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Episode Clinical Summary	Table of Contents				
PNEUMONIA					
Episode Characteristic	Episode Information				
Episode Overview	Pneumonia (all): This episode includes clinically related services for patients with a diagnosis of pneumonia on two different dates at least 1 but no more than 30 days apart or with an inpatient hospitalization with a primary diagnosis of pneumonia. This episode includes patients with: 1) pneumonia without treatment in the inpatient hospital setting; or 2) pneumonia with treatment in the inpatient hospital setting.				
Episode Subtype Overviews	"? Pneumonia without inpatient hospitalization: This episode includes clinically related services for patients with pneumonia that were not treated in the inpatient hospital setting for pneumonia.  
? Pneumonia with inpatient exacerbation: This episode includes clinically related services for patients with pneumonia that were treated in the inpatient hospital setting for pneumonia. "				
Episode Type	Acute condition				
Trigger Rules	"? Non-PB E&M visit with a trigger principal ICD-9 diagnosis code followed by an E&M visit with a trigger ICD-9 diagnosis code at least 1 but no more than 30 days apart; or
? PB E&M visit with a trigger ICD-9  diagnosis code followed by an E&M visit with a trigger ICD-9  diagnosis code at least 1 but no more than 30 days apart; or
? IP hospital admission with a trigger principal ICD-9 diagnosis code "				
Start Date	14 days before first trigger E&M visit start date or admission to trigger IP hospital stay				
Grouping Rules	"Services occurring between the episode start and end date are grouped to the episode using the following grouping rules:
? Service only: Groups services with one of the specified procedure codes listed in the episode?s definition.
? Service-diagnosis pair: Groups services with one of the specified procedure codes only if paired with one of the specified diagnosis codes.
? Principal diagnosis only: Groups services with one of the specified diagnosis codes in the principal position.
The list of codes in the episode's definition can be found on the following page. "				
"Closing Rules
(End Date)"	60 days after first trigger E&M visit or discharge from trigger IP hospital stay				
End of Worksheet					
