[Dysphagia] ICD: Aspiration, Pneumonia, Pneumonitis

[jfurstoss at acmedctr.org (Furstoss, Jeanne ACMC)]

In an effort to continue understanding definitions and promote clarity in
regards to Aspiration/Pneumonia/Pneumonitis, note the following:

The World Health Organization website  reports that the United States is
still using ICD-9 codes (International Classification of Diseases Codes,
version 9) for morbidity rates.  Thus, it appears in the US, Medicare
billing and morbidity reports are still based on ICD-9 codes.
Regarding ICD-9, 
Aspiration Pneumonia, due to Bacterial microrganisms = 482 ranges 
Aspiration Pneumonia ,Chemical = 507 ranges
 ...In ICD-9, Chemical Pneumonia and Pneumonitis are described as synonyms,
with same ICD-9 numbers; but in particular in relation to SALIVA:
..Pneumonitis 507.0 includes SALIVA; Pneumonia 507.0, does NOT include
SALIVA.   Note that this does not follow the definitions used by i.e. Marik.
(Marik: aspiration of saliva potentially including aspiration of oral flora
resulting in bacterial pneumonia, not chemical pneumonitis.)
... Aspiration of particulate matter in ICD-9 (and subsequent ICD-10), it
appears, would be coded under Pneumonia / Pneumonitis 507.8, inhalation of
solids or liquids, which would be the same code used for 'prandial'
aspiration.
I am aware of Dr. Baine's comments (Prescott, R, Respiratory Review, v4, n9,
1999) in which he suggests that "hospitals are increasingly likely to
specify aspiration pneumonia to obtain the maximum allowable reimbursement
form Medicare". Obviously this is likely. But moreover, it appears that
physicians and hospitals using ICD-9 coding ( in the U.S. and other
countries) to get paid, are currently actually forced to use incorrect
definitions for pneumonia, pneumonitis, which may further complicate
exisiting confusion around  'aspiration.' 

The revised ICD codes, ICD-10 is better in respect to the above, and is
already in use for mortality and morbidity reporting in many countries.
ICD-10 eliminates the synonym usage of Pneumonia and Pneumonitis, reserving
Pneumonitis for 'chemical' aspiration.
ICD-10, though, does not detail aspiration of "saliva" .  Thus, it appears
that a person using the coding system would best be knowledgeable to not
code aspiration of saliva under "aspiration of liquid" (which would result
in a code of chemical pneumonitis J69.8,) but under Bacterial pneumonia i.e.
J15.9 understanding it is the oral flora in the saliva which causes the
pneumonia.

Jeanne Furstoss  MS OTR SWC