Hospital-acquired pneumonia (HAP) in ICD10
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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 -- pathogen 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 pathogens cannot by itself be used to interpret the presence of pneumonia EXCEPT in the rare cases of pathogens 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).
Attribution of the HAP to a Hospital Location
- The infection is attributed to the location where the patient was on the date the infection became clinically evident -- EXCEPT if all
elements of the infection are present within the first 48 hours of arrival, the infection is attributed to the location from which they were transferred.
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.
RE:A pt with CAP on admission
Can a patient with unresolved CAP ever be coded as HAP if ETC cultures become positive for a new pathogen or is it always going to be CAP?
Do you need to follow the same guidelines for acceptable sources for cultures like for the VAP cultures?
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If a patient with CAP on admission that hasn't cleared but isn't ventilated for days then has to go on a ventilator then less than 48 hour ventilated develops a positive culture(quantitive bronchoscopically obtained) and a change in respiratory status can this be called HAP? Or are you saying it's CAP the whole admission? It seems according to the VAP quidelines patients with CAP can develop VAP under the right conditions so couldn't they also get HAP? Are you saying patients with CAP can never get HAP? I will give an example cases:
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RE:Aspiration and development of pneumonia less than 48 hours
What do we code if a patient didn't have pneumonia on admission and came in for some other reason. They aspirate on intubation less than 48 hours in hospital and develop pneumonia. How do you code that? Is it CAP?