Pneumonia Specificity
How is Pneumonia due to strenotrophomonas coded?
J158- pneumonia due to other specified bacteria OR J156-pneumonia due to other gram-negative bacteria?
Can you take this to gram negative (since it is a gram negative organism) or do they specifically have to say gram negative?
Comments
"Stenotrophomonas (Xanthomonas) maltophilia is a multidrug-resistant gram-negative bacillus that is an opportunistic pathogen [1-4], particularly among hospitalized patients. S. maltophilia infections have been associated with high morbidity and mortality in severely immunocompromised and debilitated individuals."
Per ICD 10 guidelines, diseases should always be reported to the highest specificity possible. I believe it would be appropriate based on the use of the classification above, to go ahead and report this as a gram negative.
Some coders however will disagree with that and not be comfortable using the official classification of gram negative in order to code a gram negative organism using a gram negative code unless the physician also says gram negative. It is silly...but true. For the coder doing the work, it often depends on the mood of their particular coding auditor to if they are allowed to use such common sense versus following the literal indexing of the code available in ICD 10. (IE, coders look up the definitions and types of devices and other disease definitions all the time to arrive at codes but the application here would be very inconsistent across the board for this pneumonia).
I believe a large portion of coders (just a guess here of greater than 50%) would actually take this to "other specified bacteria".
Great question Jill, I will be interested to see what others have to say.
As one with much experience as a coder, I'd certainly code this to a gram-negative w/o hesitation. I know Allen has great skill as a coder; so, I am assuming he has already verified that there is no separate classification for this particular gram negative organism. Hence, the most precise way to report this is as a gram negative organism. For the record, as an RHIA, I have been trained to code in this fashion even from the University as a 'rookie. The coding course we took trained us to think in this fashion as well as the A&P classes, clinical pharmacology, pathophysiology, etc.
If the MD documents the organism, the coder should code to the precise organism to the degree avaialbe per ICD-10 Classification.
Paul Evans, RHIA, CCDS
Paul,
Thanks, My encoder is offline at the moment. If you want to double check that organism just to make sure there is no specific indexed entry that would be great (I assumed the original post has checked first)
Allen...thanks for the response. I find no direct classification in ICD for this organism. However, knowing it is classified as gram-negative, confirming my agreement with you this should be reported with the code for a Gram Negative PNA. When I was a coding mgr (I know consider myself a CDI) we, in fact, had a very detailed clinical guide of about 20 pages as to how to classify and correctly code all manner of pneumonias. The knowledge and trainer of folks used as coders varies greatly.
Paul
due to E. Coli
Due to Gram Neg
Due to Gram Positve
Due to MRSA
Due to Virus
u get the picture.
Technically, if they reported it as anything but gram negative it would be clinically incorrect and we have a mandate from all the coding advice including compliance, guidelines and the false claims act never to KNOWINGLY falsify information. Essentially any payer or auditor demanding this be reported as something other than gram negative is requesting the facility to falsify information.
I used to use a similar argument when arguing against my coding auditors and fellow coders who wanted to take "decompensated" heart failure to unspecified (back in the day before coding clinic addressed).