COPD & PNA

lnsavage10@yahoo.com

Per coding clinic ICD 1-10+CM/PCS Coding clinic, Third Quarter ICD-10 2016 Page: 15 Effective with discharges; September 23, 2016,

COPD must be sequenced first. Assign code J44.0, Chronic obstructive pulmonary disease with acute lower respiratory infection, as the principal diagnosis. Code J18.1 Lobar pneumonia, unspecified organism, should be assigned as an additional diagnosis.

According to this guideline all patients with COPD history that come in with PNA are going to now be coded to COPD.  So we will never be able to get a complex PNA  or PNA on a patient that has a history of COPD? Is anyone else having an issue with this? Seems very strange, would like to hear other opinions.

Leah Savage, RN, MSN, CCDS

proddy@clarionhospital.org

I read that to apply specifically to Lobar pneumonia as opposed to regular pneumonia unspecified, etc

tinabrooks65

Just playing Devil's Advocate:  The classification system (ICD-10CM) is used for gathering morbidity and mortality statistics and not just for reimbursement. Therefore, it makes sense that the chronic conditions (COPD, HTN and DM) be captured as the Pdx with the associated conditions (PNA, Heart Failure, foot ulcers etc. respectively) as secondary diagnoses. The chronic conditions above are responsible for a major portion of the healthcare costs in the US; accurate data on IP admissions that are due to these chronic conditions and the associated conditions is valuable in formulating treatment and public health policy. When I look at it that way... Kudos to the cooperating parties for getting more inline with the original purpose of having an ICD. Reimbursement may someday be adjusted for COPD with lower respiratory infection with Pneumonia but that can only occur after accurate data is collected. 

lnsavage10@yahoo.com

I had not thought of it like that... thanks for clarifying and that does make a lot more sense.

evanspx@sutterhealth.org

I disagree that it is logical to use  a chronic condition that is not exacerbated,  such as COPD, as the principal diagnosis when a patient has an acute condition, such as pneumonia, that caused the admission.   The PNA, not the stable COPD is the reason the pt was admitted and 'bought the bed'.  It is not about reimbursement, and the Cooperating Parties 'got it wrong'.  The Principal Diagnosis is the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care".  I accept the edict has been issued, but not the rationale.

cseluke

I agree with Paul that it is not logical to use a chronic condition as principal diagnosis. If this Coding Clinic is interpreted literally, it would only apply in cases of documented lobar pneumonia. I do not often see lobar pneumonia documented. 

guerri

Yes, I was surprised myself to see that Coding Clinic ruling, as it makes absolutely no sense from both a coding and clinical perspective, as this new CC contradicts UHDDS definition of principal diagnosis.

I'm eager to see how this will play out. Assuming no other MCC, payers will likely argue using UHDDS rules.

- Richard G.