VAP - Ventilator Associated 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, ventilator-associated (VAP)

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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-VAP (ventilator acq'd)
Diagnosis Code:	3900-Ventilator Associated Pneumonia
Comorbid Diagnosis:	No
Charlson Comorbid coding (pre ICD10):	0
Program:	Critical Care and Medicine
Status:	Currently Collected
Start Date:	July 1, 2006

• SEE: Collection Instructions

• see Quarterly report

• For other pneumonia we are also collecting see:

Pneumonia Etiology not clear (code 36-00)

CAP Community acquired pneumonia

HAP Hospital acquired pneumonia

• Page needs remodeling here ..........when I have time.......TOstryzniuk 19:05, 16 December 2008 (CST)

When to code VAP

Ventilator Associated Pneumonia (VAP) Criteria:

• NOTE: We are tracking HOSPITAL ACQUIRED VAP's & not patient's who have acquired an pneumonia while on long term home ventilators (LTV) in the community. If a LTV patient is admitted from the community with an pneumonia, they are to coded as Community Acquired Pneumonia (CAP). (as per Dr. Bruce Light).TOstryzniuk 17:38, 15 December 2008 (CST)

If a patient has been on a device to assist respiration (ventilator) continuously through a tracheostomy or endotracheal tube (ETT) for at least 48 hours before onset of infection

and if they demonstrate new, worsening or persistent infiltrate on x-ray compatible with pneumonia

and if at least one of the following criteria is met:

• Fever (T > 38) with no other cause
• Leukopenia WBC(<4X10(9)) or leukocytosis (>12x 10(9)).
• Altered mental status with no other causes in >69 year old.

and if at least one of the following criteria is met:

• New onset of purulent secretions
• Change in character of sputum
• Increased volume of purulent secretions
• Increased suction requirement
• New onset of worsening cough
• New onset of dypsnea (SOB) or tachypnea (increased Resp Rate)
• Increased oxygen or ventilation requirement

and if at least one of the following criteria is met:

• Pathogen isolated from sputum in the last 48 hours
• Positive blood cultures not related to another infection
• Positive pleural fluid culture.

Clarification of coding VAP when moving patients between units in the city

When coding VAP's they are coded as "complication" when they occur at a specific center. However, when these patients are transferred to other centers and the VAP is still being treated, then the VAP should be coded as part of the admitting diagnosis. When Julie looks at VAP rates in ICU's she only looks for the VAP code in the complication slots. The site where the patient had the VAP occur in complication codes is the site that is given the credit. A unit where a patient has a VAP in the admitting diagnosis is not included in stats for VAP rates. When a VAP appears in the admission code slots, Julie tracks back to where patient came from and makes sure that the ICU prior to the transfer, coded the VAP in their complications, if not, you will get a query to audit the diagnosis.

VAP acquired in ICU then transferred to Ward

• If a patient has a VAP in the ICU and is then transferred to the ward, should the ward code the VAP in the admit diagnosis also? I had been talking to the medicine data collectors about this issue and they said they were told not to code it as a VAP but as a HAP.
  • that is not correct.
  • When a VAP that had been acquired in ICU is not resolved when a patient is transferred to a Medicine ward, and it is still being treated on the Medicine ward then VAP should be an admitting diagnosis code. If VAP was resolved in the ICU before the patient was sent to the ward, then don't include in your diagnosis codes.TOstryzniuk 19:03, 16 December 2008 (CST)

Discussion - This instruction conflicts with "you can't code VAP on a med ward"

Template:Discussion There was an entry in Requested Changes to implement a check that would not let medicine collectors enter a VAP. If a VAP is to be entered in the above circumstance, this check can not be set up. Possibilities:

• explain in this discussion why/how this reasoning is wrong
• accept that the check can not be set up and delete this discussion
• change the instructions and re-add the request for the check to Requested CCMDB changes for the next version

I have deleted the entry from requested changes for now. Ttenbergen 16:55, 9 February 2010 (CST)

Arrived w community acquired pneumonia and develops VAP

• If the patient was admitted to VM with a community acquired pneumonia, then in ICU grows staph aureus and they now diagnose VAP and change antibiotics, the pneumonia is still active when patient discharged to medicine ward. Do I code it as VAP with staph aureus?WGobert 09:04, 16 December 2008 (CST)
  • Just so I am clear: the patient admitted from the community to ICU with primary DX of CAP. In ICU developed a secondary VAP. Sent down to ward with unresolved VAP which continued to be treated? believe this is what you are asking?
    • If pt from ICU with DX VAP then to medicine ward with ongoing VAP requiring continued treatment then YES, must be one of the admitting DX in medicine. If it is the primary reason for ward admission from ICU, then it should be in admit DX 1.
  • The ICU where the patient was first admitted and developed the "complication" of VAP is given the credit when Julie does stats reporting. Any patient who has VAP in their admitting DX code is not included in the reporting of unit acquired VAP's.TOstryzniuk 18:56, 16 December 2008 (CST)
    • Thanks Trish,just wasn't sure if I could code the VAP on medicine. As you know, we are still not using ventilators on our tower units.....kidding....but i wasn't sure. Norine and I discussed this patient, and with the criteria, have coded this patient as a CAP not a VAP. Thanks Wendy

Reporting of VAP when patients move units

When the Statistician links admissions in the database between ICU'a & medicine wards in the city, those patient that have VAP in admitting diagnosis are excluded from complication statistics. The patient encounter that had the VAP coded in the acquired diagnosis slot is the unit that is given credit for the complication occuring in that unit. TOstryzniuk 14:10, 16 June 2008 (CDT)

Discussion

Template:Discussion If a physician does not chart the DX of VAP but patient meets the criteria above for VAP, what do collectors do?

• • If the criteria all clearly show a VAP then the doctor should be informed about this. I find often the opposite happens, ie they call it a VAP when it does not meet all the criteria and in this case it is likely still a HAP. --LKolesar 15:26, 28 January 2011 (CST)
    • What are other collectors doing or finding at their site and do you review with attendings?--TOstryzniuk 13:42, 31 January 2011 (CST)
      • I have found the same as Laura re: sometimes the MD is saying VAP when it does not meet our criteria; so, I code it as a HAP. If it meets our criteria of VAP I code it as VAP and discuss with the charge/bedside nurse or MD on shift in the unit (usually not the attending)Mlaporte 16:52, 3 February 2011 (CST)
      • Need further feedback from other ICU's. Dr. Bojan Paunovic who is the acting ICU director had asked the question.--TOstryzniuk 19:35, 3 February 2011 (CST)