When coding influenza and pneumonia in encoder, you get to the "with" section. If pneumonia is present, can you select that as a dx or does the provider need to specifically state the influenza is due to the pneumonia?
When coding influenza and pneumonia in encoder, you get to the "with" section. If pneumonia is present, can you select that as a dx or does the provider need to specifically state the influenza is due to the pneumonia?
My understanding is that "with" is equivalent to "with" or "and". Coding guidelines specify that combination codes should be used when available instead of separately coding conditions; therefore, our practice is to use the combination code for influenza and any other co-existing condition (ie pneumonia, encephalopathy, etc).
The encoder gives an option to specify type of pneumonia and type of influenza separately, so if provider does not specify pneumonia due to influenza (type), you can choose unspecified pneumonia. In APR-DRG, using combo code makes a difference, not sure about MS-DRG.
The reason you get this tie is as because ICD 10 requires influenza to be codes as pdx in pneumonia patients. There is an instructional note to "code first' the applicable pneumonia (assuming both are poa etc.).
Not to worry, it has zero impact on the DRG. You will still get to the correct Pneumonia DRG even when sequencing influenza first.
See your coding book and hard copy of your DRG expert for reference.
This instructional note is present in all ICD 10 J codes from J12 all the way through the entire J18 block, which is everything from viral pneumonia to every single organism of pneumonia that you could have including gram negative right through unspecified.
The drive for the DRG is not the pdx but rather the secondary pneumonia type. In other words if you have a SDX of E. coli pneumonia you get to DRGs 177 to 170, other respiratory infections and inflammations.
This is what is known as a "AD diagnosis" meaning in this instance it drives the DRG even when not pdx.
Don't ask me why they set it up this way, I have no clue but at least the DRG comes out right.
If you index pneumonia there IS an index entry in the look up that says "Pneumonia with Influenza, see influenza with pneumonia". You follow that Index entry it gives you "Influenza with pneumonia" and you arrive at one of two possible codes that you can actually assign without the physician stating the relationship. They are J11.00 and J11.1. J11.1 gets used if the physician specifies he exact virus, J11.00 gets used otherwise. J11.00 for "Influenza due to UNidentified influenza virus WITH UNSPECIFIED pneumonia and J11.01 is for specified pneumonia
You cannot index to the A/H1NA or Avian, or A/H5N1 codes this way, those must be specified as related by the provider.
Lastly you can index into an assumed relationship if you index it as Pneumonia with an identified virus NEC as J10.00 or J10.01 using the with rule. J10.0 is simply influenza due to other identified influenza virus with UNSPECIFIED type of pneumonia and J10.01 is for OTher identified influenza virus pneumonia.
You can see the difference between the codes available is simply whether the virus is identified or not and or if the pneumonia is identified or not.
Since all of these have the word "with pneumonia" in them, they are all assumed.
Thank you! I actually just saw this reponse...one year later as I was searching this topic AGAIN. Thank for your detailed response! Absolutely respect coders! This makes my head spin sometimes.
Comments
The encoder gives an option to specify type of pneumonia and type of influenza separately, so if provider does not specify pneumonia due to influenza (type), you can choose unspecified pneumonia. In APR-DRG, using combo code makes a difference, not sure about MS-DRG.
It isn't "with or and", it is "with or in".
The reason you get this tie is as because ICD 10 requires influenza to be codes as pdx in pneumonia patients. There is an instructional note to "code first' the applicable pneumonia (assuming both are poa etc.).
Not to worry, it has zero impact on the DRG. You will still get to the correct Pneumonia DRG even when sequencing influenza first.
See your coding book and hard copy of your DRG expert for reference.
This instructional note is present in all ICD 10 J codes from J12 all the way through the entire J18 block, which is everything from viral pneumonia to every single organism of pneumonia that you could have including gram negative right through unspecified.
The drive for the DRG is not the pdx but rather the secondary pneumonia type. In other words if you have a SDX of E. coli pneumonia you get to DRGs 177 to 170, other respiratory infections and inflammations.
This is what is known as a "AD diagnosis" meaning in this instance it drives the DRG even when not pdx.
Don't ask me why they set it up this way, I have no clue but at least the DRG comes out right.
If you index pneumonia there IS an index entry in the look up that says "Pneumonia with Influenza, see influenza with pneumonia". You follow that Index entry it gives you "Influenza with pneumonia" and you arrive at one of two possible codes that you can actually assign without the physician stating the relationship. They are J11.00 and J11.1. J11.1 gets used if the physician specifies he exact virus, J11.00 gets used otherwise. J11.00 for "Influenza due to UNidentified influenza virus WITH UNSPECIFIED pneumonia and J11.01 is for specified pneumonia
You cannot index to the A/H1NA or Avian, or A/H5N1 codes this way, those must be specified as related by the provider.
Lastly you can index into an assumed relationship if you index it as Pneumonia with an identified virus NEC as J10.00 or J10.01 using the with rule. J10.0 is simply influenza due to other identified influenza virus with UNSPECIFIED type of pneumonia and J10.01 is for OTher identified influenza virus pneumonia.
You can see the difference between the codes available is simply whether the virus is identified or not and or if the pneumonia is identified or not.
Since all of these have the word "with pneumonia" in them, they are all assumed.
Have a new respect for coders yet???
Alan,
Thank you! I actually just saw this reponse...one year later as I was searching this topic AGAIN. Thank for your detailed response! Absolutely respect coders! This makes my head spin sometimes.
Thanks again!
Janine