LTibbetts
Guest
I have a sneaky feeling that I am going to have to query the physician on this but I thought that I would start here and see what you all think.
I have an inpatient with pneumonia with presumed H1N1. I know that even though it is an inpatient, I can't code the H1N1 since it has to be specifically documented as positive findings.
That is not my question. My question is this: On the discharge summary the doc that discharged the pt claims that the primary dx is this: "it was most consistent with viral pneumonia", but on both of the progress notes in the chart, each by a different doc that saw the pt each day during the visit, it states bacterical pneumonia as primary dx on both notes. The cultures are inconclusive and since he mentions that it is most likely H1N1, would that be considered viral or bacterial since there is no other organism mentioned? I realize that there are differences between the two types of pneumonia so I am kind of stuck here. Any opinions or advice??
I have an inpatient with pneumonia with presumed H1N1. I know that even though it is an inpatient, I can't code the H1N1 since it has to be specifically documented as positive findings.
That is not my question. My question is this: On the discharge summary the doc that discharged the pt claims that the primary dx is this: "it was most consistent with viral pneumonia", but on both of the progress notes in the chart, each by a different doc that saw the pt each day during the visit, it states bacterical pneumonia as primary dx on both notes. The cultures are inconclusive and since he mentions that it is most likely H1N1, would that be considered viral or bacterial since there is no other organism mentioned? I realize that there are differences between the two types of pneumonia so I am kind of stuck here. Any opinions or advice??
