Pneumonia

mcmahons

Is anyone else challenged with trying to capture Complex Pneumonia in the absence of sputum culture? 
We have numerous patients from nursing homes, or compromised due to dialysis, chemo or organ transplant, that present with pneumonia.  Physician writes HCAP or Bacterial Pneumonia, but is unable to specify the organism, so this codes to Simple Pneumonia.

bbogda@morrishospital.org

Our docs are getting better, but we still are writing many clarifications for gram neg pneumonias if the patient is at risk,  meets supporting criteria and is being treated with the appropriate antibiotics.

Risk Factors: Immunosuppression, i.e., CA,HIV; certain drugs; chronic illness (COPD,CHF, DM, CKD); home resp tx; and age extremes

Clinical Indicators: fever, chills, tachycardia, tachypnea, elevated WBC with a “left shift”, hypoxia, purulent sputum, "patchy" infiltrate on CXR

mcmahons

Do you have a query that helps the physicians document/clarify?   We have a query, but most physicians write "bacterial pneumonia, unknown organism" which codes to simple, even though patient is on multiple antibiotics and has the clinical indicators/risk factors so it appears we are treating a complex pna. 

kelly.cutshall@ccmh.com

Some of the indicators that we include in our queries. #1 Pt went from 1st line of Antibiotics generally Azithromycin and Rocephin and didn't seem to improve and AB was changed to Zosyn or levaquin # 2 recent hospital or rehab admission #3 Resident of nursing facility #4 Other contact with healthcare-home wound care, outpt tx, hemodialysis ect. #5 Failed outpt treatment #6 risk for aspiration pneumonia #6 Immunocompromised. Complex Pneumonia -AB are not general first line, Risk factors for "Complex" pneumonia are present, Poor response to initial tx with change in AB noted, May require longer length of stay, and discharged on broad spectrum AB. The query should ask the physician to "please clarify the most likely type of pneumonia you are treating."  Our physicians have been very responsive as long as we have all the information needed to support the "Complex pneumonia." Hope this helps.

mcmahons

Thank you both for your feedback.  We do list the clinical indicators, but then as response our physicians often write : "Bacterial Pneumonia, organism unknown."  This codes to Simple Pneumonia.  Are you physicians writing "Complex Pneumonia" and that is getting coded as such, or are they documenting some other response?

evanspx@sutterhealth.org

Complex is coded as unspecified pneumonia, only - need specificity as to organism, type (VAP, ASP) in order to code in more specific manner

Paul E. RHIA

mcmahons

Yes, Paul, that's what we are finding.  Our challenge is getting the organ specificity. 

evanspx@sutterhealth.org

Indeed...very difficult!  (Good advice here)

kelly.cutshall@ccmh.com said:

Some of the indicators that we include in our queries. #1 Pt went from 1st line of Antibiotics generally Azithromycin and Rocephin and didn't seem to improve and AB was changed to Zosyn or levaquin # 2 recent hospital or rehab admission #3 Resident of nursing facility #4 Other contact with healthcare-home wound care, outpt tx, hemodialysis ect. #5 Failed outpt treatment #6 risk for aspiration pneumonia #6 Immunocompromised. Complex Pneumonia -AB are not general first line, Risk factors for "Complex" pneumonia are present, Poor response to initial tx with change in AB noted, May require longer length of stay, and discharged on broad spectrum AB. The query should ask the physician to "please clarify the most likely type of pneumonia you are treating."  Our physicians have been very responsive as long as we have all the information needed to support the "Complex pneumonia." Hope this helps.

morris-jeff@CooperHealth.edu

mcmahons said:

Yes, Paul, that's what we are finding.  Our challenge is getting the organ specificity. 

Our MD;s are using suspected, likely, probable organism based on their antibiotic selection, duration of treatment, pt's risk factors, etc...

Jeff