J44.0 with pneumonia

bbuckmasterbbuckmaster
in Clinical & Coding

We are wondering about the portion of code J44.0 - "Chronic obstructive pulmonary disease with acute lower respiratory infection." This has been a challenge for us because in the tabular we see that acute bronchitis goes to J44.0 and so does lower respiratory infection. What we have been wondering is what constitutes a lower respiratory infection. Does it include pneumonias.

Ex: If the patient the patient is admitted with pneumonia and COPD. Do you take the pneumonia as a lower respiratory infection? Then you would code it as your PDx - J44.0 and your MCC of Pneumonia.

We struggle with if pneumonia is always assumed to be a lower respiratory infection. And what diagnoses are included in the term "lower respiratory infection" or is it strictly when the provider documents "lower respiratory infection."

Thanks in advance for any help

Comments

  • proddy@clarionhospital.orgproddy@clarionhospital.org
    I have not been going to the J44.0 because I guess I don't know  that Pneumonia is always a lower respiratory infection. I use J44.9 or J44.1 and the appropriate Pneumonia code
  • jackietouch@aol.comjackietouch@aol.com
    If "lower respiratory infection" is documented and the patient has indicators and treatment for pneumonia, I will query. Lower respiratory infection includes anything below the larynx so can be tracheitis, bronchitis, bronchiolitis, etc.

    Jackie Touch
  • kathy.dorich@aah.orgkathy.dorich@aah.org

    The 3rd qrt coding clinic raises some questions.  If the patient has a gm neg PN and COPD must the COPD be sequenced first?  Does the sequencing apply if the COPD is coded as J44.9?  Must you always assume the COPD is exacerbated?  the Coding guidelines seem to say that an infection (PN) can be superimposed on a chronic COPD (J44.9).  Your thoughts?

  • guerriguerri
    kathy.dorich@advocatehealth.com said:

    The 3rd qrt coding clinic raises some questions.  If the patient has a gm neg PN and COPD must the COPD be sequenced first?  Does the sequencing apply if the COPD is coded as J44.9?  Must you always assume the COPD is exacerbated?  the Coding guidelines seem to say that an infection (PN) can be superimposed on a chronic COPD (J44.9).  Your thoughts?


    Per the new Coding Clinics, yes the COPD would be sequenced first. When you go through the coding pathway with no COPD exacerbation it should lead to J44.0 (not J44.9), as principal diagnosis, and J15.6 for the G- pneumonia, as a secondary. (J44.1 would also be reported to reflect COPD exacerbation, if present).

    Further, 3rd quarter CC clarifies pneumonia and acute bronchitis as "lower respiratory infections" and NOT influenza.

    Hope that helps.

    Richard G. RN, CCS, CCDS

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org

    Thanks, Richard:  I don't have this issue yet.  I will follow these instructions given these seem clear.  However, I maintain it is not 'logical' to sequence stable (Chronic) COPD ahead of the acute condition of pneumonia.

    Another head-scratcher and this does seem inconsistent with some of the general principles espoused by the Official Guidelines.


    Paul E. RHIA, CCDS

  • guerriguerri
    paul_evans_90314 said:

    Thanks, Richard:  I don't have this issue yet.  I will follow these instructions given these seem clear.  However, I maintain it is not 'logical' to sequence stable (Chronic) COPD ahead of the acute condition of pneumonia.

    Another head-scratcher and this does seem inconsistent with some of the general principles espoused by the Official Guidelines.


    Paul E. RHIA, CCDS


    I agree completely, Paul. Just seems odd chronic COPD would be sequenced first, given it would not meet the definition of principal diagnosis.
Sign In or Register to comment.