Coding Tip: Coding Lobar Pneumonia
Kim Carrier RHIT, CDIP, CCS, CCS-P
Director of Coding Quality Assurance
AHIMA Approved ICD-10-CM/PCS Trainer
With the implementation of ICD-10-CM there were many additional codes for more specific diagnosis reporting. One of the differences between ICD-9-CM and ICD-10-CM is the reporting of “lobar” pneumonia. In ICD-9-CM, coders were instructed to code unspecified pneumonia when the diagnosis of pneumonia was made and the only specificity was of the site (lobe) of the pneumonia (such as left lower lobe pneumonia). However, in ICD-10-CM we now have guidance (and indexing) to code this to a more specified pneumonia when only the lobe of the lung affected with pneumonia is documented.
What is “lobar” pneumonia?
“Lobar” pneumonia references a form of pneumonia that affects a specific lobe or lobes of the lung. This is a bacterial pneumonia and is most commonly community acquired. Antibiotics are almost always necessary to clear this type of pneumonia. The antibiotic will be chosen based on the causative organism identified or suspected. This type of pneumonia is also referred to as “non-segmental” or “focal non-segmental” pneumonia and is often referred to in CT of the chest to have the appearance of “ground glass opacity.” Presentation is the same as for other types of pneumonia with dyspnea, productive cough, fever/chills, malaise, pleuritic chest pain and hemoptysis as the common clinical presentation. Complications can include pleural/parapneumonic effusion and empyema. Coding Clinic 3Q2018 page 24 advised that “right upper lobe pneumonia” without documentation of causal organism should be assigned to code J18.1, Lobar pneumonia.
The picture below depicts the lungs and the pneumonia affecting the lower lobe (A). (B) shows normal alveoli and (C) shows infected alveoli.
This type of pneumonia is typically acute with four stages:
- Congestion—within the first 24 hours patient will develop vascular engorgement (the lung becomes heavy and hyperemic)
- Consolidation (red hepatization)—the vascular congestion persists. There is extravasation of red cells in the alveolar spaces. This leads to the appearance of consolidation (solidification) of the alveolar parenchyma
- Grey hepatization—red cells disintegrate. There is still appearance of consolidation but the color is paler and appears drier
- Resolution—complete recovery (exudate will liquefy and will be coughed up in sputum or drain via the lymphatic system
What organism/bacteria is responsible for “lobar” pneumonia?
The most common cause for this type of pneumonia is Streptococcus pneumoniae (pneumococcus). Other common types of bacteria responsible for “lobar” pneumonia are:
- Klebsiella pneumoniae
- Legionella pneumophila
- Haemophilus influenza
- Mycobacterium tuberculosis
ICD-10-CM Alphabetic Index:
Lobar (disseminated) (double) (interstitial) J18.1
AHA Coding Clinic for ICD-10-CM and ICD-10-PCS, Third Quarter 2018 Page 24-25
AHA Coding Clinic for ICD-10-CM and ICD-10-PCS, Third Quarter 2016 Page 15
AHA Coding Clinic Third Quarter 2009 Pages: 16 to 17
AHA Coding Clinic March-April 1985 Page 6
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
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