Pediatric Coding Alert

Question: Which ICD-9 code should we use for pneumonitis? I had been using "486" but one of our physicians disagreed with this? Please tell me if I am reporting the diagnosis incorrectly.New York SubscriberAnswer: The key to a successful claim for pneumonia is in the final diagnosis. This diagnosis should specify what organism caused the pneumonia, but it's the exception rather than the rule that a pediatrician would know the organism at the time of the initial diagnosis. Diagnostic workup typically includes chest x-rays, blood and sputum cultures. If the physician does not identify a causative organism, such as staphylococcus or streptococcus, you would assign code 486 (Pneumonia, organism unspecified). If the medical notes simply say "pneumonia," it may not be enough. You should ask the physician if there is a confirmed cause of the condition. However, identifying the specific causative organism is usually not possible at the initial E/M [...]