2024 ICD-10-CM Diagnosis Code A37.01

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

• Infection due to Bordetella
• Pneumonia in pertussis

A37.01 is grouped with Diagnostic Related Groups - MS-DRG Mapping

Diagnostic Related Groups (DRGs) are a classification system used to group together diagnosis codes for the purpose of reimbursement and healthcare management. DRGs are used to standardize the way hospitals and other providers are paid for inpatient services. In this system patients are grouped together based on their principal diagnosis in areas referred to as Major Diagnostic Categories (MDC). Once a patient is assigned a particular diagnostic category, providers receive a predetermined payment rate for the services rendered. This reimbursement rate is often fixed and is meant to cover the cost of care for that patient. Reimbursement is also affected by the relative weight of a diagnostic related group based on the severity of a patient's illness and the associated cost of care during hospitalization.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The diagnosis code is present in the following groups for version MS-DRG V41.0 applicable from 10/01/2023 through 09/30/2024.

MS-DRG	MS-DRG Title	MCD	Relative Weight
202	BRONCHITIS AND ASTHMA WITH CC/MCC	04	0.9575
203	BRONCHITIS AND ASTHMA WITHOUT CC/MCC	04	0.6949

The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Convert A37.01 to ICD-9-CM

• ICD-9-CM Code: 033.0 - Bordetella pertussis
  Combination Flag - Multiple codes are needed to describe the source diagnosis code. Correct coding should be done based on contextual judgment.
• ICD-9-CM Code: 484.3 - Pneumonia in whoop cough
  Combination Flag - Multiple codes are needed to describe the source diagnosis code. Correct coding should be done based on contextual judgment.

Patient Education

Pneumonia

What is pneumonia?

Pneumonia is an infection in one or both of the lungs. It causes the air sacs of the lungs to fill up with fluid or pus. It can range from mild to severe, depending on the type of germ causing the infection, your age, and your overall health.

What causes pneumonia?

Bacterial, viral, and fungal infections can cause pneumonia.

Bacteria are the most common cause. Bacterial pneumonia can occur on its own. It can also develop after you've had certain viral infections such as a cold or the flu. Several different types of bacteria can cause pneumonia, including:

• Streptococcus pneumoniae
• Legionella pneumophila; this pneumonia is often called Legionnaires' disease
• Mycoplasma pneumoniae
• Chlamydia pneumoniae
• Haemophilus influenzae

Viruses that infect the respiratory tract may cause pneumonia. Viral pneumonia is often mild and goes away on its own within a few weeks. But sometimes it is serious enough that you need to get treatment in a hospital. If you have viral pneumonia, you are at risk of also getting bacterial pneumonia. The different viruses that can cause pneumonia include:

• Respiratory syncytial virus (RSV)
• Some common cold and flu viruses
• SARS-CoV-2, the virus that causes COVID-19

Fungal pneumonia is more common in people who have chronic health problems or weakened immune systems. Some of the types include:

• Pneumocystis pneumonia (PCP)
• Coccidioidomycosis, which causes valley fever
• Histoplasmosis
• Cryptococcus

Who is at risk for pneumonia?

Anyone can get pneumonia, but certain factors can increase your risk:

• Age; the risk is higher for children who are age 2 and under and adults age 65 and older
• Exposure to certain chemicals, pollutants, or toxic fumes
• Lifestyle habits, such as smoking, heavy alcohol use, and malnourishment
• Being in a hospital, especially if you are in the ICU. Being sedated and/or on a ventilator raises the risk even more.
• Having a lung disease
• Having a weakened immune system
• Have trouble coughing or swallowing, from a stroke or other condition
• Recently being sick with a cold or the flu

What are the symptoms of pneumonia?

The symptoms of pneumonia can range from mild to severe and include:

• Fever
• Chills
• Cough, usually with phlegm (a slimy substance from deep in your lungs)
• Shortness of breath
• Chest pain when you breathe or cough
• Nausea and/or vomiting
• Diarrhea

The symptoms can vary for different groups. Newborns and infants may not show any signs of the infection. Others may vomit and have a fever and cough. They might seem sick, with no energy, or be restless.

Older adults and people who have serious illnesses or weak immune systems may have fewer and milder symptoms. They may even have a lower than normal temperature. Older adults who have pneumonia sometimes have sudden changes in mental awareness.

What other problems can pneumonia cause?

Sometimes pneumonia can cause serious complications such as:

• Bacteremia, which happens when the bacteria move into the bloodstream. It is serious and can lead to septic shock.
• Lung abscesses, which are collections of pus in cavities of the lungs
• Pleural disorders, which are conditions that affect the pleura. The pleura is the tissue that covers the outside of the lungs and lines the inside of your chest cavity.
• Kidney failure
• Respiratory failure

How is pneumonia diagnosed?

Sometimes pneumonia can be hard to diagnose. This is because it can cause some of the same symptoms as a cold or the flu. It may take time for you to realize that you have a more serious condition.

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A physical exam, including listening to your lungs with a stethoscope
• Various tests, such as
  • A chest x-ray
  • Blood tests such as a complete blood count (CBC) to see if your immune system is actively fighting an infection
  • A Blood culture to find out whether you have a bacterial infection that has spread to your bloodstream

If you are in the hospital, have serious symptoms, are older, or have other health problems, you may also have more tests, such as:

• Sputum test, which checks for bacteria in a sample of your sputum (spit) or phlegm (slimy substance from deep in your lungs).
• Chest CT scan to see how much of your lungs is affected. It may also show if you have complications such as lung abscesses or pleural effusions.
• Pleural fluid culture, which checks for bacteria in a fluid sample that was taken from the pleural space
• Pulse oximetry or blood oxygen level test, to check how much oxygen is in your blood
• Bronchoscopy, a procedure used to look inside your lungs' airways

What are the treatments for pneumonia?

Treatment for pneumonia depends on the type of pneumonia, which germ is causing it, and how severe it is:

• Antibiotics treat bacterial pneumonia and some types of fungal pneumonia. They do not work for viral pneumonia.
• In some cases, your provider may prescribe antiviral medicines for viral pneumonia
• Antifungal medicines treat other types of fungal pneumonia

You may need to be treated in a hospital if your symptoms are severe or if you are at risk for complications. While there, you may get additional treatments. For example, if your blood oxygen level is low, you may receive oxygen therapy.

It may take time to recover from pneumonia. Some people feel better within a week. For other people, it can take a month or more.

Can pneumonia be prevented?

Vaccines can help prevent pneumonia caused by pneumococcal bacteria or the flu virus. Having good hygiene, not smoking, and having a healthy lifestyle may also help prevent pneumonia.

NIH: National Heart, Lung, and Blood Institute

[Learn More in MedlinePlus]

Whooping Cough

What is whooping cough?

Whooping cough, or pertussis, is a respiratory infection that can cause coughing fits. In serious cases, the coughing can become violent and rapid. You may cough so hard that you vomit. The name of the disease comes from the whooping noise you might make when you try to breathe in after coughing.

Whooping cough is very contagious and can affect anyone. But it can be especially serious in babies who did not yet get the vaccine. About half of babies under age one who get whooping cough need care in the hospital.

What causes whooping cough?

Whooping cough is caused by a type of bacteria called Bordetella pertussis. It spreads from person to person. People who have pertussis usually spread it through coughing, sneezing, or breathing very close to someone. It can also sometimes be spread by touching an infected surface and then touching your nose or mouth.

If you get pertussis, you are contagious for about 2 weeks after you start coughing. Antibiotics may shorten the time that you are contagious.

What are the symptoms of whooping cough?

The symptoms of pertussis usually start within 5 to 10 days after you are exposed. But sometimes you may not get symptoms until up to 3 weeks later.

Whooping cough usually starts with cold-like symptoms. They may last for 1 to 2 weeks and can include:

• Runny nose
• Mild fever
• Mild, occasional cough

The early symptoms in babies can be different. They may only cough a little bit, or they may not cough at all. Babies may have apnea, which means that there is a pause in breathing. They may start to turn blue. If this happens, get medical care for your baby right away.

As whopping cough gets worse, the symptoms may include:

• Fits of many, rapid coughs followed by a high-pitched "whoop" sound
• Vomiting during or after coughing fits
• Exhaustion after coughing fits

The coughing fits get worse and start happening more often, especially at night. You may have them for up to 10 weeks or more.

Recovery from this can happen slowly. Your cough gets milder and happens less often. The coughing fits can come back if you have another respiratory infection, even months after you first got whooping cough.

How is whooping cough diagnosed?

Your health care provider may use many tools to diagnose whooping cough:

• A medical history, which includes asking about your symptoms
• A physical exam
• A lab test which involves taking a sample of mucus from the back of the throat through the nose. This may be done with a swab or syringe filled with saline. The sample is tested for the bacteria that causes whooping cough.
• Blood test
• Chest x-ray

What are the treatments for whooping cough?

The treatment for whooping cough is usually antibiotics. Early treatment is very important. It may make your infection less serious and can also help prevent spreading the disease to others.

Treatment after you have been sick for 3 weeks or longer may not help. The bacteria are gone from your body by then, even though you usually still have symptoms. This is because the bacteria have already done damage to your body.

Whooping cough can sometimes be very serious and require treatment in the hospital.

Can whooping cough be prevented?

Vaccines are the best way to prevent whooping cough. There are two vaccines in the United States that can help prevent whooping cough: DTaP and Tdap. These vaccines also provide protection against tetanus and diphtheria.

Babies and other people at high risk serious disease should be kept away from people who have whooping cough.

Sometimes health care providers give antibiotics to family members of people who have had whooping cough or people who have been exposed to it. The antibiotics may prevent them from getting the disease.

You may also help prevent the spread of whooping cough (and other respiratory diseases) by:

• Washing your hands often with soap and water. You can use an alcohol-based hand rub if soap and water are not available.
• Avoiding touching your face with unwashed hands
• Cleaning and disinfecting surfaces that you frequently touch, including toys
• Covering coughs and sneezes with a tissue or upper shirt sleeve, not hands
• Staying home when sick
• Avoiding close contact with people who are sick

Centers for Disease Control and Prevention

[Learn More in MedlinePlus]

Code History

• FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
• FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
• FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
• FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
• FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
• FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
• FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
• FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
• FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.