simple pneumonia

laura.bohls@prairielakes.comlaura.bohls@prairielakes.com
in CDI Talk Archive
Our facility has a high number of simple pneumonia. I've educated the MDs that we do not need positive cultures if they are suspecting a specific organism. But, they still rarely give a suspected organism. The MDs favorite description is CAP :) (which does help with POA) I know some of out pneumonias are septic, but our MDs rarely say a patient is septic. Any helpful ideas would be greatly appreciated.

Laura Bohls, RN CDS
Prairie Lakes Healthcare System
Watertown, SD
laura.bohls@prairielakes.com

Comments

  • robert.hodges2robert.hodges2
    edited May 2016
    Good luck. I beat this into my providers all the time to the point when I call and say a patients name, they usually reply, yea, pneumonia right? My favorite question to them is what kind of pneumonia are you treating? That usually gives me a better answer and then I let them know they can document it as "likely", "probable", or "possible" and you can still capture the code.

    Robert

    Robert S. Hodges, BSN, MSN, RN, CCDS
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
     
    P: 989-497-2500 x13101
    F: 989-321-4912
    E: Robert.Hodges2@va.gov
     
    "We are dealing with Veterans, not procedures; With their problems, not ours." --General Omar Bradley

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    We struggle with this too. I attached my query.

    Katy Good, RN, BSN, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Office: 928.214.3864
    Cell: 928.814.9404

  • sharon.colesharon.cole
    edited May 2016
    After years of the hospitalists documenting HCAP, I just recently made headway with the Med Director of the Hospitalist program - who made headway with his physicians. I asked him if he realized that HCAP coded to 486 Pneumonia NOS. He didn't believe me so I then told him there was no ICD-9 code for HCAP (which he didn't believe at first either). After thumbing through the code book and not finding HCAP, he got it: HCAP without any further clarification coded to pneumonia that was not otherwise specified. I noticed that the patients who are on the big combos of IV antibiotic therapies for HCAP now have suspected organisms documented.

    Sharon Cole, RN, CCDS
    Providence Health Center
    Case Management Dept
    254.751.4256
    srcole@phn-waco.org


  • swalzswalz
    We, too, have a very high number of patients admitted with simple pneumonia. We are rarely aboe to get them out of the simple pneumonia DRG. No sputum cultures, etc. The physicians, mostly pulmonary, seem to use this diagnosis as a "catch-all".

    Does anyone have any additional suggestions for how to decrease the number of simple pneunmonia's???
  • jlindseyjlindsey
    edited May 2016
    We look for the antibiotic they are on:

    Simple - Ceftriaxone, Levaquin, Azitro, Erythro

    Gram Neg Bacteria - Cefepime, Ceftazadime, Zosyn, Imipenem, Aztreonam, Meropenem, Tygacil, Tobra/Gent, Amikacin

    MRSA/Staph - Vanco, Zyvox

    Asp PNA - Clinda, Flagyl

    Too, look for swallow studies, chronic aspiration history, reflux hx, PEG/NG/G-tube, wheezing/bronchospasm, unrelenting cough w/neg CXR......

    Hope that helps!

    Jill Lindsey, RN, BSN

    Phoenix Children's Hospital
    Clinical Documentation Specialist
    602-810-4197
    Ext. 3-0725

  • robert.hodges2robert.hodges2
    edited May 2016
    Here is the VHA Pneumonia query form. The key statement in this form is:

    "Note: Should you determine or suspect that the patient has a specific type of pneumonia based on their clinical presentation, even in the absence of confirmatory lab findings, it is appropriate to document and assign the code for the specific type of pneumonia for which you suspect and are treating.

    We use this with the argument that if they are treating something they should get credit for it, the workload it generates, and the impact on severity of illness.

    Hope this helps.

    Robert

    Robert S. Hodges, BSN, MSN, RN, CCDS
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
     
    P: 989-497-2500 x13101
    F: 989-321-4912
    E: Robert.Hodges2@va.gov
     
    "We are dealing with Veterans, not procedures; With their problems, not ours." --General Omar Bradley

  • dvitalone1dvitalone1
    edited May 2016
    At last year's conference a speaker made the comment that if a physician states that he/she does not know what organism for pneumonia then reply to them "OK, then stop the IV abx."
    I have done this on a couple occasions and it has sparked a great educational conversation with the physician.


  • sharon.colesharon.cole
    edited May 2016
    I've done some education with physician groups about coding HCAP vs CAP - both code to Pneumonia NOS. They were surprised that HCAP did not have an ICD-9 code assignment. It has helped a little.

    Sharon Cole, RN, CCDS
    Providence Health Center
    Case Management Dept
    254.751.4256
    srcole@phn-waco.org


  • robert.hodges2robert.hodges2
    edited May 2016
    I do too. It appeals to me in that weird nursing way.

    Robert

    Robert S. Hodges, BSN, MSN, RN, CCDS
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
     
    P: 989-497-2500 x13101
    F: 989-321-4912
    E: Robert.Hodges2@va.gov
     
    "We are dealing with Veterans, not procedures; With their problems, not ours." --General Omar Bradley

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