What is Lobar Pneumonia?

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 is 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.

What are the signs and symptoms of lobar pneumonia?

Presentation is the same as for other types of pneumonia with:

  • dyspnea,
  • productive cough,
  • fever/chills,
  • malaise,
  • pleuritic chest pain, and
  • hemoptysis.

Complications can include:

  • pleural/parapneumonic effusion, and
  • empyema.

Lobar pneumonia documented by the provider is coded to J18.1  Lobar pneumonia, unspecified organism unless the causal organism is specified. 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.

Code Update: In the ICD-10-CM Alphabetic Index, the coder is referred to see pneumonia, by type. 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.

 

Human lungs infographic

Human lungs infographic with lung lobes and segments.

 

Lobar pneumonia is typically acute with four stages:

  • Congestion — Within the first 24 hours the 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.
  • Gray hepatization — Red cells disintegrate. There is still appearance of consolidation, but the color is paler and appears drier.
  • Resolution — Complete recovery (exudation 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

In the ICD-10-CM Alphabetic Index, if the causative bacteria for the lobar pneumonia is known it is coded to that specific type of bacterial pneumonia.


About the author:

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Srivalli Harihara, CPC, has over 10 years of experience in the healthcare industry devising organizational training strategy, oversee its implementation and assess outcomes. She is employed with AGS Health Pvt Ltd, India as the manager of Coding Education Department where she provides professional direction and monitor training program’s effectiveness, success and ROI periodically. Harihara completed her Master’s in Microbiology from the University of Madras.

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