Consolidation of lung

melb2780@gmail.commelb2780@gmail.com
in Clinical & Coding

In the ICD-10 index consolidation of lung leads you to code this as lobar pneumonia. To me consolidation of lung is a finding and not a specific diagnosis. How would consolidation of lung need to be documented to code this as lobar pneumonia? I know we wouldn't take this from an x-ray report but what if it is the physician interpretation of the x-ray report? I don't feel comfortable coding something as lobar pneumonia without that being specifically documented. Thoughts?


Melissa Shelton, CCS, CCDS

Comments

  • hooter1964hooter1964
    Interesting...If the physician states " will start on Antibiotics for the consolidation of right or left lung noted on imaging" then I would code it. A concurrent CDI review would hopefully query the provider. 
    Some notes on the term Consolidation :
    Consolidation on CT scans refers to a pattern of pulmonary abnormality that appears as a homogeneous increase in lung parenchymal attenuation that obscures the margins of vessels
    and airway walls. Consolidation consists of an exudate or other product of disease that replaces alveolar air, rendering the lung solid (as in infective pneumonia).
    Lobar consolidation is the representative pattern of lobar pneumonia. The lobar pneumonia is one of the two morphologic classifications of pneumonia (the other being bronchopneumonia). Lobar consolidation in lobar pneumonia tends to be located at the middle and outer thirds of the lung.
    Ref :Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL,
    Remy J. Fleischner Society: glossary of terms for thoracic imaging.
    Radiology. 2008;246:697–722.
  • afrady@hcpro.comafrady@hcpro.com
     Just a peek at the mind of a coder.  Some in the industry may view the statement of "consolidation of right or left lung noted on imaging"  as what we used to refer to as a "finding" or "finding without a diagnoses".   Auditors would likely try to make up some reason for taking that off with what ever the argument de jour of the day is as well "not clearly documented", "inconsistent", "lacking in the documentation of the clinical significance" etc.    If it appears appropriate to report lobar pneumonia more "MEAT" is needed I think.
  • melb2780@gmail.commelb2780@gmail.com
    Exactly afrady@hcpro.com. This is why I would be hesitant to code that as pneumonia.  Not to mention that a lung consolidation is not always due to pneumonia,
  • hooter1964hooter1964
    Not arguing with you. Just trying to come up with a reason for the code in the ICD 10 Index. 

  • afrady@hcpro.comafrady@hcpro.com
    hooter1964 said:
    Not arguing with you. Just trying to come up with a reason for the code in the ICD 10 Index. 


    Argue away!  I love the dialogue.   Also I said "the mind of a coder" which as we all know is a filtered lens significantly different than a true clinical view.      Some would in fact argue that if it can be indexed, it should be reported.   I would take that view myself if not for the denials situation I see some times.    Those who know me know that I do NOT like for guidelines and indexing to be modified based on audit results (and we are in fact, not supposed to do that).  Nonetheless I would strongly caution judicious review when reporting lung consolidation as lobar pneumonia.

    Never a dull moment.

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