ICD-10 Codes to Document Lobar Pneumonia this COVID-19 Season

by | Published on Apr 28, 2020 | Medical Coding

Codes to Document Lobar Pneumonia
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Pneumonia refers to an infection that inflames the air sacs in one or both lungs whereas Lobar pneumonia refers to a form of pneumonia that affects a specific lobe or lobes of the lung. Pneumonia is grouped by its different causes such as bacterial pneumonia, viral pneumonia, mycoplasma pneumonia and so on. Lobar pneumonia is a bacterial pneumonia and is most commonly community acquired. The world is hit by covid-19 or the coronavirus that had started in late 2019 and early 2020 in the Chinese city of Wuhan as a cluster of pneumonia cases with an unknown cause. Just as any other disease or health condition, accurate documentation is vital for the covid-19 pandemic also to understand its nature, disease progression, and effective treatment. Physicians who provide treatments to patients need to know the various types pneumonia and to code the diagnosis and treatments correctly, they can rely on medical coding companies.

Also referred to as “non-segmental” or “focal non-segmental” pneumonia, lobar pneumonia is characterized by an acute inflammation of the entire lobe or lung. The most common cause for this type of pneumonia is Streptococcus pneumoniae (pneumococcus) and some other common types of bacteria responsible for lobar pneumonia are:

  • Klebsiella pneumoniae
  • Legionella pneumophila
  • Hemophilus influenza
  • Mycobacterium tuberculosis

The signs and symptoms of lobar pneumonia is the same as for other types of pneumonia with dyspnea, productive cough, fever/chills, malaise, pleuritic chest pain, and hemoptysis. Pleuritic chest pain due to localized inflammation of pleura can be seen with any kind of pneumonia but, is more common with lobar pneumonia. Constitutional symptoms such as fatigue, headache, myalgia, and arthralgias can also be seen. Symptoms might also include chest pain while breathing or coughing, cough, often with phlegm, fever, sweats and chills, nausea, loss of appetite, vomiting or diarrhea as well as shortness of breath. Complications can include pleural/parapneumonic effusion, and empyema.

Lobar pneumonia is typically acute with four stages:

  • Congestion: This is the first stage which occurs within the first 24 hours of infection. The patient will develop vascular engorgement (the lung becomes heavy and hyperemic).
  • Consolidation (red hepatization): The vascular congestion persists and 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 and there is still appearance of consolidation, but the color is paler and appears drier. The lung is gray-brown to yellow.
  • Resolution: Complete recovery (exudation will liquefy and will be coughed up in sputum or drain via the lymphatic system)

With pathological specimens we can investigate the presence of lobar pneumonia in patients. For that the specimens to be obtained include:

  • Sputum for culture, AAFBS and gram stain
  • Blood for full hemogram/complete blood count, ESR and other acute phase reactants
  • Procalcitonin test, more specific

The most specific diagnostic test for lobar pneumonia is sputum culture. In addition, chest radiograph or CT scan can also provide the clue to the diagnosis whether it’s lobar, interstitial, unilateral or bilateral. Although CT is a more reliable and accurate test, its use is limited due to relatively high radiation exposure and high cost.

The ICD-10 code for Lobar pneumonia is

  • J18.1: Lobar pneumonia, unspecified organism

According to the American Academy of Professional Coders (AAPC), 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. 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.

Pulmonary medical billing and coding can be challenging. Pulmonologists or infectious disease specialists diagnosing the symptoms and providing specialized treatment for pneumonia need to be reimbursed for their services. The correct ICD-10 codes must be used to indicate a diagnosis of pneumonia and these include –

  • J12: Viral pneumonia, not elsewhere classified
    • J12.0: Adenoviral pneumonia
    • J12.1: Respiratory syncytial virus pneumonia
    • J12.2: Para influenza virus pneumonia
    • J12.3: Human metapneumovirus pneumonia
    • J12.8: Other viral pneumonia
    • J12.9: Viral pneumonia, unspecified
  • J13: Pneumonia due to Streptococcus pneumonia
  • J14: Pneumonia due to Hemophilus influenzae
  • J15: Bacterial pneumonia, not elsewhere classified
    • J15.0: Pneumonia due to Klebsiella pneumoniae
    • J15.1: Pneumonia due to Pseudomonas
    • J15.2: Pneumonia due to staphylococcus
    • J15.3: Pneumonia due to streptococcus, group B
    • J15.4: Pneumonia due to other streptococci
    • J15.5 Pneumonia due to Escherichia coli
    • J15.6: Pneumonia due to other Gram-negative bacteria
    • J15.7: Pneumonia due to Mycoplasma pneumoniae
    • J15.8: Pneumonia due to other specified bacteria
    • J15.9: Unspecified bacterial pneumonia
  • J16: Pneumonia due to other infectious organisms, not elsewhere classified
    • J16.0: Chlamydial pneumonia
    • J16.8: Pneumonia due to other specified infectious organisms
  • J17: Pneumonia in diseases classified elsewhere
  • J18: Pneumonia, unspecified organism
    • J18.0: Bronchopneumonia, unspecified organism
    • J18.2: Hypostatic pneumonia, unspecified organism
    • J18.8: Other pneumonia, unspecified organism

The key to proper medical coding for Pneumonia is having clinical documenting in the medical record that describes the type of pneumonia or its causal factor. With proper documentation, an experienced medical billing company can help physicians assign the right medical codes for this condition, and ensure optimal reimbursement.

Rajeev Rajagopal

Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.

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