Pulmonology Coding Alert

How do I sequence the codes for this report?

Arizona Subscriber

Answer: You’ll assign J13 (Pneumonia due to Streptococcus pneumoniae) and J95.851 (Ventilator associated pneumonia) to start. In your situation, the provider admitted the patient to the hospital because of the patient’s pneumonia due to streptococcus pneumoniae and then the patient developed ventilator-associated pneumonia (VAP).

According to the ICD-10-CM Official Guidelines, section I.C.10.d.2, “[T]he principal diagnosis would be the appropriate code from categories J12-J18 for the pneumonia diagnosed at the time of admission.” You’ll then assign J95.851 as an additional diagnosis if the provider documented the presence of VAP.

Additionally, you’ll need to carefully read the details of the provider’s documentation since J13 includes Code first and Code also notes that require additional codes if the conditions are met.

The Code first note instructs you to include the associated influenza if the condition applies. For example, if the patient had influenza A and pneumonia, then you’d assign J09. X1 (Influenza due to identified novel influenza A virus with pneumonia) before J13.

At the same time, the Code also note under J13 in the ICD-10-CM code set instructs you to assign a code if the provider’s documentation indicates the presence of an associated abscess. In that case, you’ll assign J85.1 (Abscess of lung with pneumonia) in addition to J13.

In summary, you’ll sequence the codes as J13 followed by J95.851 since the patient was admitted to the hospital with an illness, and then the patient developed VAP.