Superimposed Bacterial Pneumonia Icd 10

What Is The Icd 10 Code For Community Acquired Pneumonia

. Also, what is the ICD 10 CM code for community acquired pneumonia?

Pneumonia, unspecified organismJ18. 9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2020 edition of ICD-10-CM J18. 9 became effective on October 1, 2019.

Additionally, what is community acquired pneumonia? Community–acquired pneumonia refers to pneumonia contracted by a person with little contact with the healthcare system. CAP, the most common type of pneumonia, is a leading cause of illness and death worldwide. Its causes include bacteria, viruses, fungi and parasites.

Additionally, how do you code community acquired pneumonia?

A: When the provider uses terms such as CAP,HAP, or HCAP, these would default to code J18. 9, pneumonia, unspecified organism, which maps to simple pneumonia MS-DRG 193/194/195. Community acquired pneumonia is typically a simple pneumonia, but could also be atypical pneumonia.

What does pneumonia organism unspecified mean?

Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Typically symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing. Severity is variable. Pneumonia believed to be due to bacteria is treated with antibiotics.

Complications In Nosocomial Pneumonia

Failure to successfully wean the patient from the respirator is a common problem following intubation for nosocomial pneumonia.

HSV-1 pneumonitis develops in intubated patients who have unchanging or persistent pulmonary infiltrates after 2 weeks of antimicrobial therapy. These patients usually have low-grade fevers with variable degrees of leukocytosis. Demonstrating HSV-1 in samples of respiratory secretions may establish the diagnosis.

Start treatment with acyclovir in patients diagnosed with HSV-1 infection acyclovir decreases hypoxemia and subsequently permits weaning of the patient from the respirator.

Contributor Information and Disclosures

Kartika Shetty, MD, FACP Program Director, Internal Medicine Residency Program, Sunrise GME Facility Medical Director, TEAMHealth, Mountain View HospitalKartika Shetty, MD, FACP is a member of the following medical societies: American College of Physicians, Association of Program Directors in Internal Medicine, Medical Council of IndiaDisclosure: Nothing to disclose.

Maycky Tang, DO Resident Physician, Department of Internal Medicine, Sunrise Health GME ConsortiumMaycky Tang, DO is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Osteopathic AssociationDisclosure: Nothing to disclose.

Nazanin Sheikhan, MD Resident Physician, Department of Internal Medicine, Sunrise Health GME Consortium

Microbiologic Approach To Diagnosing Ventilator

For patients with suspected VAP, sampling of the lower airways for quantitative cultures can be obtained through the following methods:

• Blind tracheobronchial aspiration can be done by inserting a flexible catheter into the distal trachea however, since it is blind sampling, there is no direct sampling of the lung in which radiographic evidence shows infiltrates. Furthermore, as the catheter is inserted through the endotracheal tube, there is a risk of contamination leading to false-positive results.
• Bronchoscopy with bronchoalveolar lavage allows for direct sampling of the lung segments with radiographic evidence of infiltrates. Limitations of the technique include operator-skill, contamination, and risk of worsening hypoxemia.
• Protected specimen brush can be advanced through a bronchoscope to avoid upper airway contamination.

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Microbiologic Approach To Diagnosing Hospital

IDSA recommends that patients with suspected HAP be treated according to microbiologic results obtained from noninvasively-collected respiratory samples and routine blood culture. It is very important to accurately target antibiotic therapy and deescalate as appropriate. Of note, noninvasive respiratory sampling includes spontaneous expectoration and sputum induction.

When no respiratory secretions can be obtained and blood cultures are negative, bronchoalveolar lavage should be considered in patients who are not responding to initial antibiotic therapy.

For patients who are treated empirically for HAP and either have a risk factor for MRSA, including previous IV antibiotic use within 90 days, hospitalization in a unit with > 20% MRSA, unknown MRSA prevalence, or who have high mortality risk are recommended for empiric coverage of MRSA. If the patients with HAP does not have MRSA risk factors, then empiric coverage should include MSSA. Double coverage for Pseudomonas aeruginosa and other strong gram-negative bacilli is only suggested for high mortality risk patients with prior IV antibiotic use within 90 days given very low-quality evidence. A single agent is often enough, though it is strongly recommended against using an aminoglycoside as the sole antipseudomonal agent.

Organisms Associated With Ventilator

Organisms associated with ventilator-associated pneumonia include the following:

• P aeruginosa
• S Aureus, including MSSA and MRSA
• S maltophilia
• Acinetobacter species
• Enterobacteriaceae are less commonly seen in VAP than in hospital-acquired pneumonia

These organisms are commonly recovered from respiratory secretions in patients with VAP. The recovery of a respiratory pathogen from respiratory secretions does not establish it as the cause of nosocomial pneumonia. MSSA/MRSA frequently colonize respiratory secretions in intubated patients but rarely, if ever, cause nosocomial pneumonia/VAP. In contrast, MSSA/MRSA may cause community-acquired pneumonia in those with influenza. Anaerobic organisms are not important pathogens in nosocomial pneumonia.

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Differential Diagnoses Of Nosocomial Pneumonia

All patients with presumed nosocomial pneumonia should undergo testing to rule out conditions that mimic nosocomial pneumonia. The diagnosis of nosocomial pneumonia is difficult because it may present in a very nonspecific fashion.

Many conditions other than nosocomial pneumonia mimic pulmonary infiltrates on chest radiographs.

Clinical findings in ventilated patients with fever and/or leukocytosis may have alternative causes, including antibiotic-associated diarrhea, central lineassociated infection, sinusitis, urinary tract infection, pancreatitis, and drug fever. Noninfectious inflammation may produce fever.

The most common causes of infiltrates in ventilated patients with fever and/or leukocytosis include the following conditions:

• Congestive heart failure

Diet Activity And Deterrence

Many patients with nosocomial pneumonia have significant nutritional deficiencies. Early enteral nutrition appears to decrease infectious complications. Parenteral nutrition does not seem to have this effect and should be considered only in patients with a contraindication to enteral replacement.

Beds that permit some degree of patient turning may decrease the likelihood of hospital-acquired pneumonia /ventilator-associated pneumonia in at-risk patients. Decontamination of the mouth and gut may affect the risk of producing MDR organisms.

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Coding Pneumonia Correctly Keeps Oig Relationship Healthy

Vol. 16 Issue 17 Page 14CCS Prep!

Coding Pneumonia Correctly Keeps OIG Relationship Healthy

Prepared by HSS Inc. Staff

Pneumonia is a common infection or inflammation of the lung that can be caused by bacteria, viruses, parasites and other organisms. Pneumonia is one of the leading causes of death in the U.S. and is a concern particularly for the elderly. However, throughout the world it is one of the leading causes of death in children.

Pneumonia coding remains a top the Office of the Inspector General initiative. The central focus of the OIG relates to the over utilization of the diagnosis codes for specified bacteria. Therefore coding pneumonia correctly is essential.

The following ICD-9-CM codes and categories from Chapter 8, Diseases of the Respiratory System, are commonly used to code pneumonia:

480.X, Viral Pneumonia

483.X, Pneumonia, due to other specified organism

485, Bronchopneumonia, organism unspecified

486, Pneumonia, unspecified organism

507.X, Pneumonitis due to solids and liquids

There are pneumonia codes from Chapter 1, Infectious and Paracitic Diseases, that are also used and they include:

003.22, Salmonella pneumonia

011.6, Tuberculous pneumonia

052.1, Varicella pneumonia

Pneumonia in whooping cough-033.9 and 484.3

Bronchial pneumonia in typhoid fever- 002.0 and 484.8

Questions

a. 507.0, 482.49 438.82

c. 507.0, 482.40 438.82

d. 482.40, 438.82

a. 486 038.9 995.92 518.81

b. 038.9, 995.91, 518.81, 486

c. 518.81, 486, 038.9, 995.92

a. 482.89

b. 482.9

Pneumonia Due To Staphylococcus Unspecified

2016201720182019202020212022Billable/Specific Code

• J15.20 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 J15.20 became effective on October 1, 2021.
• This is the American ICD-10-CM version of J15.20 – other international versions of ICD-10 J15.20 may differ.

• Applicable To annotations, or

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Aspiration And Development Of Pneumonia Less Than 48 Hours

Scenario: What do we code if a patient didn’t have pneumonia on admission and came in for some other reason. They aspirate on intubation less than 48 hours in hospital and develop pneumonia. How do you code that? Is it CAP?

Code as: In most circumstances, an aspiration event DOES NOT cause an actual lung infection in < 48 hrs. The entity you’re describing (an aspiration event followed quickly by new infiltrate, and possible also new fever and leukocytosis, is an Aspiration pneumonitis — see that article for some guidance on this question.

Review Of Literature And Inclusion Criteria

We conducted a PubMed search of papers published in the peer-reviewed, English language literature through September 16, 2020, using the terms coronavirus disease 2019, COVID-19, novel coronavirus, severe acute respiratory syndrome virus coronavirus-2 or SARS-CoV-2 and autopsy, postmortem, or histopathology. Studies were considered for inclusion if they presented histopathologic data from postmortem samples of lungs from SARS-CoV-2-infected persons. Papers cited in eligible studies identified by PubMed searches were also reviewed. Cases were included if they described histopathologic findings in the lung that were consistent with bacterial superinfections . An author of this study contacted the corresponding authors of eligible postmortem studies by e-mail with requests for clarification of published data, as well as queries about pathogen visualization and culture and polymerase chain reaction results that may not have appeared in the respective publications.

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Bacterial Pneumonia Not Elsewhere Classified

2016201720182019202020212022Non-Billable/Non-Specific Code

• associated abscess, if applicable

• bronchopneumonia due to bacteria other than S. pneumoniae and H. influenzae

• Bacterial bronchopneumonia

• Inflammation of the lung parenchyma that is caused by bacterial infections.
• Pneumonia caused by various species of bacteria commonly results from bronchogenic spread of infection following microaspiration of secretions.

• 193 Simple pneumonia and pleurisy with mcc
• 194 Simple pneumonia and pleurisy with cc
• 195 Simple pneumonia and pleurisy without cc/mcc
• 791 Prematurity with major problems
• 793 Full term neonate with major problems
• 974 Hiv with major related condition with mcc
• 975 Hiv with major related condition with cc
• 976 Hiv with major related condition without cc/mcc

• : New code
• 2017

Initial And Definitive Treatment Of Hospital

MSSA should be covered unless the patient has risk factors for MRSA, including intravenous antibiotic use within the preceding 90 days, exposure to a hospital unit where more than 20% of S aureus isolates are MRSA, or a high risk for death . Vancomycin or linezolid should be used, guided by local antibiogram, to empirically cover MRSA.

For empiric coverage of MSSA, piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem are preferred. In cases of proven MSSA infection, oxacillin, nafcillin, or cefazolin is favored.

Double coverage against P aeruginosa should be provided in the empiric treatment of individuals with HAP who are likely to have Pseudomonas and other gram-negative infections or who are at a high risk for mortality . For all other cases, single coverage of P aeruginosa is indicated.

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Diseases Of The Respiratory Systemnote

• 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

Epidemiology Of Nosocomial Pneumonia

Incidence in the United States

Nosocomial pneumonia accounted for 22% of all hospital infections in the United States. It is the second most common infection in hospitalized patients, and the most common infection in the intensive care unit responsible for one-fourth of all ICU infections.

International incidence

The international incidence and prevalence of nosocomial pneumonia is similar to that in the United States, with comparable rates of responsible microorganisms.

Racial and sexual predilections

Nosocomial pneumonia has no racial or sexual predilection.

Age predilection

Nosocomial pneumonia is most common in elderly patients however, patients of any age may be affected.

Morbidity and mortality in hospital-acquired pneumonia and ventilator-associated pneumonia

Intubation and ventilatory support bypass the normal host defense mechanisms, predisposing patients with ventilator-associated pneumonia to infection.

In addition, hospital-acquired pneumonia /VAP that develops in ICU patients is associated with high morbidity and mortality rates, because these patients are already critically ill. Estimated all-cause mortality is between 25-50%.

Compromised cardiac and lung function may further decrease their cardiopulmonary reserve.

Ventilator-associated barotrauma often decreases already compromised lung function. In addition, it may alter chest radiographic appearances.

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Initial And Definitive Treatment Of Ventilator

Empiric treatment of VAP should include coverage of S aureus, P aeruginosa, and other gram-negative bacilli.

MRSA should be covered empirically in patients with any of the following risk factors for antibiotic resistance:

• Patients located in units where more than 10-20% of S aureus isolates are MRSA
• Patients in units where the prevalence of MRSA is unknown

The preferred antibiotics for treatment of MRSA infections include vancomycin and linezolid. Linezolid appears to be 15% more efficacious than even adjusted-dose vancomycin. It should be considered over Vancomycin in patients with renal insufficiency and those infected with high-MIC isolates of MRSA.The recommended antibiotics for the treatment of suspected MSSA infections include piperacillin-tazobactam, cefepime, levofloxacin, imipenem, and meropenem. When the pathogen is confirmed as MSSA, the patient should be switched to oxacillin, nafcillin, or cefazolin.

A single antibiotic with activity against P aeruginosa should be administered, except in patients with risk factors for multidrug-resistant organisms, including the following:

• Intravenous antibiotic use within the preceding 90 days
• Five or more days of hospitalization prior to VAP onset
• Acute renal replacement therapy prior to the onset of VAP
• The patient is located where more than 10% of gram-negative isolates are resistant
• Patients in ICUs where antibiotic sensitivity rates are not available

Caveats

Duration of therapy

Pathogens Infrequently Associated With Hospital

The following are infrequently implicated pathogens in nosocomial pneumonia clusters/outbreaks, usually affecting severely immunocompromised patients:

• Legionella species
• Human parainfluenza virus 3
• Human metapneumovirus

Nosocomial Legionella pneumonia occurs often in outbreaks or clusters.Influenza A, RSV, hMPV, or HPIV-3 may cause hospital-acquired pneumonia from person-to-person spread.

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Re: A Patient With Cap On Admission

Can a patient with unresolved CAP ever be coded as HAP if ETC cultures become positive for a new pathogen or is it always going to be CAP?

• AG REPLY — this is a very difficult clinical determination. Since our ability to identify the lung pathogen in ANY type of pneumonia isn’t that good it is very very difficult to tell whether a new pathogen is a new infection. This is especially true since it is well known that hospitalized and intubated patients quickly get colonized in their airways with bugs that don’t usually live there — thus again just identifying a new bug in sputum that is a POTENTIAL pathogen is far from a diagnosis that that potential pathogen is actually the bug for an actual pneumonia or bronchitis. Thus, there can be no real rule here. It IS possible to get a new HAP/VAP after being admitted for a CAP, and even without cure of the CAP, but that determination requires things like: 1-A new potential pathogen PLUS 2-chest imaging that shows infiltrates in an area that was virtually COMPLETELY clear before PLUS 3-a clinical decision about this whole thing.

I will give an example cases:

• The pt has CAP no culture is sent. The patient is in the ICU for 8 days not on a ventilator. The ventilation status gets worse. The CXR continues to have persisent infiltrates. The pt gets intubated and less than 48 hours on a ventilator a bronchoscopy is done and both ETC and quantitive cultures grow aspergillos. Is this still CAP or can it be called HAP?

Q& a: Preparing For Covid

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

Q: We are seeing an influx of possible novel coronavirus patients at our facility. How can we prepare to query for COVID-19-related documentation and coding issues that are bound to come our way due to the newness of the diagnosis?

A: CDI and coding professionals can use the mnemonic M.U.S.I.C. as a model for record reviews to identify potential COVID-19-related documentation and coding issues and to formulate queries when encountering incomplete, imprecise, or unclear documentation.

This model may be useful as it drills through layers of due to, caused by, and demonstrated by, addressed in physician queries.

The M.U.S.I.C mnemonic, outlined below, can be used as a foundation for critical thinking when determining the correct documentation and ICD-10-CM coding for the COVID-19:

• Manifestations What are the signs and symptoms indicative of the COVID-19 illness?
• These may include fever, cough, shortness of breath, or even hypoxemia, respiratory distress, or signs and symptoms commonly associated with sepsis

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Q& a: Coding Guidelines For Copd And Pneumonia

Q: Im having problems determining the correct coding guidelines for chronic obstructive pulmonary disease and pneumonia. Have the guidelines changed regarding COPD and pneumonia? Do you now have to code the pneumonia as a COPD with a lower respiratory infection?

A: Yes, the AHAs Coding Clinic for ICD 10-CM/PCS, Third Quarter 2016, discusses an instruction note found at code J44.0, chronic obstructive pulmonary disease with acute lower respiratory infection requires that the COPD be coded first, followed by a code for the lower respiratory infection. This means that the lower respiratory infection cannot be used as the principal diagnosis. We would assign code J44.0 as the principal diagnosis, followed by an additional code to identify the lower respiratory infection.

If the patient has an acute exacerbation of COPD and pneumonia, we would assign both codes J44.0 and code J44.1 . Per the instructions, either code may be sequenced first and it should be based on the circumstances of the admission, followed by a code to identify the infection, such as code J18.9 .

Additionally, the type of pneumonia needs to be clarified. For example, aspiration pneumonia is not classified as a lower respiratory infection, but as a lung disease due to the external agents. To assign the appropriate code in the case of aspiration pneumonia, we would need to know the external agent, i.e. milk versus vomit.