Cracking the Code

Coding Pneumonia

Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.” -Mayo Clinic

When coding for pneumonia, codes are selected based on the infection that caused the pneumonia. If the infection is not documented, code selection would be J18.9 Pneumonia, unspecified organism. Types of pneumonia are named based on the causative agent or based on the location of the pneumonia (for example, lobar pneumonia or bronchopneumonia).

Pneumonia should only be coded as ventilator associated pneumonia (or VAP) when the documentation supports that condition. If the patient is on a ventilator and develops pneumonia, the provider must document they are associated to code ventilator associated pneumonia. When VAP is assigned, an additional code from subcategories J12-J18 to identify the type of pneumonia is not coded in addition to VAP.

Q: Susan is admitted to the hospital with pneumonia. Lab results indicate the Susan’s pneumonia is due to Staphylococcus aureus and is methicillin resistant (MRSA). What is the appropriate ICD-10-CM code(s)?
A: J15.212. Rationale: We follow the ICD-10-CM Alphabetic Index for Pneumonia/in (due to)/staphylococcus/aureus/methicillin resistant (MRSA) J15.212. As always, we want to verify code selection in the Tabular. Additionally, ICD-10-CM guideline 1.C.1.e.1.(a), states, when a combination code exists for MRSA and the infection, only the combination code should be reported.
Reference: 2024 ICD-10-CM code book
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