ICD-10 Codes to Document Lobar Pneumonia this COVID-19 Season
April 30, 2020
Pneumonia refers to an infection that inflames the air sacs in one or both lungs whereas Lobar pneumonia refers to a form of pneumonia that affects a specific lobe or lobes of the lung. Pneumonia is grouped by its different causes such as bacterial pneumonia, viral pneumonia, mycoplasma pneumonia and so on. Lobar pneumonia is a bacterial pneumonia and is most commonly community acquired. The world is hit by covid-19 or the coronavirus that had started in late 2019 and early 2020 in the Chinese city of Wuhan as a cluster of pneumonia cases with an unknown cause. Just as any other disease or health condition, accurate documentation is vital for the covid-19 pandemic also to understand its nature, disease progression, and effective treatment. Physicians who provide treatments to patients need to know the various types pneumonia and to code the diagnosis and treatments correctly, they can rely on medical coding companies.
Also referred to as "non-segmental" or "focal non-segmental" pneumonia, lobar pneumonia is characterized by an acute inflammation of the entire lobe or lung. The most common cause for this type of pneumonia is Streptococcus pneumoniae (pneumococcus) and some other common types of bacteria responsible for lobar pneumonia are:
The signs and symptoms of lobar pneumonia is the same as for other types of pneumonia with dyspnea, productive cough, fever/chills, malaise, pleuritic chest pain, and hemoptysis. Pleuritic chest pain due to localized inflammation of pleura can be seen with any kind of pneumonia but, is more common with lobar pneumonia. Constitutional symptoms such as fatigue, headache, myalgia, and arthralgias can also be seen. Symptoms might also include chest pain while breathing or coughing, cough, often with phlegm, fever, sweats and chills, nausea, loss of appetite, vomiting or diarrhea as well as shortness of breath. Complications can include pleural/parapneumonic effusion, and empyema.
Lobar pneumonia is typically acute with four stages:
Congestion: This is the first stage which occurs within the first 24 hours of infection. The patient will develop vascular engorgement (the lung becomes heavy and hyperemic).
Consolidation (red hepatization): The vascular congestion persists and there is extravasation of red cells in the alveolar spaces. This leads to the appearance of consolidation (solidification) of the alveolar parenchyma.
Gray hepatization: Red cells disintegrate and there is still appearance of consolidation, but the color is paler and appears drier. The lung is gray-brown to yellow.
Resolution: Complete recovery (exudation will liquefy and will be coughed up in sputum or drain via the lymphatic system)
With pathological specimens we can investigate the presence of lobar pneumonia in patients. For that the specimens to be obtained include:
Sputum for culture, AAFBS and gram stain
Blood for full hemogram/complete blood count, ESR and other acute phase reactants
Procalcitonin test, more specific
The most specific diagnostic test for lobar pneumonia is sputum culture. In addition, chest radiograph or CT scan can also provide the clue to the diagnosis whether it's lobar, interstitial, unilateral or bilateral. Although CT is a more reliable and accurate test, its use is limited due to relatively high radiation exposure and high cost.
The ICD-10 code for Lobar pneumonia is
J18.1: Lobar pneumonia, unspecified organism
According to the American Academy of Professional Coders (AAPC), as of October 1, 2019, if pneumonia is documented as affecting a particular lobe, it is coded to:
J18.9: Pneumonia, unspecified organism
and NOT J18.1. Be cautious when using encoders, as some are still leading the coder to report J18.1 when only the lobe or multilobar is documented.
Lobar pneumonia is a clinical diagnosis made by the physician.
Pulmonary medical billing and coding can be challenging. Pulmonologists or infectious disease specialists diagnosing the symptoms and providing specialized treatment for pneumonia need to be reimbursed for their services. The correct ICD-10 codes must be used to indicate a diagnosis of pneumonia and these include –
J12: Viral pneumonia, not elsewhere classified
J12.0: Adenoviral pneumonia
J12.1: Respiratory syncytial virus pneumonia
J12.2: Para influenza virus pneumonia
J12.3: Human metapneumovirus pneumonia
J12.8: Other viral pneumonia
J12.9: Viral pneumonia, unspecified
J13: Pneumonia due to Streptococcus pneumonia
J14: Pneumonia due to Hemophilus influenzae
J15: Bacterial pneumonia, not elsewhere classified
J15.0: Pneumonia due to Klebsiella pneumoniae
J15.1: Pneumonia due to Pseudomonas
J15.2: Pneumonia due to staphylococcus
J15.3: Pneumonia due to streptococcus, group B
J15.4: Pneumonia due to other streptococci
J15.5 Pneumonia due to Escherichia coli
J15.6: Pneumonia due to other Gram-negative bacteria
J15.7: Pneumonia due to Mycoplasma pneumoniae
J15.8: Pneumonia due to other specified bacteria
J15.9: Unspecified bacterial pneumonia
J16: Pneumonia due to other infectious organisms, not elsewhere classified
J16.0: Chlamydial pneumonia
J16.8: Pneumonia due to other specified infectious organisms
J17: Pneumonia in diseases classified elsewhere
J18: Pneumonia, unspecified organism
J18.0: Bronchopneumonia, unspecified organism
J18.2: Hypostatic pneumonia, unspecified organism
J18.8: Other pneumonia, unspecified organism
The key to proper medical coding for Pneumonia is having clinical documenting in the medical record that describes the type of pneumonia or its causal factor. With proper documentation, an experienced medical billing company can help physicians assign the right medical codes for this condition, and ensure optimal reimbursement.
Source: Established in 2002, Outsource Strategies International (OSI), a Managed Outsource Solutions service is headquartered in Tulsa, Oklahoma. OSI is a service developed to provide innovative and comprehensive solutions in healthcare that focused more on practice functions from front office administrative management to back office Coding, billing and collection. Our Clientele are Medical practices, Dental practices, Dentists and Physicians.