VAP - Ventilator Associated Pneumonia

Ventilator Associated Pneumonia is coded as dx ???

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)

Click Expand to show legacy content.

edit dx infobox
Category/Organ System:	Category: Pneumonia-VAP (vent acq'd) (old)
Type:
Main Diagnosis:	39-00
Sub Diagnosis:	Critical Care and Medicine
Diagnosis Code:	Currently Collected
Comorbid Diagnosis:
Charlson Comorbid coding (pre ICD10):
Program:
Status:

When to code VAP

Ventilator Associated Pneumonia (VAP) Criteria (based on NNIS definition)

• If a patient has been on a device to assist respiration continuously through a tracheostomy or ETT with the 48 hour period before onset of infection

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

and if one of the following criteria is met:

• Fever (T > 38) with no other cause
• Leucopenia (,4000 WBC/mm3) or leukocytosis (12000 WBC/mm3)
• Altered mental status with no other causes in >69 year old.

and if 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 or worsening cough
• New onset of dypsnea or tachypnea
• Increased oxygen or ventilation requirement

and if 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.

When not to code VAP

• Do not code a VAP if the criteria are not met as described in "When to code a VAP"--LKolesar 09:00, 17 June 2008 (CDT)

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.

Things to do before de-stubbing

• see dicussion page for a required clarification
• fill in when and when not to sections...

Discussion

• 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 HAP but as a HAP.
  • 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.
  • 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)