Pulmonology Coding Alert

Question: Can you advise on which diagnosis codes apply for bacterial vs. viral pneumonia?

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Answer: You have numerous codes for bacterial cause of pneumonias, mostly from the code category J15.

In order for you to decide the correct code from 13 possible code options, you will need to know the exact causative organism, such as Klebsiella, Pseudomonas, staphylococcus, staphylococcus, streptococci and Escherichia coli.

Example: The provider diagnoses a patient with pneumonia along with an abscess in the right lung. The reports show the causative organism as Klebsiella pneumoniae. How do you code for this situation?

Pneumonia due to Klebsiella is a diagnosis that might seem fairly easy to code, but don't get ahead of yourself. Yes, you do have a dedicated code for this case (J15.0, Pneumonia due to Klebsiella pneumoniae), but you will need to be careful as you need to code the associated abscess first: J85.1 (Abscess of lung with pneumonia).

That's not all. Before picking a bacterial pneumonia code in haste, you need to remember that according to CMS if the patient happens to have associated viral influenza as well, you should not miss reporting that with J09.X1 (Influenza due to identified novel influenza A virus with pneumonia), J10.00 (... other identified influenza virus with unspecified type of pneumonia), or J11.00 (... unidentified influenza virus with unspecified type of pneumonia).

You will also need to be aware of code options for pneumonia due to viral causes. While Category J12 talks of viral pneumonias such as SARS and syncytial virus; category J10 and J11 have codes for an influenza with associated pneumonia.

Example: Let's tackle another case. A patient has influenza with pneumonia, and the provider documents the presence of novel influenza A virus and parainfluenza virus. How do we code this?

You do have a specific code J12.2 (Parainfluenza virus pneumonia). However, we will need to first report the influenza A virus. So, the first code would be J09.X1 (Influenza due to identified novel influenza A virus with pneumonia).