Home Health ICD-9/ICD-10 Alert

Wondering which code to list for hospital-acquired pneumonia? There is no specific code for this condition, but patients with symptoms that presented after 48 hours of admission to the hospital or who become infected after the discharge from the hospital, are considered to have hospital acquired pneumonia -- provided the organisms were acquired during the hospital stay.

Hospital-acquired pneumonia (nosocomial pneumonia) is acquired during or after hospitalization for treatment of another illness or procedure, says Jan McLain, RN, BS, LNC, HCS-D, COS-C, with Adventist Health System Home Care in Port Charlotte, Fla. Look to the original inpatient admitting diagnosis for clues to the timing of the diagnosis.

Hospitalized patients are at higher risk for pneumonia due to malnutrition, underlying heart and lung diseases, immune system disturbances and exposure to different types of microorganisms than those at home including resistant bacteria such as MRSA or Pseudomonas, McLain says.

According to American Thoracic Society (ATS) guidelines, nosocomial pneumonia (also known as hospital-acquired pneumonia or health care"associated pneumonia [HAP]) is defined as pneumonia that occurs more than 48 hours after hospital admission but that was not incubating at the time of admission.

Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs after 48 to 72 hours of endotracheal intubation, McLain says. VAP is coded as 997.31 from ICD-9-CM Chapter 17: Injury and Poisoning, if there is a documented relationship between the pneumonia and the ventilator status. You'll list an additional code to identify the type of pneumonia.

Gram negative bacilli are seen in 50 percent of HAP infections, McLain says. These types of bacterial pneumonia should be coded by organism, but only if the physician has documented the etiology link. Types of bacterial pneumonia include

If the patient presents with an unspecified influenza viral infection with pneumonia, you'll list the specific virus code first, followed by an additional code to identify the type of pneumonia from 180.0 to 485. Some examples include:

Pneumonia due to Staphylococcal aureus present in 15 percent of all HAP cases, McLain says.

The staphylococcal pneumonia codes do not require a second code.