Pneumonia ICD-10 CM code tips for coders

Basics of ICD-10 CM code for Pneumonia

Pneumonia is a lung infection caused by bacteria, viruses, fungi, or parasites. Medical coders use a specific ICD 10 code for pneumonia as per ICD 10 code book.

J18.9 is a billable/specific ICD-10-CM code for Pneumonia that can be used to indicate a diagnosis for reimbursement purposes.

The 2023 edition of ICD-10-CM J18.9 became effective on October 1, 2022.

Applicable stages (or types)
Pneumonia can range in seriousness from mild to life-threatening and is a complication of another condition, such as the flu. There are several types of pneumonia, including:

• Community-acquired pneumonia. This refers to pneumonia that a patient acquires during the course of his or her’s daily life (e.g., at school, work, or the gym). It’s most commonly caused by bacterium Streptococcus pneumoniae. Another, less common cause is Mycoplasma pneumoniae, a tiny organism that typically produces milder signs and symptoms than other types of pneumonia.
• Walking pneumonia. This is a term used to describe pneumonia that isn’t severe enough to require bed rest. It may be caused by Mycoplasma pneumoniae.
• Hospital-acquired (nosocomial) pneumonia. This type of pneumonia is acquired in the hospital. Patients who are breathing with the help of a mechanical ventilator, in an intensive care unit, or who have a weakened immune system are at a higher risk for developing this condition.
• Aspiration pneumonia. This type of pneumonia occurs when foreign matter is aspirated into the lungs. It occurs most often when the contents of the stomach enter the lungs after one vomits.
• Pneumonia caused by opportunistic organisms. This type of pneumonia strikes people with weakened immune systems, those who have had an organ transplant, or those who are taking medications that suppress the immune system, such as corticosteroids or chemotherapy.
• Other pathogens. Pneumonia may also be caused by the following pathogens:
  • H5N1 influenza (bird flu) virus
  • Severe acute respiratory syndrome (SARS)
  • Anthrax
  • Plague
  • Tularemia
  • Some forms of fungi, when inhaled
  • Tuberculosis in the lung

Synonyms of Pneumonia ICD-10 CM code

• Atypical pneumonia
• Bilateral basal pneumonia
• Bilateral pneumonia
• Chronic pneumonia
• Community acquired pneumonia
• Drug induced pneumonitis
• Fungal pneumonia
• Healthcare associated pneumonia
• Nosocomial pneumonia
• Pneumonia
• Pneumonia after surgery
• Pneumonia due to fungus
• Pneumonia, atypical
• Pneumonitis
• Post obstructive pneumonia
• Postobstructive pneumonia
• Postoperative pneumonia
• Recurrent pneumonia

Symptoms
Pneumonia often mimics the flu and begins with a cough or fever. Other symptoms of pneumonia may include the following:

• Cough with mucus that may be rusty or green or tinged with blood
• Fever
• Fast breathing and feeling short of breath
• Shaking and “teeth-chattering” chills
• Chest pain
• Fast heartbeat
• Fatigue and weakness
• Nausea and vomiting
• Diarrhea

Treatment
Physicians typically use antibiotics to treat pneumonia caused by bacteria. If the pneumonia is caused by a virus, most physicians simply recommend rest and self care.

Documentation and ICD 10 coding for Pneumonia

Pneumonia coding for the inpatient setting has been under scrutiny for more than eight years, and Office of Inspector General cases remain in the news due to upcoding reportedly found for pneumonia DRGs. Pneumonia is a fairly common diagnosis in the hospital setting. Look for coding guidelines published in AHA Coding Clinic, 2nd Quarter 1998, which provides specific details regarding the proper coding of a pneumonia diagnosis. Don’t assume the type of pneumonia from the laboratory examination or results. Look for the physician to link the organism or cause (e.g., Klebsiella) of the pneumonia before you assign the specific pneumonia type.

Remember that a gram-stain is not conclusive evidence of a gram-negative pneumonia. If the physician documented that the patient has pneumonia, he or she also should document in the medical record that this pneumonia is gram-negative before you assign the ICD-10-CM code for other gram-negative bacteria. When no additional information is available, assign pneumonia, unspecified.

Notice whether the patient was admitted from a skilled nursing home (SNF) or has a history of a CVA with dysphagia, which could be indicative of an aspiration. Aspiration pneumonia often can be present without specific documentation by the physician. Query the physician, if necessary; clarify the specific type of pneumonia with these indications.

ICD-10-CM Coding for Pneumonia

Unspecifed pneumonia codes include:

• J18.-, pneumonia, unspecified organism
  • J18.0, bronchopneumonia, unspecified organism
  • J18.1, lobar pneumonia, unspecified organism
  • J18.2, hypostatic pneumonia, unspecified organism
  • J18.8, other pneumonia, unspecified organism
  • J18.9, pneumonia, unspecified organism
• To report a more specific code look for documentation