AAPC - Back to school
Page 2 of 2 FirstFirst 12
Results 11 to 13 of 13

Thread: clinical pneumonia

  1. #11
    Join Date
    Apr 2007
    Bangor, Maine


    AAPC: Back to School
    Yes, Dawn, you are right. Here is an article from Coding Clinic for pneumonia that might be helpful with pna coding:

    Pneumonia, unspecified
    ******Coding Clinic, Third Quarter 1994 Page: 10 Effective with discharges: July 1, 1994
    ******Related Information


    A patient is discharged with the diagnosis of pneumonia; however, the physician's diagnostic statement does not specify the organism. We were recently told that pneumonia not specified as viral or bacterial is assumed to be bacterial. What code should be assigned?


    Code assignment is always based on the physician's diagnostic statement. If the physician has not specified the organism then code 486, Pneumonia, unspecified, should be assigned.

    All code assignments should be based upon medical record documentation, therefore, it is inappropriate to assume the presence of an organism when the documentation cannot support the code assignment. As stated in the January-February 1986 Coding Clinic and the official coding guidelines (Guideline 1.3) unspecified codes, "... are used only when neither the diagnostic statement nor a thorough review of the medical record provides adequate information to permit assignment of a more specific code." An unspecified code should be assigned when the information at hand does not permit either a more specific or "other" code assignment.

    Which in summation means that pna is usually either viral or bacterial unless unspecified. Besides, if you look at code 481 - that is for pneumoccal (strep) pna, which is bacterial.

    Hope some of this helps a little

  2. #12


    Thanks Leslie.

    I just wanted to put it out there that 481 would be incorrect on a LLL Dx if the organism is not specified.

    Thanks for the info I printed and saved it for future reference.

  3. #13
    Join Date
    Apr 2007
    Bangor, Maine


    No problem...my pleasure. I have printed off so many references from this forum that I had to start a huge binder..lol

Page 2 of 2 FirstFirst 12

Similar Threads

  1. Pneumonia with cavitation
    By Hernf in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 11-25-2014, 06:26 AM
  2. Hx Pneumonia
    By jaime9543 in forum Diagnosis Coding
    Replies: 1
    Last Post: 08-19-2012, 07:05 AM
  3. Bibasal pneumonia
    By Gemini18 in forum Diagnosis Coding
    Replies: 0
    Last Post: 09-18-2009, 07:24 AM
  4. Cavitary Pneumonia
    By Gemini18 in forum Diagnosis Coding
    Replies: 0
    Last Post: 04-22-2009, 01:59 PM
  5. pneumonia
    By NJcoder in forum Diagnosis Coding
    Replies: 1
    Last Post: 11-25-2008, 01:09 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.