CAP-Community Acquired Pneumonia

Legacy Content

This page is about the pre-ICD10 diagnosis coding schema. See the ICD10 Diagnosis List, or the following for similar diagnoses in ICD10:Pneumonia, bacterial, SARS (severe acute respiratory syndrome), Aspiration pneumonitis

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Category/Organ System:	Category: Infection (old)
Type:	[[:Category: Medical Problem (old)]][[Category: Medical Problem (old)]]
Main Diagnosis:	Pneumonia
Sub Diagnosis:	PNEUMONIA-CAP
Diagnosis Code:	3700 - CAP-Community Acquired Pneumonia
Comorbid Diagnosis:	No
Charlson Comorbid coding (pre ICD10):	0
Program:	CC & Med
Status:	Currently Collected

Note: Aspiration is not the important thing. Dr. Kumar. Trish Ostryzniuk 17:04, 2012 May 15 (CDT)

• Admit DX: CAP-Aspiration
  • if clear aspiration AND no pathogen was isolated from a culture drawn within 48 hours or less of admission. (culture will usually say normal flora or no organism)
• Admit DX CHANGE TO: CAP-with organism:
  • if a pathogen IS isolated from a culture drawn within 48 hour or less of admission.

If pathogen IS isolated from a culture drawn greater than 48 hours AFTER admission, code as a HAP with organism. Note: a sterile aspiration can become superinfected while in hospital.

• Trish Ostryzniuk 16:35, 2012 May 15 (CDT) as per Dr. Kumar reply on this date.

Template:Data Integrity Rules

A CAP is not allowed in acquired/complications. While in hospital a patient can acquire a VAP if ventilated or a HAP but not CAP. Rule added in version ver 2012-04-12.

Question

• When patients come in with COPD exacerbation and are put on oral antibiotics, do other collectors in city code as admitted with a CAP along with the COPD?
  • at HSC on wards, it is not the norm to see the written DX of CAP along with COPD exacerbation, yet or patient is prescribed antibiotics. Pat codes a CAP if on IV antibiotic but if prescribe oral antibiotics and not written DX of CAP, then she will not code as CAP. Pat says her interpretation is that it could it upper airway infection or even bronchitis, but Dr. has not committed to either DX. What do others do? Thank you for feedback-Trish Ostryzniuk 14:25, 2012 April 13 (CDT) & Pat Stein
• If patient is treated with antibiotics I code both COPD exascerbation and CAP because quite often their CXR cannot rule out an underlying pneumonia so the physicians will treat on spec (as they often chart it this way in the IPN).--CMarks 14:50, 2012 April 16 (CDT)
• I only code a CAP if the doctors are calling it a pneumonia. If anyone wants to research CAP's they should know that all COPD exacerbations are potentially a pneumonia.--LKolesar 08:33, 2012 April 17 (CDT)
• At the Vic, we will code a CAP on a COPD patient if the patient is on antibiotics AND a chest X-ray is showing infiltrates and indicates that a CAP is likely. Judy

Also see

• Pneumonia Etiology not clear
• HAP Hospital acquired pneumonia
• VAP Ventilator acquired/associated pneumonia