Sickle Cell Pain Crisis with ACS and pneumonia

Living in Mississippi, we get quite a few SSPC with ACS in pediatrics. Coding ACS and pna in SCPC has been an ongoing battle in my mind. So, in doing some research, I found:

"In 40% of children with ACS, most are due to infections... Infectious causes most commonly are viral, mycoplasma pneumonia, or chlamydia pneumonia.

  To be diagnosed with ACS, a patient must meet the following criteria”

New pulmonary infiltrates on chest imaging (chest x-ray, CT) involving at least one lung segment; this cannot be due to atelectasis and must have one of the following symptoms: 

1. Chest pain 

2. Temperature more than 38.5 C (101.3)

3. Tachypnea, wheezing, rales, coughing, appearance of an increased work of breathing 

4. Hypoxemia, relative to baseline (more than 2% decrease in SpO2 from steady state on room air, PaO2 less than 60 mmHg) "

(here is where my problem lies) This algorithm lacks some specificity, and can also be diagnostic of pneumonia. 

So…

1. If we have a pediatric pt with SSPC with ACS and they have infiltrate, temp, increased WOB, started on abx. Do you query for pna or not? 

2. If not, what do you feel would be the clinical indicators (for coding) would delineate a pt with ACS from PNA?

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