Tuesday, July 28, 2020

Lobar Pneumonia Revisited

Remember the phrase “Round and round she goes, and where she stops nobody knows”?  Well, that’s how I feel when considering coding direction related to lobar pneumonia.  It seems we are on a merry-go-round and just when we think it is safe to get off, it picks up speed and keeps going.  So let’s review coding of lobar pneumonia discussed in the first blog which was posted on this topic last March and then examine the subsequent advice change.

(Original blog post)

Change - a concept with which coding professionals are all too familiar.   This “In the kNOW” delves into an example of why it is so vital to constantly update a coding professional’s knowledge base by examining the diagnosis of lobar pneumonia and reviewing relevant Coding Clinics related to that diagnosis.  

Lobar pneumonia is type of pneumonia that affects an entire pulmonary lobe or multiple lobes of the lung.  In the vast majority of cases, lobar pneumonia is caused by Streptococcus pneumonia.  As such, initial guidance from Coding Clinic back in 1985 instructed coders to code the diagnosis of lobar pneumonia to pneumococcal pneumonia, which under ICD-9 coded to 481 and under ICD-10 codes to J13.

Fast forward to 2009, when another question surfaces, this time regarding the appropriate coding for multilobar pneumonia.  Now coding professionals are instructed to query the physician for the specific type of pneumonia.  If no further clarification is obtained, then the code to be used is 486 (ICD-9) (J18.9 ICD-10) for an unspecified pneumonia.  It had been determined that the term “lobar pneumonia” was outdated, and that lobar pneumonia actually had many causes not just pneumococcal (which traditionally affected one lobe but could encompass several lobes).

In a recent 3rd Qtr. 2018 update, Coding Clinic once again addressed the coding for a lobar pneumonia diagnosis.  Guidance provided that when a diagnosis of “lobe pneumonia” (such as left lower lobe pneumonia) was documented, it is to be considered lobar pneumonia and coded to J18.1.  This is true regardless of whether the documentation indicates one lobe, multiple lobes, or a partial lobe are impacted.     

Code J18.1 is specific to the location of the pneumonia rather than the causative organism.  Should the documentation further specify the agent responsible, then there are combination codes available under “Pneumonia, lobar” in the Alphabetic Index to capture that information.  For example, E. coli lobar pneumonia codes to J15.5.      

Assignment of J18.1 for the unspecified lobar pneumonia results in the MS-DRG of 195-Simple Pneumonia and Pleurisy w/o CC/MCC with a reimbursement weight of 0.6868.  Hemophilus influenzae, pneumococcal, streptococcal, or specified organism NEC types of lobar pneumonia will all fall into the same MS-DRG of 195.  Note that Klebsiella pneumoniae, Pseudomonas, Escherichia coli, and Proteus specific lobar pneumonias will result in assignment to MS-DRG 179-Respiratory Infections and Inflammations w/o CC/MCC with a reimbursement weight of 0.9215. 

This brings us back to querying the physician.  While it is possible to code lobe or lobar pneumonia, there is the potential for increased reimbursement as illustrated above, should the physician be able to specify the exact type of pneumonia.  Therefore, it may be beneficial for a coder to query the physician for the exact type of lobar pneumonia affecting the patient.

Review of this one diagnosis, lobar pneumonia, is just one incidence of the changes that coding professionals see on a frequent basis.  A coder can never assume that information learned years ago is still relevant today.  Medicine is changing it an ever-increasing speed, in turn influencing how we code.  It is our responsibility to maintain a commitment to life-long learning to ensure we keep up with those changes. 

(Newest Revision)

The last paragraph in the original blog is so true and how quickly another change has come.  A correction to lobar pneumonia coding was published in the 3rd Qtr. 2019 Coding Clinic.  Now coding professionals are instructed that the diagnosis must be specific to “lobar” pneumonia in order to assign code J18.1.  Documentation of pneumonia in one lobe or multiple lobes is NOT to be coded to “lobar” pneumonia without that term being specified by the provider.  Clarification states that lobar pneumonia represents a consolidation of an entire lobe rather than just infiltrates and that it would not be appropriate to assign lobar pneumonia if imaging shows pneumonia in one or multiple lobes.

Now you are In the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.

Tuesday, July 21, 2020

OHIMA FY20-21 Board President's Message

Greetings to the membership! I am both honored and excited to serve as President of the Ohio Health Information Management Association (OHIMA) for the 2020-2021 year. As we enter a year of many uncertainties, difficult decisions and new normals, I am confident in the adaptability of our board and members.

As you know, the association implemented a new website in December with only a few months notice. Our new website features the ability to log into your OHIMA profile to register for events and online education at discounted member prices, access "Member Only" content and resources, view OHIMA CEUs, and much more!  Without this new website, we would not have been able to deliver the annual virtual meeting the way we did. Because of our success and agility in turning the 2020 Annual Meeting into a virtual conference, OHIMA applied for an AHIMA Triumph Award. We are proud that the hard work and dedication of our executive director and board was indeed recognized nationally. OHIMA was awarded the Triumph Award in the Innovation category!

Last week, I along with several new Board members attended the virtual AHIMA Leadership Symposium and heard more about crisis management, situational leadership and AHIMA’s strategic direction. In the upcoming year, OHIMA will re-evaluate its strategic plan to align with AHIMA’s, and as a result of the COVID-19 pandemic. In addition, OHIMA will be diving deeper into additional website features as well as offering members only content for the benefit of our valued members.

In closing, I must state, that as health information management professionals, we are uniquely positioned to be change agents in society.  We can take action as individuals and work to advance equitable healthcare for vulnerable populations and serve as role models for human connection in healthcare. OHIMA will commit to delivering strong and consistent leadership and ensure we have an understanding of the different types of resources our membership needs during this unique time.

I am looking forward to this upcoming year, and invite you to reach out to me at the email address below with any thoughts, specifically, ideas that foster inclusion and diversity within OHIMA. 

I wish everyone a safe and happy year!

“Perseverance is not a long race; it is many short races one after the other”.-Walter Elliot


Kristin Nelson, M.S., RHIA
OHIMA Board President FY 2020-21

Tuesday, July 14, 2020

Pandemic Phalange Pitfalls

by Dianna Foley, RHIA, CHPS, CCS 

Test your ICD-10-CM coding skills with this Klutz family experience.

Image by <a href="https://pixabay.com/users/AnnaliseArt-7089643/?utm_source=link-attribution&amp;utm_medium=referral&amp;utm_campaign=image&amp;utm_content=4881091">Annalise Batista</a> from <a href="https://pixabay.com/?utm_source=link-attribution&amp;utm_medium=referral&amp;utm_campaign=image&amp;utm_content=4881091">Pixabay</a>
Image by Annalise Batista from Pixabay

As a way to help pass the time during the COVID-19 pandemic, Mrs. Klutz suggested the children put on a backyard gymnastics show.  This would help keep the children active and entertained, as well as showcase their gymnastic talents from years of lessons.  In true Klutz family form however, each child sustained an injury during the show.  Read on to see what injury befell each child and test your ICD-10-CM coding knowledge by assigning the appropriate injury and external cause codes for each situation that occurred in the backyard of the single- family home.

Little Dana began the parade of phalangeal injuries when she attempted a somersault and bent back the little finger on the right hand.  Luckily, the sprain was minor and Mrs. Klutz put an ice-pack on it to keep any swelling down. 

Raymond chose a floor exercise routine to illustrate his talent.  All was well until he went to perform a handstand and his left thumb got caught in a hole in the ground and twisted as he tried to walk on his hands.  He immediately fell over and Mrs. Klutz brought out another ice pack for Raymond’s undoubted flexor tendon strain.

Next, Peter attempted a vault, but on his barefoot run up to the vault his Dad had built, he stepped on a sharp rock causing a small, open wound of the second toe on his right foot.  Mrs. Klutz cleaned the wound with alcohol and applied an antibiotic ointment and band-aid.

 Janine did a very complicated routine on the balance beam her Dad constructed and was quietly confident that she was going to emerge unscathed when, upon her dismount, she struck her left foot on the beam and ended up with an abrasion of the left big toe.  Mrs. Klutz was glad she had kept the alcohol and antibiotic ointment handy after Peter’s injury and used them to minister to Janine.

The final act was from Egon whose routine was on the parallel bars. He was making his last turn at the far end of the bars when his right hand slipped and he struck it hard on the parallel bar, bruising the index, middle, and long fingers.  Another ice pack was brought out for Egon’s hand.

Mr. and Mrs. Klutz were glad that the children had not suffered greater injuries…at least for now!        

Click HERE for the answers.

Tuesday, July 7, 2020

Book Excerpt: Etiology of Pediatric Respiratory Conditions

By Leah Savage, MSN, RN

There are a number of etiologies leading to pediatric respiratory failure, just as there are with adult patients. To begin with, pediatric patients can come to an acquired extrathoracic airway from an infectious source (e.g., retropharyngeal abscesses, Ludwig’s angina, bacterial tracheitis, acute viral bronchiolitis, bacterial/fungal/viral pneumonia), trauma (such as postop extubation croup, thermal burns, foreign-body aspiration, or direct trauma), allergic reactions, and other causes such as hypertrophic tonsils and adenoids.

Pediatric patients may also enter respiratory failure because of a number of congenital extrathoracic airway conditions. Some of the common conditions are:

  • Subglottic stenosis
  • Subglottic web or cyst
  • Laryngomalacia
  • Tracheomalacia
  • Vascular ring
  • Cystic hygroma
  • Craniofacial anomalies

There are also a number of respiratory pump causes that can lead to respiratory failure such as diaphragm eventration, diaphragmatic hernias, agenesis of the diaphragm, flail chest, kyphoscoliosis, Duchenne muscular dystrophy, Guillain-Barré syndrome, infant botulism, myasthenia gravis, spinal cord trauma, and spinal muscular atrophy. While many of these conditions can be present in adult patients as well, they are particularly risky for pediatric patients due to their less developed airways, etc., as discussed above.

Central control issues can also lead to respiratory failure. Some of these are central nervous system infections, sleep apnea, strokes, traumatic brain injuries, overuse of anti-epileptic drugs leading to apnea, and an underdeveloped brain due to prematurity. As a note, prematurity affects every aspect of the child’s developmental health and can be a significant contributing risk factor for respiratory failure.

A number of intrathoracic airway and lung conditions can also lead to respiratory failure. Many of these conditions are acquired, and therefore they could affect the adult population as well. But, because pediatric patients are still developing, these conditions can be much more severe and lead to larger consequences down the line. These conditions include:

  • Asthma
  • Aspiration
  • Bronchiolitis
  • Bronchomalacia
  • Cardiac abnormalities
  • Pulmonary contusion 
  • Near drowning
  • Pneumonia
  • Pulmonary edema and embolus
  • Sepsis
  • Pulmonary hypertension

Editor’s note: This is an excerpt from the recently released book Pediatric CDI: Building Blocks for Success

Copyright Association of Clinical Documentation Improvement Specialists (ACDIS).  Article reprinted with permission.