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: | |
| External ICD10 Documentation | |
This diagnosis is a part of ICD10 collection.
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?
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.
Follow Criteria Strictly for this one!
Data collectors should follow criteria listed below regardless of what a physician writes in chart as a DX. 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.
If a patient has a Acquired Diagnosis / Complication of VAP, consider #VAP Attribution Transfer Rule and code QA Infection VAP if applicable.
Criteria
IF a patient has been on a device to assist respiration (ventilator) either continuously or intermittently through a tracheostomy or endotracheal tube (ETT) for at least 48 hours before #onset of infection, or new infection. Start counting the 48 hours from the time of intubation no matter where this intubation occurs before or during an admission to the ICU.
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 (not on the #Pathogen exclusion list) isolated from sputum in the last 48 hours
- Positive blood cultures not related to another infection
- Positive pleural fluid or lung tissue culture.
Timeframe for reviewing criteria
The time frame for looking at the VAP criteria is within 1-3 days on either side of when the positive culture was sent.
Additional Information
Onset of infection
The onset of an infection (pneumonia) can begin prior to the 48 hours on a ventilator. It is important to rule out these patients in the VAP criteria because often we do not have a positive culture sent until after the 48 hrs on a ventilator. If a patient has at least 2 symptoms from the list below within the first 48 hours on a ventilator, it is not a VAP because the onset of infection is prior to the 48 hour mark.
- CXR infiltrates (see #CXR implications
- increased WBC or fever (with no other infective source identified)
- starting to have purulent secretions
- increased ventilation requirements (for no other reason).
CXR implications
Whenever a positive sputum culture is reported, the data collector should check to see if this is, first of all, a pneumonia and then, to see if it is a CAP, HAP or VAP. If the CXR does not give evidence of a pneumonia, code it as (old: Tracheobronchitis)/(ICD10: Bronchitis, infectious or noninfectious/Respiratory disorder, postprocedure/postop NOS).
Infiltrates that are present on admission (ie CAP) need to persist/ worsen and also meet the VAP criteria to code VAP.
VAP Attribution Transfer Rule
If a patient meets all criteria of a VAP after the first 48 hours on your ICU, code VAP as a Acquired Diagnosis / Complication and enter QA Infection VAP .
If a patient meets all criteria of a VAP within the first 48 hours on your medicine ward of ICU, code VAP as an Admit Diagnosis, not as a Acquired Diagnosis / Complication. Don't enter a QA Infection VAP for these patients.
For these patients, inform the sending ICU collector to code the VAP in their Acquired Diagnosis / Complication and enter the QA Infection VAP.
If you code VAP as an Admit Diagnosis the statistician will track back to previous units until the one where the VAP was an Acquired Diagnosis / Complication is found. If no unit has the VAP as an acquired the data processor will contact you to clarify whether this is correct.
VAP can't be Medicine complication
VAP cannot be coded as a Acquired Diagnosis / Complication on a Medicine ward but can be used as an Admit Diagnosis if patient came from an ICU and requires ongoing treatment for this problem.
Pathogen exclusion list
The following organisms are excluded because they are common upper respiratory tract commensurable, colonizers or contaminants, and are unusual causes of VAP.
- Normal respiratory flora, normal oral flora, mixed respiratory flora, mixed oral flora, altered oral flora or any other similar results indicating isolation of commensal flora of the oral cavity or upper respiratory tract.
- Candida Species (specified or unspecified)
- Yeast (might be a HAP or CAP)
- coagulase-negative staphyllococcus species (specified or unspecified) except Staphylococcus aureus including MRSA
- Enterococcus species (specified or unspecified)
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 HAP or CAP.
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.)
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