COPD Exacerbation with Pneumonia

Provident has been engaged in ongoing DRG audits since ICD-10 was implemented in October 2015. We have identified potential DRG audit target areas related to our audit work, changes to the ICD-10 codeset, and Coding Clinic updates. We will be posting cases regularly in our newsletter. Please see this edition’s case below:

Case Summary:

Patient is a 65-year-old smoker who presented to Emergency Department with severe respiratory distress requiring Bi-PAP and was diagnosed with COPD exacerbation, respiratory acidosis and pneumonia likely due to MRSA (sputum culture positive for MRSA). ABGs on admission: pH = 7.23.

DRG Options:

Audit Considerations & Strategies:

• In ICD-9 either COPD exacerbation or pneumonia can be selected as the Principal Diagnosis (PDX) depending on the circumstances of the admission
• In ICD-10, the COPD exacerbation or COPD with acute lower respiratory tract infection codes must be designated as the PDX
• Bronchitis and pneumonia are both lower respiratory tract infections
• Influenza is both an upper and lower respiratory infection
• Even if a patient is admitted for pneumonia and only has a history of COPD (without exacerbation), the PDX is still COPD
• When auditing ICD-10 cases, always confirm that COPD is sequenced as the PDX with pneumonia as a secondary diagnosis
• For patients admitted with pneumonia and COPD exacerbation, a strategy would be to consider if acute respiratory failure is also present on admission (For a potential DRG shift by selecting acute respiratory failure as the PDX)

Reference

1. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM): Tabular Section – Category: J44.0 – Chronic obstructive pulmonary disease with acute lower respiratory infection – Use additional code to identify the infection
2. Chronic Obstructive Pulmonary Disease with Lobar Pneumonia  Coding Clinic – 3^rd Quarter 2016: Page 15
3. Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Pneumonia  Coding Clinic – 3^rd Quarter 2016: Page 15
4. Lower Respiratory Infections Included with Chronic Obstructive Pulmonary Disease  Coding Clinic – 3^rd Quarter 2016: Page 16