ICD-10-CM Code Z87.01

Personal history of pneumonia (recurrent)

Version 2020 Billable Code Unacceptable Principal Diagnosis POA Exempt

Valid for Submission

Z87.01 is a billable code used to specify a medical diagnosis of personal history of pneumonia (recurrent). The code is valid for the year 2020 for the submission of HIPAA-covered transactions. The ICD-10-CM code Z87.01 might also be used to specify conditions or terms like h/o: pneumonia or history of aspiration pneumonia or history of pneumocystis jirovecii pneumonia or history of recurrent pneumonia. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.

The code Z87.01 describes a circumstance which influences the patient's health status but not a current illness or injury. The code is unacceptable as a principal diagnosis.

ICD-10:Z87.01
Short Description:Personal history of pneumonia (recurrent)
Long Description:Personal history of pneumonia (recurrent)

Index to Diseases and Injuries

The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10 code(s). The following references for the code Z87.01 are found in the index:


Code Edits

The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10 Code Edits are applicable to this code:

  • Unacceptable principal diagnosis - There are selected codes that describe a circumstance which influences an individual’s health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis.

Synonyms

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

  • H/O: pneumonia
  • History of aspiration pneumonia
  • History of Pneumocystis jirovecii pneumonia
  • History of recurrent pneumonia

Present on Admission (POA)

Z87.01 is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here .

CMS POA Indicator Options and Definitions
POA Indicator CodePOA Reason for CodeCMS will pay the CC/MCC DRG?
YDiagnosis was present at time of inpatient admission.YES
NDiagnosis was not present at time of inpatient admission.NO
UDocumentation insufficient to determine if the condition was present at the time of inpatient admission.NO
WClinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission.YES
1Unreported/Not used - Exempt from POA reporting. NO

Convert Z87.01 to ICD-9

  • V12.61 - Prsnl hx recur pneumonia

Code Classification

  • Factors influencing health status and contact with health services (Z00–Z99)
    • Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99)
      • Personal history of other diseases and conditions (Z87)

Code History

  • FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016
    (First year ICD-10-CM implemented into the HIPAA code set)
  • FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020

Information for Patients


Pneumonia

Pneumonia is an infection in one or both of the lungs. Many germs, such as bacteria, viruses, and fungi, can cause pneumonia. You can also get pneumonia by inhaling a liquid or chemical. People most at risk are older than 65 or younger than 2 years of age, or already have health problems.

Symptoms of pneumonia vary from mild to severe. See your doctor promptly if you

  • Have a high fever
  • Have shaking chills
  • Have a cough with phlegm that doesn't improve or gets worse
  • Develop shortness of breath with normal daily activities
  • Have chest pain when you breathe or cough
  • Feel suddenly worse after a cold or the flu

Your doctor will use your medical history, a physical exam, and lab tests to diagnose pneumonia. Treatment depends on what kind you have. If bacteria are the cause, antibiotics should help. If you have viral pneumonia, your doctor may prescribe an antiviral medicine to treat it.

Preventing pneumonia is always better than treating it. Vaccines are available to prevent pneumococcal pneumonia and the flu. Other preventive measures include washing your hands frequently and not smoking.

NIH: National Heart, Lung, and Blood Institute


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