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J13 - Pneumonia due to Streptococcus pneumoniae

ICD-10-CM Chapter 10: Diseases of the respiratory system · J09-J18 Influenza and pneumonia (J09-J18) · Top-level category · FY2027

Applicable To

Inclusion terms listed under J13 in the ICD-10-CM tabular list.

  • Bronchopneumonia due to S. pneumoniae

Includes, Excludes and Coding Notes

Excludes 1 — Not Coded HereFrom J13

Mutually exclusive: these conditions are never reported together with this code.

  • congenital pneumonia due to S. pneumoniae (P23.6)
  • lobar pneumonia, unspecified organism (J18.1)
  • pneumonia due to other streptococci (J15.3-J15.4)
Code FirstFrom J13

Sequence the underlying condition before this code.

  • , if applicable, associated influenza (J09.X1, J10.0-, J11.0-)
Code AlsoFrom J13

Report an additional code when both conditions apply.

  • , if applicable, any associated condition such as:
  • abscess (J85.1)
  • aspiration pneumonia (J69.-)
Excludes 2 — Not Included HereFrom J09-J18 Influenza and pneumonia (J09-J18)

Not part of this code; report both codes when the patient has both conditions.

  • allergic or eosinophilic pneumonia (J82)
  • aspiration pneumonia NOS (J69.0)
  • meconium pneumonia (P24.01)
  • neonatal aspiration pneumonia (P24.-)
  • pneumonia due to solids and liquids (J69.-)
  • congenital pneumonia (P23.9)
  • lipid pneumonia (J69.1)
  • rheumatic pneumonia (I00)
  • ventilator associated pneumonia (J95.851)
Use Additional CodeFrom J09-J18 Influenza and pneumonia (J09-J18)

Add a secondary code to identify the associated condition or cause when it is documented.

  • code, if applicable, to identify resistance to antimicrobial drugs (Z16.-)
Excludes 2 — Not Included HereFrom Chapter J00-J99

Not part of this code; report both codes when the patient has both conditions.

  • certain conditions originating in the perinatal period (P04-P96)
  • certain infectious and parasitic diseases (A00-B99)
  • complications of pregnancy, childbirth and the puerperium (O00-O9A)
  • congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
  • endocrine, nutritional and metabolic diseases (E00-E88)
  • injury, poisoning and certain other consequences of external causes (S00-T88)
  • neoplasms (C00-D49)
  • smoke inhalation (T59.81-)
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Use Additional CodeFrom Chapter J00-J99

Add a secondary code to identify the associated condition or cause when it is documented.

  • code, where applicable, to identify:
  • exposure to environmental tobacco smoke (Z77.22)
  • exposure to tobacco smoke in the perinatal period (P96.81)
  • history of tobacco dependence (Z87.891)
  • occupational exposure to environmental tobacco smoke (Z57.31)
  • tobacco dependence (F17.-)
  • tobacco use (Z72.0)
NotesFrom Chapter J00-J99

Instructional notes from the ICD-10-CM tabular list.

  • When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).

Inpatient DRG Payments

DRG 193139,034 discharges

Simple Pneumonia And Pleurisy With Mcc

Avg. Medicare Payment

$9,899

Total Payment$12,050
Patient Responsibility$2,150
Hospital Charge$59,757
DRG 19448,668 discharges

Simple Pneumonia And Pleurisy With Cc

Avg. Medicare Payment

$5,976

Total Payment$8,028
Patient Responsibility$2,052
Hospital Charge$38,379
DRG 1958,023 discharges

Simple Pneumonia And Pleurisy Without Cc/mcc

Avg. Medicare Payment

$4,312

Total Payment$6,244
Patient Responsibility$1,932
Hospital Charge$30,173
DRG 9742,609 discharges

Hiv With Major Related Condition With Mcc

Avg. Medicare Payment

$29,027

Total Payment$33,402
Patient Responsibility$4,375
Hospital Charge$149,750
DRG 975954 discharges

Hiv With Major Related Condition With Cc

Avg. Medicare Payment

$13,978

Total Payment$17,230
Patient Responsibility$3,252
Hospital Charge$68,377

Related condition guides

Documentation requirements, coding pitfalls and FAQs for conditions coded with J13.