Primary Care Coding Alert

Question: What is the difference between "lobar pneumonia" and "lobular pneumonia?" When there is no further clarification from the physician, is code 481 (Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia]), which includes lobar pneumonia, organism unspecified, the appropriate code assignment for both "lobar pneumonia" and "multilobar pneumonia?" When should we use 481 versus 485?

Answer: A patient with lobar pneumonia has pneumonia that affects a large and continuous area of the lobe of a lung. A patient who is diagnosed with lobular pneumonia, or bronchopneumonia, has an acute inflammation of the walls of his bronchioles, affecting many small areas of his lung tissue rather than the large area impacted by lobar pneumonia.

Another distinction between 481 and 485 is the cause. Code 481 is for pneumonia in which the causative agent is pneumococci. In comparison, code 485, "Bronchopneumonia, organism unspecified" is an unspecified code used in situations where the causative agent is not mentioned.

Multilobar pneumonia affects more than one lobe of your patient's lung and is a more serious illness than lobar pneumonia. Absent any additional details about your patient's pneumonia, you would list 481 for either lobar or multilobar pneumonia. However, the most accurate code for pneumonia of any type should be determined by the physician, in part based on the causal organism.

You'll list 485 (Bronchopneumonia, organism unspecified) when your patient has lobular pneumonia, but you are unable to determine the causative organism.