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Wiki Inpatient Medicare Pnuemonia ICD-9 Coding Guidance Sought

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jsd123

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Hi All! :-) I realize this may seem really simple to most of you, and maybe I'm just "brain blocked" on this matter, but I hope someone can help! I am a seasoned CPC and CCS BUT a newbie "CDIS" and am "auditing" documentation of already billed charts, selecting those that need 're-addressing. I have a question about how to code a "pneumonia" diagnosis for an inpatient stay, which may or may not impact the DRG, so need to know that too! The sputum culture reports both "gram negative anaerobes" (482.81) and "trace E coli" (481.82); do I code both? Does it matter? This is a Medicare patient, though i guess that's obvious as i chose this forum! :-)

Thanks!
 
You can not code based off a sputum culture alone. The physician needs to document that the pneumonia is due to anaerobes.

Refer to Coding Clinic, Second Quarter 1998 Page: 4 to 5

As to the DRG, 482.81 and 482.82 both produce DRG 179, (this is without further documentation or CC/MCCs) it doesn't effect the DRG whether you code both or just one.

It is a higher DRG amount than 195 (simple pneumonia)
 
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