Health Information Management

Ask the expert: A physician diagnoses a patient with ventilator-associated pneumonia (VAP) caused by pseudomonas aeruginosa. What ICD-9-CM diagnosis code should I report?

HIM Connection, October 14, 2008

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A: Report codes 997.31 and 041.7. According to the ICD-9-CM Official Guidelines for Coding and Reporting, coders should assign code 997.31, VAP, only when the provider has documented VAP. Coders should also assign an additional code to identify the causative organism (e.g., Pseudomonas aeruginosa, code 041.7). 

Editor’s note: This Q&A was excerpted from the October issue of Medical Records Briefing. For more information, click here.



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