Template:ICD10 Recent Previous Pneumonia

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

To use: {{ICD10 Recent Previous Pneumonia}}

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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.

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

• 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.

• • It is possible to have subsequent pneumonia episodes with the same organism as the prior pneumonia. 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, and you should NOT code it as a VAP.
  • The same rule 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 - 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 and Stenotrophomonas maltophilia cultured again. This IS 2 separate VAP episodes with the same organism.

Example 2 - An intubated patient is admitted and intubated with Strep pneumoniae pneumonia. The patient does NOT have clinical resolution, 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.