Coding, Classification and Reimbursement

Diagnosis of influenza and aspiration pneumonia

  • 1.  Diagnosis of influenza and aspiration pneumonia

    Posted 01-11-2019 17:12
    I am hoping someone can give me some guidance on coding influenza (unidentified) and aspiration pneumonia for selection of PDX. There is no documentation of bacterial pneumonia. I know CC 1st Q 2017 page 24 states that " Code J69.0, Pneumonitis due to inhalation of food and vomit, is under the section titled "Lung diseases due to external agents." Aspiration pneumonia is an inflammation of the lungs caused by the inhalation of solid and/or liquid matter" J18.9 or other pneumonias in this category have the "code first" convention but aspiration pneumonia does not. We are bouncing this back and forth as we have no guidance on this, just COPD and aspiration pneumonia. I would think this CC would apply to influenza as well. Any help would be greatly appreciated.

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    Sharon, Stephenson, RHIT, CDIP, CCS QA Specialist
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  • 2.  RE: Diagnosis of influenza and aspiration pneumonia

    Posted 01-12-2019 09:23
    J11.08  Influenza due to unidentified influenza virus with specified pneumonia
    code also other specified type of pneumonia
    J69.0 Aspiration pneumonia

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    Louise Smalling
    Senior Medical Coder
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  • 3.  RE: Diagnosis of influenza and aspiration pneumonia

    Posted 01-12-2019 21:41
    I brought this up to our Coding group this morning, so thank you for the question that gave us great discussion!
    We came up with influenza  with other pneumonia (J11.08) and aspiration pneumonia (J69.0)  with no particular sequencing as there is a code also note, not a code first note.  Sequencing will depend on the circumstances of the admission.  If both are considered to be equally responsible for causing the admission and either can be sequenced first, in an inpatient setting, the aspiration pneumonia results in the higher weighted DRG.

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    [Dorothy "Dotsy"] [Baxter] RHIA CCS
    [ICD-10-CM/PCS AHIMA Trainer Certificate holder]
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  • 4.  RE: Diagnosis of influenza and aspiration pneumonia

    Posted 01-14-2019 08:53
    Thank you so much for the responses. I agree that there is no sequencing directive so either can be used as PDX.

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    Sharon, Stephenson, RHIT, CDIP, CCS QA Specialist
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