Question Pneumonia coding inpt vs outpt

Pataskala, OH
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I am in need of clarification and guidance on pneumonia coding in family practice. I was told inpatient pneumonia coding would be the proper active pneumonia code such as j18.9, but all follow up coding-including the first post-hospital visit- is assumed the pneumonia is completely resolved and there is no circumstance where the active pneumonia code would be used. I'm being told to use the history code of z87.01. I can't find any documentation showing this type of guideline. My doctor sees a lot of follow up pneumonia from hospital or er and they are still on rx meds for it. He will perform xrays, also, showing active pneumonia. To me, that is still an active dx. Am I incorrect in this thought? I can not find specific guidelines. To me, if they are discharged from the hospital with active pneumonia code, the first visit follow up should be an active code until the doctor establishes it is finished. Please advise. I appreciate it.


True Blue
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You are correct - as you describe it, this is still an active diagnosis. I'm not sure who told you that all follow-up coding assumes that any condition is resolved, or what they were referring to, but this is not correct. Patients are discharged from hospitals when it is deemed safe for them to go home, not when their conditions are resolved. In many cases they continue to receive treatment for their conditions as an outpatient.

Remember that coding is always based on the physician's statement that a condition is present at the encounter - no diagnosis is ever 'assumed' to be one thing or another - so just stick to coding what your providers document.
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