Pneumonia, ventilator-associated (VAP)
| ICD10 Diagnosis | |
| Dx: | Pneumonia, ventilator-associated (VAP) |
| ICD10 code: | J95.88 |
| Pre-ICD10 counterpart: | VAP - Ventilator Associated Pneumonia |
| Charlson/ALERT Scale: | none |
| APACHE Como Component: | none |
| APACHE Acute Component: | none |
| Start Date: | |
| Stop Date: | |
| Data Dependencies(Reports/Indicators/Data Elements): | No results |
| External ICD10 Documentation | |
This diagnosis is a part of ICD10 collection.
Additional Info
- This code supercedes the codes for bacterial, fungal and viral pneumonias. For example, if the patient qualifies for having a bacterial VAP, you code the VAP linked to the bug, and you do NOT have to code Pneumonia, bacterial.
- Data collectors should follow criteria listed below regardless of what a physician writes in chart. If patient meets criteria VAP below, code as VAP. If patient does not meet all listed criteria, then do not code as VAP. It may qualify as a HAP or CAP.
- The only way VAP can be coded on a medicine ward is if (see criterion#1, below) the patient's MV ended that day or the prior day in an ICU AND he/she met all the criteria.
Onset of infection
- It's tricky but important to try and ensure that the pneumonia was not present prior to the onset of MV.
- So, for example, a person who has been on MV for only 1 or 2 calendar days before identification of a pneumonia, by definition cannot have VAP, so it must be one of the other forms of pneumonia (CAP or HAP).
Attribution of the VAP to a 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 on the day of transfer OR the next day, the infection is attributed to the location from which they were transferred.
- The CDC case definition explicitly states that these rules should be followed -- that the physician’s statement of where the infection was acquired should not be substituted for these rules.
Criteria
Must meet all of #1, AND #2, AND #3, AND #4A or #4B
1. VAP is an infectious pneumonia in a patient who, as of the day it was identified (“day of event”) had been on mechanical ventilation for >2 calendar days
- The mechanical ventilation must be delivered via an endotracheal tube or tracheostomy.
- e.g: if MV is started on Tuesday, first day that that VAP can occur is Thursday.
- It can occur on the day MV ends or the day following MV ends IF the MV had been in place already for >2 calendar days before ending.
2. Has at least ONE of the following 3 things:
- Fever > 38.0
- WBC<4000 or >12,000
- If >70 years old, altered mental status without another recognized cause
3. Chest imaging (X-ray) study or studies showing at least ONE of the following 3 things, that must be new & persistent OR progressive and persistent:
- Infiltrate
- Consolidation
- Cavitation
4A. Has at least TWO of the following 4 things (this criteria does not require a positive culture, though it's OK to have one):
- New onset of purulent sputum or change in character of sputum, or increased respiratory secretions, or increased suctioning requirements.
- New onset or worsening cough, or dyspnea, or tachypnea
- Rales or bronchial breath sounds.
- Worsening gas exchange -- e.g., O2 desaturations (e.g., PaO2/FiO2 <240), increased oxygen requirements, or increased ventilator demand
4B. Meets both of 4B Part 1 & 4B Part 2:
- 4B Part 1: Has at least ONE of the following 4 things:
- New onset of purulent sputum or change in character of sputum, or increased respiratory secretions, or increased suctioning requirements.
- New onset or worsening cough, or dyspnea, or tachypnea
- Rales or bronchial breath sounds.
- Worsening gas exchange -- e.g., O2 desaturations (e.g., PaO2/FiO2 <240), increased oxygen requirements, or increased ventilator demand
- 4B Part 2: Has at least ONE of the following 11 things:
- Organism identified from blood (see pathogen exclusion list, below)
- Organism identified from pleural fluid (see pathogen exclusion list, below)
- Positive quantitative culture, performed according to accepted protocols, from bronchoalveolar lavage or protected brush specimens (see pathogen exclusion list, below)
- >5% of cells obtained from bronchoalveolar lavage contain intracellular bacteria on direct microscopic exam
- Positive culture of lung tissue (see pathogen exclusion list, below)
- Histopathologic exam of lung tissue identifies abscess formation, or foci of consoliation with intense PMN accumulation in bronchioles and alveoli
- Histopathologic exam of lung tissue identifies lung invasion of fungal hyphae or pseudohyphae
- Virus, Bordetella, Legionella, Chlamydia or Mycoplasma identified from respiratory secretions or tissue by a culture or non-culture based microbiologic testing method
- Fourfold rise in paired sera (IgG) for pathogen (e.g., influenza viruses, Chlamydia)
- Fourfold rise in Legionella pneumophila serogroup 1 antibody titer to ≥1:128 in paired acute and convalescent sera by indirect IFA.
- Detection of L. pneumophila serogroup 1 antigens in urine by RIA or EIA
- In an immunocomprimised patient: identification of matching Candida from blood and sputum, endotracheal aspirate, BAL or protected specimen brushing.
- In an immunocomprimised patient: Evidence of fungi from BAL or protected specimen brushing) from one of the following:
VAP Pathogens Excluson List
- Normal respiratory flora
- Normal oral flora
- Mixed respiratory flora
- coagulase-negative staph species (includes S. epidermidis, does not include S. aureus)
- Enterococcus species
- Blastomyces species (blasto)
- Histoplasma species
- Coccidioides species
- Paracoccidioides species
- Cryptococcus species
- Pneumocystis species
- Patients might be treated for infection with these pathogens, but we should still not code them as VAP. In that case you might be able to code it as a Hospital-acquired pneumonia (HAP) in ICD10 or Community-acquired pneumonia (CAP) in ICD10.
new info?
Searched for the CDC document and found this. The document is from January 2017. Are there any changes to what was used before that we need to integrate into our documentation?
For these patients, inform the sending ICU collector to code the VAP in their Acquired Diagnosis / Complication and enter the QA Infection VAP.
Recurrent/ongoing pneumonia
If a patient had any pneumonia (incl HAP or CAP previously during the same admission and then develops pneumonia again, meeting the VAP criteria, it is only a VAP if it is a new organism and has persistent or worsening infiltrates. If it is the same original organism, then the pneumonia has not completely been resolved. Do not code these as a VAP.
Long term ventilator patients with pneumonia
If a LTV patient is admitted from the community with an pneumonia, Community Acquired Pneumonia (CAP) should be coded as Admit Diagnosis, not VAP, even though it is technically a VAP.
We are tracking Hospital Acquired VAP's, not patients who have acquired an pneumonia while on long term home ventilators (LTV) in the community.
After 48hrs in the hospital an LTV patient could still become a VAP as an Acquired Diagnosis / Complication.
Data use
Used in:
Reporting of complication when patients move units
The Ventilator Associated Pneumonia Rate we report are based only on Acquired Diagnosis / Complication occurring in a unit. If VAP is coded as an Admit Diagnosis, we check if the patient came from one of the ICUs where we collect data, and if so, make sure that the VAP is coded as a Acquired Diagnosis / Complication and QA Infection VAP there.
If a VAP Admit Diagnosis doesn't have a corresponding Acquired Diagnosis / Complication in the previous unit, the data processor will ask the collector to audit.
Alternate ICD10s to consider coding instead or in addition
| Pneumonia codes: |
Candidate Combined ICD10 codes
(put links to likely candidates coded with this one, eg. a cause for a trauma.)
Related Articles
Show all ICD10 Subcategories