Certain clinical terms for pneumonia do not provide adequate risk adjustment or accurately capture the patient’s severity of illness. Terms such as Community
Acquired Pneumonia (CAP) or Healthcare Associated Pneumonia (HCAP) are captured as “simple pneumonias”. Other terms such as aspiration pneumonia
are captured as “complex pneumonias,” which are expected to have a higher cost of care and length of stay.
Aspiration pneumonia should be considered when the patient has any of the following risk factors:
• Failed swallow study
• RLL pneumonia
• Advanced age
• Nursing home resident
• Degenerative neurologic disorder (Parkinson’s, etc.)
If the patient is on antibiotics to treat suspected aspiration, make sure to document the term “aspiration pneumonia.”
Download the complete tip, Aspiration Pneumonia.