Pneumonia Specificity

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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).

• The clinician’s antibiotic choice should be reviewed to identify query opportunities:
-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

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