--- title: "Query Tip: Identifying Opportunities To Query For Pneumonia" description: Recognizing opportunities to query for pneumonia requires understanding the types of pneumonia, their complications, if any, and the organism(s) causing the infection. image: https://hiacode.com/hubfs/iStock-531924510.jpg --- # Query Tip: Identifying Opportunities To Query For Pneumonia ![Donna Franke, CCS](https://hiacode.com/hubfs/Donna%20Franke.png) [Donna Franke, CCS](https://hiacode.com/blog/author/donna-franke-ccs) Jun 18, 2025 [Industry News](https://hiacode.com/blog/tag/industry-news) [Query Tips](https://hiacode.com/blog/tag/query-tips) [CDI Tips](https://hiacode.com/blog/tag/cdi-tips) ![Query Tip: Identifying Opportunities To Query For Pneumonia](https://hiacode.com/hubfs/iStock-531924510.jpg) - Share on: - [![](https://hiacode.com/hubfs/Facebook%20svg.svg)](http://www.facebook.com/share.php?u=https://hiacode.com/blog/identifying-opportunities-to-query-for-pneumonia) - [![](https://hiacode.com/hs-fs/hubfs/twitter.png?width=32&height=32&name=twitter.png)](https://twitter.com/intent/tweet?text=I+found+this+interesting+blog+post&url=https://hiacode.com/blog/identifying-opportunities-to-query-for-pneumonia) - [![](https://hiacode.com/hubfs/LinkedIn%20svg.svg)](http://www.linkedin.com/shareArticle?mini=true&url=https://hiacode.com/blog/identifying-opportunities-to-query-for-pneumonia) - [![](https://hiacode.com/hubfs/mdi_email.svg)](mailto:?subject=Check%20out%20https://hiacode.com/blog/identifying-opportunities-to-query-for-pneumonia%20&body=Check%20out%20https://hiacode.com/blog/identifying-opportunities-to-query-for-pneumonia&media=https://learn.hiacode.com/hubfs/iStock-531924510.jpg) - ![](https://hiacode.com/hubfs/entypo_link.svg) copied Pneumonia is a medical condition that can vary from mild to life-threatening depending on age of the patient, especially in adults ages 65 and older and children younger than 2, overall health of the patient, and the cause/type of pneumonia. Many cases of pneumonia are treated successfully, but in serious cases, pneumonia can lead to complications and even death. Some complications associated with pneumonia are acute respiratory failure, ARDS (acute respiratory distress syndrome, sepsis, and lung abscesses. Treatment depends on the etiology of the patient’s pneumonia, and involves utilizing the correct antibiotic, anti-viral or anti-fungal, fluids, oxygen therapy and medicines to control pain, cough, and fever. The type of pneumonia and any complications that develop can increase resource utilization and costs incurred by the hospital or facility by lengthening the patient’s stay, requiring use of oxygen or ventilation devices, and the medications given. Ensuring complete and accurate code assignment is essential to covering the costs incurred from treating pneumonia. Failure to clarify the type of pneumonia may mean the incorrect DRG is assigned and does not reflect the patient’s severity of illness and resources required for treatment of the patient. Recognizing opportunities to query for pneumonia requires understanding the types of pneumonia, their complications, if any, and the organism(s) causing the infection. ## What are the Two Most Common Types of Pneumonia? - **Infectious Pneumonia: **Infection resulting in inflammation in the lungs usually caused by bacteria, viruses or fungi. Methods of transmission include community-acquired (CAP), hospital-acquired (HAP) and ventilator-associated (VAP). - **Aspiration Pneumonia: **A condition that causes inflammation secondary to aspirating/inhaling food, liquid, saliva or vomit. This type of pneumonia can be infectious or non-infectious. ## What Organisms Cause Infectious Pneumonia? Many types of infectious organisms can cause pneumonia. Certain organisms are more common culprits depending on whether pneumonia was contracted in the community or is healthcare related. - Bacterial- - **Community acquired**-Streptococcus pneumoniae, H. Flu, Legionella, Mycoplasma, Chlamydia, Moraxella catarrhalis, MRSA - **Hospital acquired or ventilator associated**- MRSA, Pseudomonas, and other gram-negative bacteria Viral (most common cause of CAP) - Influenza A and B, Coronavirus including SARS CoV-2, Rhinoviruses, parainfluenza, Respiratory Syncytial Virus, and adenoviruses Fungal-- Pneumocystis, Cryptococcus, Aspergillus, Coccidioidomycosis, Histoplasmosis, Blastomycosis - Viral (most common cause of CAP) - Influenza A and B, Coronavirus including SARS CoV-2, Rhinoviruses, parainfluenza, Respiratory Syncytial Virus, and adenoviruses - Fungal-- Pneumocystis, Cryptococcus, Aspergillus, Coccidioidomycosis, Histoplasmosis, Blastomycosis This table lists some organisms that may cause pneumonia. | **Pneumonia Type** | **Organism** | | --- | --- | | Gram-Positive | Streptococcus pneumoniae, Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus faecalis, Staphylococcus lugdunensis, Actinomyces isrealii, anaerobic | | Gram- Negative | E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Haemophilus influenzae, Acinetobacter baumannii, Legionella pneumophilia, Serratia marcescens, Chlamydophila pneumoniae, Achromobacter xylosoxidans, mycoplasma, anaerobic, Proteus mirabilis | | Fungal | Histoplasmosis, coccidioidomycosis, Blastomycosis, Aspergillus, Candida, Cryptococcus, Pneumocystis |   ## What are the Causes of Aspiration Pneumonia? There are many conditions and circumstances that make a patient more vulnerable to developing aspiration pneumonia, including: - Vomiting - Dysphagia, positive swallow study, impaired gag reflex - Chest x-ray - Cerebrovascular disease - Drug overdose, alcohol use disorder - Seizures - Sedative medication use - Central nervous system disorders- head trauma, intracranial masses, dementia, amyotrophic lateral sclerosis, Multiple sclerosis, Parkinsons disease, Pseudobulbar palsy - Poor mobility and debility (bedridden status) - Esophageal strictures, motility disorders, cancer, GERD - Tracheostomy status - NG tube placement - Muscular disorders- inflammatory myopathies, bulbospinal muscular atrophy, oculopharyngeal dystrophy - Advanced Age ## How is Pneumonia Diagnosed? Pneumonia is generally diagnosed by performing certain lab and radiological diagnostic testing. - Sputum Cultures - **Note: **A negative sputum culture does not preclude a provider making a clinical diagnosis of pneumonia due to a certain organism. - Chest x-ray - Blood tests ## How is Pneumonia Treated? The primary treatment of pneumonia is administration of antibiotics for bacterial pneumonia or antivirals for viral pneumonia. Below is a list of antibiotics and antivirals commonly used in the treatment of pneumonia. - Antibiotics: - Augmentin- - Aztreonam, cefazoline, cefepime, cefotaxime, ceftazidime, ertapenem, meropenem- - Ciprofloxacin - Clindamycin - Doxycycline - Flagyl - Gentamicin, tobramycin, amikacin - Levaquin, moxifloxacin, Gemifloxacin - Oxacillin, dicloxacillin, flucloxacillin - Rocephin - Vancomycin - Zithromax, clarithromycin - Zosyn- - Zyvox (linezolid) - **Antivirals (Influenza A&B): ** - Tamiflu - Relenza (Zanamivir) - Rapivab (Peramivir) ## Coding Challenges Pneumonia cases can be complex. In some cases, patients with pneumonia may not have elevated WBCs if they are already on an antibiotic or the patient’s chest x-ray may be negative, but the patient clinical picture points to pneumonia according to other diagnostic findings. A positive sputum culture alone cannot be used to determine whether the patient is being treated for a specific type of pneumonia. Without the provider’s confirmation of the type of pneumonia being treated, a query would be necessary for accurate code assignment. When coding encounters for pneumonia, be on the lookout for multiple types of pneumonia and corresponding treatments. A patient can have both viral and bacterial or aspiration and bacterial pneumonia, etc. ICD-10-CM Official Guidelines for Coding and Reporting provide direction when coding for pneumonia due to other conditions. - **I.C.10.d.1 **Ventilator Associated Pneumonia - **I.C.10.e** Vaping-related Disorders - **I.C.1.a.2.a** Patient Admitted for HIV-related Condition ## Knowing When to Query for Type of Pneumonia and/or the Organism Involved A query for the type of pneumonia and the organism involved is appropriate when the treatment involves antibiotics likely used for gram-negative organisms or organisms with antibiotic resistance. A query is also appropriate when the patient has a pre-disposing condition, clinical syndrome or diagnosis that could lead to aspiration of fluids such as dysphagia, vomiting, or impaired swallowing etc. ## Take Aways - Identifying type of pneumonia and any associated complications is essential to correct coding - Pneumonia is caused by infectious organisms and/or aspiration of liquids/solids - Pneumonia is largely diagnosed though diagnostic testing - Pneumonia is largely treated with antibiotic or antivirals medication - The results of a sputum culture alone are not enough to determine a causative organism - A negative sputum culture does not preclude diagnosis of pneumonia due to a specific causative organism - Querying for a pneumonia due to a specific organism (e.g., gram-negative or antibiotic resistant) based on method of treatment - Querying for aspiration as the cause of pneumonia is appropriate when a patient has conditions or factors that predispose them to aspiration [![  Pneumonia Coding Course   Master the complexities of coding pneumonia with this in-depth course. From diagnosis and treatment to sequencing with comorbidities like COPD, you'll gain the knowledge and confidence to code pneumonia cases accurately and in compliance with official guidelines.  ](https://no-cache.hubspot.com/cta/default/20824215/interactive-191522850117.png) ](https://hiacode.com/hs/cta/wi/redirect?encryptedPayload=AVxigLJi3fVgNhaz%2BBS0z9ATIQcZLiosQNRtmSoBe2cp0q911nGyxd6jGTdFN7o8Yfc2W3uPowGLDw4XCq5PC8mhfOqq83VrFuNdnCd4rb2oqoY2s5p74%2B%2BN%2FVY6Oets%2B5ioX04amTUrQ14r676Xa0GjeSkxt7r4rZee1H%2B0hzRjW1GBz1YBK%2FIXi35U5oXW7ZbS6Yl%2FV9SqhQ%3D%3D&webInteractiveContentId=191522850117&portalId=20824215) *References* - [ ICD-10-CM Official Guidelines for Coding and Reporting 2025 ](https://www.cms.gov/files/document/fy-2025-icd-10-cm-coding-guidelines.pdf) - [NIH Aspiration Pneumonia Continuing Education Activity](https://www.ncbi.nlm.nih.gov/books/NBK470459/) - [John Hopkins Medicine Infectious Disease-Pneumonia ](https://www.hopkinsmedicine.org/health/conditions-and-diseases/pneumonia#:~:text=Other%20treatment%20may%20include%20a,It%20can%20even%20be%20deadly.) - [Vaping-Induced Lung Injury: A Case of Lipoid Pneumonia Associated with E-Cigarettes Containing Cannabis](https://pmc.ncbi.nlm.nih.gov/articles/PMC7157807/) --- For more than 30 years, HIA has been the leading provider of [compliance audits](https://hiacode.com/acute-review), [coding support services](https://hiacode.com/acute-coding-support) and [clinical documentation audit services ](https://hiacode.com/clinical-documentation-integrity)for [hospitals](https://hiacode.com/hospitals), [ambulatory surgery centers](https://hiacode.com/asc-coding), [physician groups](https://hiacode.com/provider-groups) and other healthcare entities. 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