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Icd 10 Code For Pneumonia

Dry Eye Syndrome Of Unspecified Lacrimal Gland

How to Code Aspiration Pneumonia & PEG Placement in ICD-10 (Coding Tip by PPS Plus) – Aug 2016
    2016201720182019202020212022Billable/Specific Code
  • H04.129 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
  • The 2022 edition of ICD-10-CM H04.129 became effective on October 1, 2021.
  • This is the American ICD-10-CM version of H04.129 – other international versions of ICD-10 H04.129 may differ.
  • Applicable To annotations, or

Cms Will Implement 21 New Icd

The Food and Drug Administration recently approved baricitinib, a rheumatoid arthritis drug sold under the brand name Olumiant, for the treatment of COVID-19 in hospitalized patients when used in conjunction with remdesivir.

The new ICD-10 procedure codes will allow healthcare providers to document the use of the drug, as well as administration of potential COVID-19 vaccines, including second injections, and monoclonal antibodies and immunomodulators approved for use in infected patients.

Dig Deeper

CMS also assigned Medicare Severity-Diagnosis-Related Groups to six new ICD-10 diagnosis codes for conditions related to COVID-19, according to the latest news announcement on the agencys MS-DRG Classifications and Software webpage.

The codes that received MS-DRGs were for pneumonia due to COVID-19 multisystem inflammatory syndrome other systemic involvement of connective tissue encounter for COVID-19 screening suspected exposure to COVID-19 and personal history of COVID-19.

Providers will be able to report the ICD-10 diagnosis codes on medical claims on January 1, 2021, CMS announced.

The new ICD-10 procedure codes will not affect the MS-DRG assignment, the agency added.

CMS also noted in the announcement that Medicare will pay for the COVID-19 vaccines and their administration separately from the Diagnosis-Related Group rate.

So far, the emergency use authorization filed by Pfizer is on the agenda.

Diseases Of The Respiratory Systemnote

  • When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site .
    • certain conditions originating in the perinatal period
    • certain infectious and parasitic diseases
    • complications of pregnancy, childbirth and the puerperium
    • congenital malformations, deformations and chromosomal abnormalities
    • endocrine, nutritional and metabolic diseases
    • injury, poisoning and certain other consequences of external causes
    • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
    • code, where applicable, to identify:
    • exposure to environmental tobacco smoke
    • exposure to tobacco smoke in the perinatal period
    • history of tobacco dependence
    • occupational exposure to environmental tobacco smoke
  • allergic or eosinophilic pneumonia
  • aspiration pneumonia NOS
    • 2016201720182019202020212022Non-Billable/Non-Specific Code

    Code First

  • associated influenza, if applicable
    • abscess of lung with pneumonia
    • aspiration pneumonia due to anesthesia during labor and delivery
    • aspiration pneumonia due to anesthesia during pregnancy
    • aspiration pneumonia due to anesthesia during puerperium
    • aspiration pneumonia due to solids and liquids
    • aspiration pneumonia NOS
    • drug-induced interstitial lung disorder
    • interstitial pneumonia NOS
    • pneumonitis due to external agents
    • pneumonitis due to fumes and vapors
    • usual interstitial pneumonia
    • Atypical pneumonia
    • : New code
    • 2017

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    Concise Overview Of New Icd

    Here is a concise overview of the new ICD-10 coding rules that are relevant to the population of suspected/confirmed COVID-19 patients.

    For confirmed COVID-19 cases, the new ICD-10 code effective April 1, 2020 is U07.1 . The attending clinician who is treating COVID-19 should list COVID-19 as the principal diagnosis. Consultants should document the diagnoses they are specifically treating.

    Effective April 1, 2020

    ICD-10 Coding of COVID-19 Confirmed Cases

    • Pneumonia due to COVID-19
    • Principal diagnosis ICD-10 U07.1
    • Secondary diagnosis ICD-10 J12.89
  • Bronchitis due to COVID-19
  • Principal diagnosis ICD-10 U07.1
  • Secondary diagnosis ICD-10 J20.8
  • Secondary diagnosis ICD-10 J40
  • Acute respiratory infection NOS due to COVID-19
  • Principal diagnosis ICD-10 U07.1
  • Secondary diagnosis ICD-10 J22
  • Respiratory infection due to COVID-19
  • Principal diagnosis ICD-10 U07.1
  • Secondary diagnosis ICD-10 J98.8
  • Acute Respiratory Distress Syndrome due to COVID-19
  • Principal diagnosis ICD-10 U07.1
  • Secondary diagnosis ICD-10 J80
  • Acute Respiratory Failure due to COVID-19
  • Principal diagnosis ICD-10 U07.1
  • Secondary diagnosis ICD-10 J96.0 or J96.2
  • Asymptomatic Principal diagnosis ICD-10 U07.1
  • ICD-10 Coding of Exposure to COVID-19

    • Possible exposure to COVID-19, ruled out after evaluation
    • Principal Diagnosis ICD-10 Z03.818
  • Exposure to someone with confirmed COVID-19
  • Principal Diagnosis ICD-10 Z20.828 exposure to other viral communicable diseases)
  • Development Of Comparators For Pneumonia Icd


    Given the difficulty of defining a reference standard for the diagnosis of pneumonia, three comparators were developed for the purpose of examining the validity of ICD-10 coded cases using retrospective chart review: medical record notation of pneumonia, CXR report and both, since interpretation of both clinical and radiological findings is generally used in clinical practice to make a definitive diagnosis of pneumonia. As ICD-10 codes were not integrated with the database until after completion of the study, record review occurred blinded to coding status.

    Hospital records for the selected admission were reviewed for notation of pneumonia as a diagnosis considered probable by the clinical team under whose care the patient was admitted. This notation was considered most likely to be consistent with a diagnosis of pneumonia given it would be based on all information available to the clinical team at the time of discharge . To examine relevance of signs and symptoms in retrospective identification of pneumonia, for patients with notation of pneumonia, the documentation of cough, sputum production, pleuritic chest pain, fever 37·5°C, shortness of breath, crackles , and aspiration was also sought these being the most common symptoms and signs of pneumonia suggested by descriptive studies of pneumonia .

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    Info For Medical Coders On How To Properly Use This Icd

    Associated influenza, if applicable See code J09.X
    Code Type-1 Excludes:

    Type-1 Excludes

    Type-1 Excludes mean the conditions excluded are mutually exclusive and should never be coded together. Excludes 1 means “do not code here.”

    Abscess of lung with pneumonia – instead, use code J85.1
    Aspiration pneumonia due to anesthesia during labor and delivery – instead, use code O74.0

    How To Query To Classify Covid

    It is critical that the CDISs compose their queries to get codable verbiage in response.

    In my most recent consulting project, I read many cases and queries regarding pneumonia related to COVID-19, and our Talk Ten Tuesdays listeners have been sending me cases soliciting my opinion as to how to code them.

    There are two basic problems with this condition: first, clinically, providers are not sure whether the current pneumonia is from an active case of COVID-19 and second, the providers dont know how to document it such that the coder can derive the appropriate code.

    Let me give you a few examples of the clinical indicators, as presented by the clinical documentation integrity specialists in their queries:

    Case 1: Patient with a recent episode of COVID-19 treated with remdesivir and steroids, presents with shortness of breath and fatigue two weeks later. SARS-CoV-2 antibody test negative, PCR negative.

    New patchy ground glass infiltrates.

    Pulmonary documented relapsing COVID-19 pneumonia. Discharge summary states recently treated for COVID-19 pneumonia.

    Case 2: Admitted with pneumonia . Had been in hospital for seven days, two weeks prior, for COVID-19 pneumonia. CXR with developing bilateral infiltrates.

    Pulmonary consult: possible bacterial pneumonia, history of COVID-19 pneumonia, possible sepsis.

    DC summary: Pneumonia due to recent COVID-19 infection.

    You can find more examples posed in the Coding Clinic FAQs.

    Lets take Case 1 as an example:

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    What Is Lobar Pneumonia

    Lobar pneumonia references a form of pneumonia that affects a specific lobe or lobes of the lung. This is a bacterial pneumonia and is most commonly community acquired. Antibiotics are almost always necessary to clear this type of pneumonia. The antibiotic will be chosen based on the causative organism identified or suspected. This type of pneumonia is also referred to as non-segmental or focal non-segmental pneumonia and is often referred to in CT of the chest to have the appearance of ground glass opacity. Presentation is the same as for other types of pneumonia with dyspnea, productive cough, fever/chills, malaise, pleuritic chest pain and hemoptysis as the common clinical presentation. Complications can include pleural/parapneumonic effusion and empyema. Lobar pneumonia documented by the provider is coded to J18.1 unless the causal organism is specified. Be cautious when using some encoders, as some are still leading the coder to report J18.1 when only the lobe or multilobar is documented. In the ICD-10-CM Alphabetic Index, the coder is referred to see pneumonia, by type. As of October 1, 2019, if pneumonia is documented as affecting a particular lobe, it is coded to J18.9, Pneumonia and NOT J18.1. Lobar pneumonia is a clinical diagnosis made by the physician

    The picture below depicts the lungs and the pneumonia affecting the lower lobe . shows normal alveoli and shows infected alveoli.

    This type of pneumonia is typically acute with four stages:

    Validity Using Cxr Plus Medical Record Notation Of Pneumonia As The Comparator

    Pneumonia Code it Right in ICD-10-CM

    The level of agreement was similar to that of CXR report alone . Indicators of validity were within the range provided by the previous two comparators, except for PPV which was lower . Stratification indicated no effect of season or hospital of separation on estimates . Estimates for validity also changed very little when all cases of pneumonia were included rather than just first presentations .

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    Study Population And Data Sources

    The Hospital Discharge Data System of the Tennessee Department of Health receives information from UB-92 forms on all inpatient discharges from Tennessee hospitals. Each form contains information on patient diagnoses, procedures performed on the patients, charges for services provided, and selected patient demographics. Hospitalization data from one large academic hospital were used to recode pneumonia hospitalizations identified from 2 periods: 1 year before and 1 year after implementation of ICD-10-CM.

    Pneumonia definition

    We based our algorithm to identify hospitalizations for all-cause pneumonia in the HDDS data on that used by Griffin et al to analyze national pneumonia trends. The algorithm required a first-listed discharge diagnosis of pneumonia or a first-listed discharge diagnosis of meningitis, septicemia, empyema, or acute respiratory failure in addition to a diagnosis of pneumonia in another diagnostic field.

    The ICD-9-CM pneumonia algorithm was translated to an ICD-10-CM algorithm using General Equivalence Mappings . The National Center for Health Statistics, Centers for Medicare & Medicaid Services, American Health Information Management Association, American Hospital Association, and 3M Health Information Systems developed GEMS as a publicly available reference map, to aid in navigating the complex meanings between code sets., Codes used for this study are listed in

    Validity Using Cxr As The Comparator

    Of 5101 eligible subjects, 3464 had had a CXR conducted, representing 2239/2329 subjects with ICD codes for pneumonia and 1374/2927 subjects not coded as having pneumonia. Eighty-seven of 5101 subjects had no CXR performed and an ICD-coded diagnosis of pneumonia. In total, 3345/3464 subjects with a CXR had radiology reports available for review and 1724/3345 with CXR reports had some form of pneumonia based on review . This represented 1538/2154 ICD-10-coded cases and 186/1191 ICD-10-coded non-cases with a report. A good level of agreement was present between pneumonia status according to ICD-10 codes and CXR report . No difference in estimates was found when stratifying by season, and only one difference in strata-specific estimates for NPV when stratifying by hospital suggesting a true difference .

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    Coding Tip: Coding Lobar Pneumonia

    Kim CarrierRHIT, CDIP, CCS, CCS-PDirector of Coding Quality AssuranceAHIMA Approved ICD-10-CM/PCS Trainer

    With the implementation of ICD-10-CM there were many additional codes for more specific diagnosis reporting. In late 2018, coding guidance was published instructing coders to report the diagnosis of lobar pneumonia to J18.1 when the pneumonia was specified to a particular lobe. This did cause some confusion and discussion amongst many coders. Due to all the concerns, this was reviewed further by AHA clinical experts and this coding advice has now been rescinded. Lobar pneumonia typically involves consolidation of one or more lobes of the lung. This is different than having the presence of an infiltrate in the lobe of the lung. Lobar pneumonia should only be coded when the physician/provider specifically documents lobar pneumonia and there is no causal organism specified.

    Ahima And Aha Faq: Icd

    Pin on ICD 10

    The following questions and answers were jointly developed and approved by the American Hospital Associations Central Office on ICD-10-CM/PCS coding for COVID-19 and AHIMA. Coding professionals with comments and questions, please contact Sue Bowman, MJ, RHIA, CCS, FAHIMA, Senior Director, Coding Policy and Compliance, at

    ICD-10-CM Questions
    Question #1: What is the ICD-10-CM code for COVID-19?

    Answer: ICD-10-CM code U07.1, COVID-19, may be used for discharges/date of service on or after April 1, 2020. For more information on this code, click here. The code was developed by the World Health Organization and is intended to be sequenced first followed by the appropriate codes for associated manifestations when COVID-19 meets the definition of principal or first-listed diagnosis. See the ICD-10-CM Official Guidelines for Coding and Reporting available on the Centers for Disease Control and Preventions National Center for Health Statistics website for specific guidelines on usage of this code. For guidance prior to April 1, 2020, please refer to the supplement to the ICD-10-CM Official Guidelines for coding encounters related to the COVID-19 coronavirus outbreak.

    Question #2: Is the new ICD-10-CM code U07.1, COVID-19, a secondary code?
    Question #3: Are there additional new codes to identify other situations specific to COVID- 19? For example, codes for exposure to COVID-19, or observation for suspected COVID-19 but where the tests are negative?




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    The Creation Of The New Combined Code Would Improve Coding Specificity For Pneumonia Due To According To Committee Members

    A version of this article was first published September 28, 2020, by HCPro’s Revenue Cycle Advisor, a sibling publication to HealthLeaders.

    During a meeting in early September, members of the ICD-10 Coordination and Maintenance Committee proposed creating new ICD-10-CM codes related to screening, exposure, and personal history for the novel coronavirus .

    The new codes, if finalized, would take effect in January 2021.

    In response to multiple requests for related codes, the ICD-10 Coordination and Maintenance Committee announced that it is considering adding the following codes to the ICD-10-CM code set:

    • Z11.52, encounter for screening for COVID-19
    • Reported for people who are asymptomatic
  • Z20.822, contact with and exposure to COVID-19
  • Z86.16, personal history of COVID-19
  • In addition, the committee proposed adding a new code that would allow providers to report COVID-19-caused pneumonia with one code instead of two:

    • J12.82, pneumonia due to coronavirus disease 2019
    • Includes the inclusion terms, pneumonia due to COVID-19 and pneumonia due to severe acute respiratory syndrome coronavirus 2

    Existing coding guidance for COVID-19-related pneumonia instructs coders to report two ICD-10-CM codes for the condition: U07.1 and J20.89 .

    The creation of the new combined code would improve coding specificity for pneumonia due to , according to committee members.

    • M35.81, multisystem inflammatory syndrome

    Validity Using Medical Record Notation Of Pneumonia As The Comparator

    Clinical notation of pneumonia was able to be determined for 5098/5101 subjects . Of these, 2281 had pneumonia documented as a probable diagnosis, representing 2230/2318 ICD-10-coded cases and 51/2780 ICD-10-coded non-cases. Among cohort subjects, 128/179 pneumonia notations had pneumonia defined by ICD-10 codes. There was a very high level of agreement between ICD-10-coded pneumonia or non-pneumonia and clinical notation, with a kappa statistic of 0·95 and high sensitivity, specificity, PPV and NPV . Stratification by season and hospital of selection indicated these factors did not play an important role, with small differences between strata in real terms .

    Table 1. Validity of ICD-10 coding vs. three comparators

    CI, Confidence interval PPV, positive predictive value NPV, negative predictive value.

    Among the 2281 subjects with notation of pneumonia, a median of four of the seven symptoms and signs of interest were present. Three or more were present in 1911/2281 . The symptoms and signs that were most frequently recorded as present or absent and that were present most often were crackles , shortness of breath , cough , fever 37·5°C and sputum production .

    Table 2. Frequency of symptoms and signs extracted from medical records for subjects with notation of pneumonia as a probable diagnosis

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    The Icd Code J18 Is Used To Code Bronchopneumonia

    Bronchopneumonia, bronchial pneumonia or bronchogenic pneumonia is the acute inflammation of the walls of the bronchioles. It is a type of pneumonia characterized by multiple foci of isolated, acute consolidation, affecting one or more pulmonary lobules.

    ICD 9 Codes:

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