COPD and specified pneumonia other than aspiration
How is everyone interpreting the above? At our institution gm neg, pseudomonas pneumonia are being coded as the mcc in the presence of COPD. I have read the coding clinic over and over and am not finding anyway around this. Am I missing something? Please help.
Comments
It is ludicrous to me that the diagnosis of COPD whether acute or chronic should be listed as the PDX in an encounter to the hospital setting. Since this ruling came about, we have had to sequence COPD as principal diagnosis regardless of the type of pneumonia being treated. In our facility COPD is generally treated with IV Rocephin and/or Azithromycin. Other types of pneumonias are treated based on the sputum culture or decision of the provider if a culture is not collected. If anyone can explain to our CDI team why a chronic or history of COPD should be the PDX when pneumonia is the acute condition that occasioned the admission and is clearly being treated I'd be happy to hear it.
AHA Coding Clinic for ICD-10-CM and ICD-10 PCS, 3Q 2016, Volume 3, Number 3, Pages 15&16
Ask the Editor Question: The patient has chronic obstructive pulmonary disease (COPD), and is admitted to the hospital for treatment of lobar pneumonia. Under code J44.10, Chronic obstructive pulmonary disease with acute lower respiratory infection, there is a note instructing: "Use additional code to identify the infection." Based on this note is the COPD required to be sequenced first? Answer: Yes, based on the instructional note, the 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. Question: What are the diagnosis code assignments for an acute exacerbation of COPD with pneumonia? Is it appropriate to assign code J44.0, Chronic obstructive pulmonary disease with acute lower respiratory infection, and code J44.1, Chronic obstructive pulmonary disease with (acute) exacerbation and the code for pneumonia? Answer: Yes, it is appropriate to assign both codes (J44.0 and J44.1). Either code may be sequenced first, based on the reason for the admission. Assign code J44.0, Chronic obstructive pulmonary disease with acute lower respiratory infection, code J18.9, Pneumonia, unspecified organism, and code J44.1, Chronic obstructive pulmonary disease with (acute) exacerbation. As stated in the ICD-10-CM Official Guidelines for Coding and Reporting in relation to category J44, "An acute exacerbation is a worsening or a decompensation of a chronic condition. An acute exacerbation is not equivalent to an infection superimposed on a chronic condition, though an exacerbation may be triggered by an infection.I have another question for you all: the title of this message series is "COPD and specified Pneumonia other than Aspiration". Do you sequence differently when it is Aspiration PNA (as opposed to another type of pneumonia) with COPD?
Jeanne McCorkle, BSN, RN, CCDS
Stanford Healthcare - Valleycare
https://acdis.org/articles/tip-pneumonia-copd
I'm sharing this with our Coders and the CDI team!