Pulmonology Coding Alert

Question: A nursing home patient who has been dependent on ventilator was brought to the office for evaluation. The pulmonologist found him to have pneumonia. What ICD-9 code should I report?

Kentucky Subscriber

Answer: You should use 997.31 (Ventilator-associated pneumonia) on your claim, after confirmation by the pulmonologist. This is a fairly new diagnosis code which premiered in ICD-9 2009. Report this code when a patient on a respirator develops pneumonia.

In the past, you would use the generic 997.3 (Respiratory complications) for this type of pneumonia. The new ICD-9 offers a clearer description of the source of the patient's pneumonia.

Quick fact: You will never find 997.3 as a complete code in the ICD-9 book because it requires an additional digit. Code 997.31 (Ventilator associated pneumonia) and 997.39 (Other respiratory complications) has further specified 997.3. 997.39 code descriptor's vagueness should tell you to submit it only as a last resort, when you cannot find a more appropriate diagnosis code. For instance, a patient develops pneumonia after a procedure or Mendelson's syndrome following surgery, other than for labor and delivery (668.0x).