Coding, Classification & Reimbursement

Lobar Pneumonia, Coding Clinic Q3, 2018

  • 1.  Lobar Pneumonia, Coding Clinic Q3, 2018

    Posted 09-27-2018 12:31
    Just wondering what everyone's thoughts are regarding CC advice to code Right Lower Lobe pneumonia to J18.1-Lobar Pneumonia?  Thanks.

    Teresa Seville


  • 2.  RE: Lobar Pneumonia, Coding Clinic Q3, 2018

    Posted 09-27-2018 13:57
    ​That's the code that I use if it's in the lung. If they just put unspecified and the xray in inconclusive, I just use J18.9.

    Abbi Telford, RHIT
    Health Information
    Inpatient &Outpatient Coder / Release of Information
    Credentialied Trainer: ASAP & Inpatient Physicians; HIM
    IaHIMA Communications Liason
    Humboldt County Memorial Hospital - Humboldt IA

  • 3.  RE: Lobar Pneumonia, Coding Clinic Q3, 2018

    Posted 09-28-2018 09:34
    OH MY GOODNESS!!!  Here we go again.  After reading 3rd quarter, 2018, read also March-April 1985 and 3rd quarter 2009 Coding Clinics.  My question is "who is making these confusing decisions with the Coding Clinic"?

    Nelda Laskey RHIT
    Coder/RAC Coordinator
    Kearny County Hospital

  • 4.  RE: Lobar Pneumonia, Coding Clinic Q3, 2018

    Posted 09-30-2018 18:27
    I'm glad I'm not the only one to remember the 1985 and 2009 Coding Clinic advice on this issue.  I'm not even stunned anymore when Coding Clinic publishes new, conflicting advice.. They should at minimum publish it as "supercedes previous advice." Don't even get me started on the personal advice responses in writing they send out and then change advice when they print in the publication. 

    Laura C Jones, RHIT, CCS
    Coding Validator

  • 5.  RE: Lobar Pneumonia, Coding Clinic Q3, 2018

    Posted 10-12-2018 10:55
    I also cannot believe this is the current and appropriate guidance for lobar pneumonia - having been through all the compliance issues that were created by indiscriminate use of the term under ICD-9-CM.  The prior compliance issues evolved around coders picking up "lobar" for specificity, oftentimes on the basis of a radiology-generated finding.  The interpretation of Lobar Pneumonia at the time - from the medical community perspective - was that this is a term commonly applied to streptococcal pneumoniae.  This is significant because this was one of the key issues in all of the Pneumonia Upcoding investigations.  Lobar pneumonia implies a bacterial infection and has a complicating presentation.  "Lobar" as a location was considered at the time to be a non-essential modifier.

    I certainly hope that Coding Clinic provides a subsequent clarification on this if they are absolutely changing the guidance.  This is obviously one of the problems with having to balance I-9 Coding Clinic with the ICD-10-CM coding process.  Maybe it is time for a different format to get these issues addressed in a more timely fashion - or even put it out there as a "proposed rule" prior to locking it down.  I worry about the implications from a clinical validation and RAC investigative process perspective.

    Karen M. Karban, RHIT, CDIP, CCS
    Sr. Product Manager

  • 6.  RE: Lobar Pneumonia, Coding Clinic Q3, 2018

    Posted 09-28-2018 10:45
    ​Hi Teresa,

    the J18.1 would be the correct code. There's another coding clinic or the Coding Handbook, that further explains the code.

    William Johnson
    Sr. Internal Consultant

  • 7.  RE: Lobar Pneumonia, Coding Clinic Q3, 2018

    Posted 10-12-2018 13:31
    Edited by Lawrence Barr 10-12-2018 13:33

    The term "lobar" pneumonia is no longer considered synonymous with pneumococcal or strep pneumoniae pneumonia.  This organism is the usual but not always responsible organism  for lobar pneumonia.

    I do agree with others who feel such a significant change from prior advice should be noted.

    Lawrence Barr

  • 8.  RE: Lobar Pneumonia, Coding Clinic Q3, 2018

    Posted 12-11-2018 11:37
    ​Wholeheartedly agree with what's stated above.  Coding Clinic needs to further explain their advice.

    Lobar pneumonia causes consolidation of the whole lung; bronchopneumonia produces patchy pneumonic consolidation

    There are good You Tube videos explaining the difference between lobar pneumonia and bronchopneumonia.

    Christine Crockford
    Coding Reviewer
    Peace Health

  • 9.  RE: Lobar Pneumonia, Coding Clinic Q3, 2018

    Posted 12-25-2018 01:41
    we cannot code simply right lower lobe pneumonia without clinical evidence. Chest x-ray should support for lobar pneumonia. left or right lower or upper lung will get infected for lobar pneumonia. Hence, based on physician documentation we have to code. dont listen to other. Apply your knowledge in coding and documentation. query to physician in effectively to code accurately.


    Shankara Papaiah Narasimha
    Clinical Coding Auditor