Remember that positive cultures are not needed because coding allows physicians to use words such as Possible/Probable/Likely/Suspected/“Compatible with” and “Consistent with” to describe the type of pneumonia.
- Use the choice of antibiotics to guide documentation.
- Pneumonia diagnoses will bucket into DRG 195 Simple Pneumonia or DRG 179 Complex Pneumonia.
- When possible, the organism or “suspected” organism causing pneumonia should be documented.
- Complex Pneumonia has higher expected length of stay (GLOS) and relative weight (RW).
Complex Pneumonia has higher expected length of stay (GLOS) and relative weight (RW).
- -Zosyn –> “possible” gram negative or pneumonia “compatible with” aspiration pneumonia
- -Cefepime –> “probable” gram negative pneumonia
- -Vancomycin –> “likely” staph aureus pneumonia
- -Meropenem –> “suspected” gram negative pneumonia
