. On hospital day 16 (which is past the 14-day RIT), Strep pneumoniae is cultured again. This is NOT a separate VAP episode with the same organism.

Example 4 - An intubated patient is admitted and intubated with culture negative pneumonia. Using best clinical judgement, the patient does NOT have clinical resolution of the first pneumonia (ie. persistent leukocytosis, fevers, purulent secretions) and has persistent infiltrates. On day 16 (which is past the 14-day RIT), E. coli is cultured. This would NOT be a separate VAP because the first pneumonia did not appear to be resolved. IF however the patient DID have resolution of the first pneumonia using best clinical judgement, then develops progressive and persistent infiltrates and meets the other VAP criteria on day 16, then this IS a VAP.