ICD-10 Coding for History of Pneumonia(Z87.01, Z86.19)
Complete ICD-10-CM coding and documentation guide for History of Pneumonia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to History of Pneumonia
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Z87.01 | Personal history of recurrent pneumonia | Use when documenting a patient's history of recurrent pneumonia episodes. |
|
| Z86.19 | Personal history of other infectious diseases | Use for a single past episode of pneumonia without recurrence. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for history of recurrent pneumonia
Essential facts and insights about History of Pneumonia
Primary ICD-10-CM Codes for history of pneumonia
Decision Criteria
documentation Criteria
- Document 'recurrent pneumonia' with dates and treatment history.
Applicable To
- History of recurrent pneumonia
Excludes
- Current pneumonia (J18.9)
Clinical Validation Requirements
- Documented multiple episodes of pneumonia
- Past medical records showing treatment for pneumonia
- Chest X-ray reports confirming past pneumonia
Code-Specific Risks
- Incorrectly using for a single past episode
- Not specifying recurrence in documentation
Coding Notes
- Ensure documentation specifies 'recurrent' to use Z87.01.
Z86.19 - Personal history of other infectious diseases
Use for a single past episode of pneumonia without recurrence.
Applicable To
- History of a single episode of pneumonia
Excludes
- Recurrent pneumonia (Z87.01)
Clinical Validation Requirements
- Single documented episode of pneumonia
- Discharge summary with pneumonia diagnosis
Coding Notes
Ensure documentation specifies 'single episode' to use Z86.19.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting History of Pneumonia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z87.01.
Impact
Clinical: Misleading patient history., Regulatory: Potential audit issues., Financial: Incorrect billing and reimbursement.
Mitigation Strategy
Always document recurrence with specific details.
Impact
Reimbursement: Incorrect reimbursement due to miscoding., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient history data.
Mitigation Strategy
Use Z86.19 for a single past episode.
Impact
Using Z87.01 for single episodes can lead to audits.
Mitigation Strategy
Educate staff on proper documentation of recurrence.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for History of Pneumonia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for History of Pneumonia
Use these documentation templates to ensure complete and accurate documentation for History of Pneumonia. These templates include all required elements for proper coding and billing.
Patient with recurrent pneumonia history
Specialty: PulmonologyRequired Elements
- Recurrent episodes
- Dates of last occurrences
- Treatment history
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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