Variation in Diagnostic Coding of Patients With Pneumonia and Its Association With Hospital Risk-Standardized Mortality Rates A Cross-sectional Analysis

standardized mortality rates for pneumonia. Rates exclude severe cases, which may be assigned a secondary diagnosis of pneumonia and a principal diagnosis of sepsis or respiratory failure. By assigning sepsis and respiratory failure codes more liberally, hospitals might improve their reported performance. Objective: To examine the effect of the definition of pneumonia on hospital mortality rates. Design: Cross-sectional study. Setting: 329 U.S. hospitals. Patients: Adults hospitalized for pneumonia (as a principal diagno-sis or secondary diagnosis paired with a principal diagnosis of sepsis or respiratory failure) between 2007 and 2010. Measurements: Proportion of patients with pneumonia coded with a principal diagnosis of sepsis or respiratory failure and risk-standardized mortality rates excluding versus including a principa