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Pneumonia viral or bacterial?? H1N1

  1. #1
    Default Pneumonia viral or bacterial?? H1N1
    Medical Coding Books
    I have a sneaky feeling that I am going to have to query the physician on this but I thought that I would start here and see what you all think.

    I have an inpatient with pneumonia with presumed H1N1. I know that even though it is an inpatient, I can't code the H1N1 since it has to be specifically documented as positive findings.
    That is not my question. My question is this: On the discharge summary the doc that discharged the pt claims that the primary dx is this: "it was most consistent with viral pneumonia", but on both of the progress notes in the chart, each by a different doc that saw the pt each day during the visit, it states bacterical pneumonia as primary dx on both notes. The cultures are inconclusive and since he mentions that it is most likely H1N1, would that be considered viral or bacterial since there is no other organism mentioned? I realize that there are differences between the two types of pneumonia so I am kind of stuck here. Any opinions or advice??

  2. #2
    Stratford, NJ
    Default viral or bacterial
    Hi Leslie,
    If you're using H1N1, I would think you'd have to use viral since H1N1 is not bacterial.
    What do u think of:
    487.0 - Flu w/Pneumonia of any form
    Plus additional code:
    480.8 (viral pneum due to other virus NEC) or
    483.8 (pneum due to other specified organism)

    Hope you get a definitive answer
    good luck, Liza
    Liza M. Baccari, CPC
    Stratford, NJ Chapter

  3. #3
    I can't use the H1N1 because they only stated that it was possibly H1N1 and all of those new coding guidelines for H1N1 says that you can not code it unless there has been a positive finding or result.
    But, I did actually end up going with the viral code, so thanks for your back-up. I appreciate it!

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