Template:ICD10 Guideline Pneumonia

This template is used for in Pneumonia pages to explain when and how to code...

To use:

{{ICD10 Guideline Pneumonia}}

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VAP supersedes this code

• The diagnosis of VAP Pneumonia, ventilator-associated (VAP) supercedes this code.

HAP vs CAP

• For coding of hospital-acquired ICD10 Guideline Pneumonia, see Hospital-acquired pneumonia (HAP) in ICD10
• To decide about whether a CAP or HAP has occurred, requires clinical correlation.
  • For example, sputum is almost never sterile -- bugs 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 interpret them. THUS, respiratory fluid that grows bugs cannot by itself be used to interpret the presence of pneumonia EXCEPT in the rare cases of bugs 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).

In the context of COVID

Some special rules apply in the context of COVID infections, see COVID-19 (SARS-COV-2)#Coding of pneumonia in the context of COVID.

Possible Simultaneous Presence of Multiple Different Types of Pneumonia

• This usually refers to the situation where 1 type of pneumonia is "proven" and the clinical team is wondering about and presumptively treating the simultaneous presence of another type of organism. Examples:
  • Proven influenza pneumonia and the question of a superimposed bacterial pneumonia as indicated by the patient also being placed on antibacterials.
  • Proven COVID pneumonia and the question of a superimposed bacterial pneumonia as indicated by the patient also being placed on antibacterials.
  • These are tricky because it is pretty common that before the primary (proven type) has been proven, that a patient is put on multiple types of antimicrobials -- e.g. it's flu season and patient comes in with a diffuse infiltrate and signs of infection, and the ED starts anti-viral + antibacterial drugs. What often happens is that in the next few days the team decides it was only influenza and stops the antibiotics. As it would be very very uncommon to treat a true bacterial pneumonia for <7 days, in THIS case we will use the guideline to code a bacterial pneumonia if the antibacterial agent was given for >4 days or the patient died before the 5th day of antimicrobials.
• As per our usual practice, we will consider a diagnosis as present if the clinical team thinks it's present and are treating it, with the exception (as directly above) that the team initially treated for the possible 2nd type of pneumonia but then decided it likely was NOT present and stopped those agents.
• Regarding use of Pneumonia, NOS versus any of Pneumonia, bacterial, Pneumonia, viral, Pneumonia, fungal/yeast
  • Pneumonia, NOS should be used when there is a presumed pneumonia but the team is unsure what kind of organism is involved (bacteria, virus, fungus). So simply not having an organism from culture doesn't necessarily mean that Pneumonia, NOS should be used. If, for example, the team is assuming that it's a bacterial pneumonia (and treating it as such), but doesn't know which bacterium, then use Pneumonia, bacterial + Infectious organism, unknown
    • this example highlights that Infectious organism, unknown is used when the the specific organism is unknown (this could be either not even knowing the TYPE of organism), while when the organism has been identified but it's not in our bug list, THEN use Bacteria, NOS, Virus, NOS or Fungus or yeast, NOS.