Journal excerpt: Unspecified pneumonia validation

By William E. Haik, MD, FCCP, CDIP

Let’s take a moment to talk about unspecified pneumonia validation. In certain circumstances a pneumonia can be validated even in the absence of a chest x-ray revealing an acute pulmonary infiltrate, for example, it may be absent on admission in the presence of severe dehydration, leukopenia, and small volume of aspirate. Additionally, a radiographic infiltrate may be obscured by underlying pulmonary fibrosis or may not coalesce in the presence of severe bullous emphysema, which often occurs in patients who have underlying chronic obstructive pulmonary disease.

A repeat chest x-ray during the hospital stay may confirm pneumonia when it reveals the evolution of an acute pulmonary infiltrate after the patient is hydrated or the white blood count recovers. Frequently, however, chest x-rays are not repeated during the hospital stay in a patient who clinically improves.

Also, it is difficult to differentiate between an acute pulmonary infiltrate and a chronic pulmonary infiltrate when a chest x-ray is repeated within a few days. This is because resolution of a pulmonary infiltrate in pneumonia may take up to six weeks even in healthy patients.

Signs and symptoms of pneumonia may be either absent or very subtle in an elderly patient; specifically, symptoms such as cough and shortness of breath, and signs such as fever, may be absent. In fact, the only consistent finding of pneumonia in the elderly population is tachypnea, usually with a respiratory rate greater than 20 breaths/minute.

Once a pneumonia is validated, the next question is, can it be further specified as to its type? Determining the pneumonia type through documentation is very important for coders, especially since ICD-10-CM offers a variety of pneumonia codes.

For more tips related to complex pneumonias, read my full column in the January/February edition of the CDI Journal.

Editor’s note: This article is an excerpt from the January/February edition of the CDI Journal. Dr. Haik will present a webinar on Thursday, January 24, 1-2:30 p.m. eastern, reviewing clinical indicators and query opportunities related to the 2019 CC/MCC list for CDI professionals. Click here to learn more and to register.