on Thursday, 06 March 2014. All News Items | Coding


Pneumonia is a common illness seen in the healthcare industry that affects millions of people each year in the United States. Bacteria are the most common cause of pneumonia in adults.

  • Community Acquired Pneumonia (CAP) is acquired by people that have not recently been hospitalized or live in some type of healthcare facility such as a nursing home.
  • Healthcare Associated Pneumonia (HCAP) is acquired by people while they’ve been in a healthcare facility such as a nursing home.
  • Hospital Acquired Pneumonia (HAC) is acquired while a patient is hospitalized.

When a patient is admitted to the hospital with either HCAP or HAC, code Y95 for Nosocomial Condition should also be added – Refer to Coding Clinic 4th Qtr. 2013 page 118.

External sources may also be the source of Pneumonia.

  • Aspiration Pneumonia – Caused by the inhalation of foreign material such as food, liquids, vomit or gastric secretions.
    • Pneumonitis due to Inhalation of Food and Vomit – J69.0
      • Code also any associated foreign body in the respiratory tract from category T17
    • Pneumonitis due to Inhalation of Oil and Essences – J69.1
      • Code first (T51-T65) to identify substance
    • Pneumonitis due to Inhalation of Other Solids and Liquids – J69.8
      • Code first (T51-T65) to identify substance
  • Radiation Pneumonitis (J70.0) – Due to exposure of therapeutic doses of radiation.
    • Use additional code (W88-W90, X39.0) to identify the external cause
  • Ventilator Assisted Pneumonitis – J95.851

Official ICD-10-CM Guidelines for Coding and Reporting – Section I.C.10.d.1

As with all procedural or post-procedural complications, code assignment is based on the provider’s documentation of the relationship between the condition and the procedure. Code J95.851, should be assigned only when the provider has documented Ventilator Associated Pneumonia (VAP). An additional code to identify the organism (e.g., Pseudomonas aeruginosa, code B96.5) should also be assigned. Do not assign an additional code from categories J12.0-J18.9 to identify the type of pneumonia.

Code J95.851 should not be assigned for cases where the patient has pneumonia and is on a mechanical ventilator and the provider has not specifically stated that the pneumonia is ventilator-associated pneumonia. If the documentation is unclear as to whether the patient has a pneumonia that is a complication attributable to the mechanical ventilator, query the provider.



Official ICD-10-CM Guidelines for Coding and Reporting – Section I.C.10.d.2

A patient may be admitted with one type of pneumonia (e.g., code J13, Pneumonia due to Streptococcus pneumonia) and subsequently develop ventilator associated pneumonia (VAP) J95.851. In this instance, the principal diagnosis would be the appropriate code from categories J12.0-J18.9 for the pneumonia diagnosed at the time of admission. Code J95.851, Ventilator associated pneumonia, would be assigned as an additional diagnosis when the provider has also documented the presence of ventilator associated pneumonia.


In ICD-10-CM there will be combination codes to include Hypoxia and Hypercapnia

Acute Respiratory Failure

  • Unspecified Whether with Hypoxia or Hypercapnia – J96.00
  • With Hypoxia – J96.01
  • With Hypercapnia – J96.02

Chronic Respiratory Failure

  • Unspecified Whether with Hypoxia or Hypercapnia – J96.10
  • With Hypoxia – J96.11
  • With Hypercapnia – J96.12

Acute on Chronic Respiratory Failure

  • Unspecified Whether with Hypoxia or Hypercapnia – J96.20
  • With Hypoxia – J96.21
  • With Hypercapnia – J96.22

Respiratory Failure, Unspecified

  • Unspecified Whether with Hypoxia or Hypercapnia – J96.90
  • With Hypoxia – J96.91
  • With Hypercapnia – J96.92

Post-procedure Respiratory Failure

            Excludes 1 – Respiratory Failure in other conditions (J96)

  • Acute Post-procedure Respiratory Failure – J95.821
  • Acute and Chronic Post-procedure Respiratory Failure – J95.822

Respiratory Failure is always due to an underlying condition. Sequencing will be dependent on the circumstances of the admission. If two conditions are equally responsible and there are no chapter specific guidelines, the guideline for two or more diagnosis that equally meets the definition of principal diagnosis may be applied.

If the documentation is not clear as to whether Acute Respiratory Failure and another condition are equally responsible for occasioning the admission, query the provider for clarification.

Official Guidelines for Coding and Reporting – Section I.C.10.b.3


Manifestations of Acute Bronchitis can now be reflected in ICD-10-CM under category J20.

Acute Bronchitis due to:

  • Mycoplasma Pneumoniae – J20.0
  • Hemophilus Influenza – J20.1
  • Streptococcus – J20.2
  • Coxsackievirus – J20.3
  • Parainfluenza Virus – J20.4
  • Respiratory Syncytial Virus – J20.5
  • Rhinovirus – J20.6
  • Echovirus – J20.7
  • Other Specified Organism – J20.8
  • Unspecified – J20.9


Emphysema is a type of Chronic Obstructive Pulmonary Disease (COPD) involving damage to the air sacs (alveoli) in the lungs.

ICD-10 will now have codes to cover two different forms of Emphysema.

  • Panlobular Emphysema (J43.1) - alveolar destruction occurs in all alveoli within the lobule simultaneously.
  • Centrilobular Emphysema (J43.2) - destruction that begins at the center of the lobule.

When reporting categories for COPD (J44), Asthma (J45), Chronic Bronchitis (J42) and Emphysema (J43), an additional code should be assigned to show any specific external factors such as:

  • Exposure to environmental tobacco smoke (Z77.22)
  • Exposure to tobacco smoke in the perinatal period (P96.81)
  • History of tobacco use (Z87.891)
  • Occupational exposure to environmental tobacco smoke (Z57.31)
  • Tobacco dependence (F17-)
  • Tobacco use (Z72.0)


In ICD-10, there will also be individual codes for Acute Sinusitis, Acute Recurrent Sinusitis and Chronic Sinusitis for each individual sinus cavity.

  • Acute Sinusitis – defined as symptoms of less than 4 weeks’ duration.
    • Maxillary – J01.00
    • Frontal – J01.10
    • Ethmoidal – J01.20
    • Sphenoidal – J01.30
    • Pansinusitis – J01.40
    • Other Acute Sinusitis – J01.80
    • Acute Sinusitis, Unspecified – J01.90
  • Acute Recurrent Sinusitis – defined as three or more episodes per year, with each episode lasting less than 2 weeks.
    • Maxillary – J01.01
    • Frontal – J01.11
    • Ethmoidal – J01.21
    • Sphenoidal – J01.31
    • Pansinusitis – J01.41
    • Other Acute Recurrent Sinusitis – J01.81
    • Acute Recurrent Sinusitis, Unspecified – J01.91
  • Chronic Sinusitis – defined as symptoms lasting longer than 8 weeks.
    • Maxillary – J32.0
    • Frontal – J32.1
    • Ethmoidal – J32.2
    • Sphenoidal – J32.3
    • Pansinusitis – J32.4
    • Other Chronic Sinusitis – J32.8
    • Other Chronic Sinusitis, Unspecified – J32.9

Pansinusitis is when each sinus cavity on one or both sides of the face is affected. When multiple sinus cavities are affected but not Pansinusitis, a code from Other Acute, Acute Recurrent or Chronic (J01.80, J01.81 or J32.8) should be assigned.

Note:   When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should then be classified to the lower anatomic site. One example would be Tracheobronchitis to Bronchitis – J40.



Official ICD-10-CM Guidelines for Coding and Reporting – Section I.C.10.C

Code only confirmed cases of influenza due to certain identified influenza viruses (category J09), and due to other identified influenza virus (category J10). This is an exception to the hospital inpatient guideline Section II, H. (Uncertain Diagnosis).

In this context, “confirmation” does not require documentation of positive laboratory testing specific for avian or other novel influenza A or other identified influenza virus. However, coding should be based on the provider’s diagnostic statement that the patient has avian influenza, or other novel influenza A, for category J09, or has another particular identified strain of influenza, such as H1N1 or H3N2, but not identified as novel or variant, for category J10.

If the provider records “suspected” or “possible” or “probable” avian influenza, or novel influenza, or other identified influenza, then the appropriate influenza code from category

J11, Influenza due to unidentified influenza virus, should be assigned. A code from category J09, Influenza due to certain identified influenza viruses, should not be assigned nor should a code from category J10, Influenza due to other identified influenza virus.

Subcategory J10.8 - Influenza due to Other Identified Influenza Virus with Other Manifestation has been expanded to reflect the manifestations of the Influenza.

Influenza Due to Other Identified Influenza Virus with -

  • Encephalopathy – J10.81
  • Myocarditis – J10.82
  • Otitis Media – J10.83
  • Other Manifestation – J10.89

To derive at the most appropriate code for any condition, be sure to always read the additional instructions and Excludes Notes in your coding book and/or encoder.

Article by Marsha Manning

Marsha Manning RHIT, CCS, AHIMA Approved ICD-10-CM/PCS Trainer, is an Inpatient Coding Consultant at Medical Management Plus, Inc.  Marsha has over 24 years’ experience in the coding profession and has held various positions such as DRG coordinator, Coding Supervisor and HIM Supervisor. In her current position, Marsha reviews records and assists clients with coding accuracy, compliance, education and Case Mix Index (CMI) as they relate to specific entities concerning Medicare. You may contact Marsha at This email address is being protected from spambots. You need JavaScript enabled to view it..

This material was compiled to share information. MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.

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