COPD and Pneumonia Sequencing

susan.donnelly@unitypoint.org

Anyone have insight on how the new sequencing will of COPD and Pneumonia will effect a facilities CMI?  Coding clinic

Coding Clinic, Third Quarter 2016, pp. 15-16 addresses this new convention. The question pertains to a patient with COPD who is admitted for treatment of lobar pneumonia. Due to the instructional note, the submitter asks whether the note requires the COPD to be sequenced first.

Coding Clinic answers in the affirmative, responding that J44.0 should be the principal diagnosis, with J18.1 (lobar pneumonia, unspecified organism) as an additional diagnosis.

Does this also include complex pneumonia? such as gram negative pneumonia and aspiration?

cseluke

We have interpreted this Coding Clinic to mean that any patient with diagnoses of COPD and pneumonia (not limited to lobar pneumonia) will have COPD with lower respiratory infection (J44.0) sequenced first and pneumonia sequenced as a secondary diagnosis. There is an instructional note under J44.0 to code the specific infection; i.e., pneumonia. We did send this issue to 3M Nosology and were given this advice. Our vendor for CE also gave the same advice. We did not want to hear it due to the effect on our medical case mix, but rules are rules. 

Cathy Seluke

annnd2009@gmail.com

One thing that struck me odd recently, when I first read this it seemed bas enough to HAVE to have COPD sequenced first automatically, but it really seems odd if you have COPD NOT in exacerbation to allow that to be PDX and PNA secondary... when the COPD is stable  ( no wheezing, RT tx, IV steroids), but that is the latest interpretation I have heard. Is that the way everyone is perceiving that coding clinic? It would have been nice if coding clinic said exacerbation vs non-exacerbation ( or clearly state, it doesn't matter)...

jmccorkl@stanfordhealthcare.org

annnd2009@gmail.com said:

One thing that struck me odd recently, when I first read this it seemed bas enough to HAVE to have COPD sequenced first automatically, but it really seems odd if you have COPD NOT in exacerbation to allow that to be PDX and PNA secondary... when the COPD is stable  ( no wheezing, RT tx, IV steroids), but that is the latest interpretation I have heard. Is that the way everyone is perceiving that coding clinic? It would have been nice if coding clinic said exacerbation vs non-exacerbation ( or clearly state, it doesn't matter)...

Definitely!  It seems like if the COPD is stable, the PDx should be the acute condition: PNA.  However, for now, our Coders & CDIS are interpreting that Coding Clinic as COPD (stable & exacerbated) trumps PNA for PDx status.  That doesn't mean we like it, though!  : )

Jeanne McCorkle BSN, RN, CCDS

proddy@clarionhospital.org

So, my pt has AE COPD and interstitial Pneumonia of suspected viral origin.  Since the pneumonitis is more of an inflammatory disease, would you think that releases it to be used as a primary diagnosis instead of J440?