J13

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Pneumonia due to Streptococcus pneumoniae

Chapter 10: Diseases of the respiratory system

Additional Information

From parent codes: J00-J99 (Chapter 10)

Excludes 2 — Not Included HereFrom J00-J99

Excludes2 means 'NOT INCLUDED HERE!' An Excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time.

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 J00-J99

The 'use additional code' note instructs that a secondary code should be added to provide more detail.

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 J00-J99

Additional notes from parent codes that apply to this code.

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 193136,649 discharges

Simple Pneumonia And Pleurisy With Mcc

Avg. Medicare Payment

$9,868

Total Payment$12,020

Patient Responsibility$2,153

Hospital Charge$60,101

DRG 19441,948 discharges

Simple Pneumonia And Pleurisy With Cc

Avg. Medicare Payment

$5,880

Total Payment$7,941

Patient Responsibility$2,061

Hospital Charge$38,636

DRG 1951,837 discharges

Simple Pneumonia And Pleurisy Without Cc/mcc

Avg. Medicare Payment

$4,015

Total Payment$6,019

Patient Responsibility$2,004

Hospital Charge$29,430

DRG 974404 discharges

Hiv With Major Related Condition With Mcc

Avg. Medicare Payment

$38,450

Total Payment$46,016

Patient Responsibility$7,566

Hospital Charge$220,691

DRG 97534 discharges

Hiv With Major Related Condition With Cc

Avg. Medicare Payment

$33,387

Total Payment$36,171

Patient Responsibility$2,784

Hospital Charge$86,733

Chapter Information

Chapter 10: Diseases of the respiratory system

Range: J00-J99

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Additional Information

From parent codes: J00-J99 (Chapter 10)

Excludes 2 — Not Included HereFrom J00-J99

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 J00-J99

The 'use additional code' note instructs that a secondary code should be added to provide more detail.

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 J00-J99

Additional notes from parent codes that apply to this code.

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 193136,649 discharges

Simple Pneumonia And Pleurisy With Mcc

Avg. Medicare Payment

$9,868

Total Payment$12,020

Patient Responsibility$2,153

Hospital Charge$60,101

DRG 19441,948 discharges

Simple Pneumonia And Pleurisy With Cc

Avg. Medicare Payment

$5,880

Total Payment$7,941

Patient Responsibility$2,061

Hospital Charge$38,636

DRG 1951,837 discharges

Simple Pneumonia And Pleurisy Without Cc/mcc

Avg. Medicare Payment

$4,015

Total Payment$6,019

Patient Responsibility$2,004

Hospital Charge$29,430

DRG 974404 discharges

Hiv With Major Related Condition With Mcc

Avg. Medicare Payment

$38,450

Total Payment$46,016

Patient Responsibility$7,566

Hospital Charge$220,691

DRG 97534 discharges

Hiv With Major Related Condition With Cc

Avg. Medicare Payment

$33,387

Total Payment$36,171

Patient Responsibility$2,784

Hospital Charge$86,733