InnovaRx Innova Health Strategies

J13

Pneumonia due to Streptococcus pneumoniae

Billable FY2026 2025-10-01 → 2026-09-30
Exclusions 21 never code together
J13code
Excludes1
J09-J18block
Excludes2
  • allergic or eosinophilic pneumonia (J82)J82
  • aspiration pneumonia NOS (J69.0)J69.0
  • meconium pneumonia (P24.01)P24.01
  • neonatal aspiration pneumonia (P24.-)P24.-
  • pneumonia due to solids and liquids (J69.-)J69.-
  • congenital pneumonia (P23.9)P23.9
  • lipid pneumonia (J69.1)J69.1
  • rheumatic pneumonia (I00)I00
  • ventilator associated pneumonia (J95.851)J95.851
J00-J99chapter
Excludes2
  • certain conditions originating in the perinatal period (P04-P96)P04-P96
  • certain infectious and parasitic diseases (A00-B99)A00-B99
  • complications of pregnancy, childbirth and the puerperium (O00-O9A)O00-O9A
  • congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Q00-Q99
  • endocrine, nutritional and metabolic diseases (E00-E88)E00-E88
  • injury, poisoning and certain other consequences of external causes (S00-T88)S00-T88
  • neoplasms (C00-D49)C00-D49
  • smoke inhalation (T59.81-)T59.81-
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)R00-R94

Excludes1 — never code together. The excluded condition and this one are mutually exclusive.

Excludes2 — not included here, but the patient may have both. Code both when documented.

Instructional notes 14
J13code
Inclusion terms
  • Bronchopneumonia due to S. pneumoniae
Code first
Code also
J09-J18block
Use additional code
  • code, if applicable, to identify resistance to antimicrobial drugs (Z16.-)Z16.-
J00-J99chapter
Notes
  • 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).J40
Use additional code
  • code, where applicable, to identify:
  • exposure to environmental tobacco smoke (Z77.22)Z77.22
  • exposure to tobacco smoke in the perinatal period (P96.81)P96.81
  • history of tobacco dependence (Z87.891)Z87.891
  • occupational exposure to environmental tobacco smoke (Z57.31)Z57.31
  • tobacco dependence (F17.-)F17.-
  • tobacco use (Z72.0)Z72.0
Index entries leading here 3
  • Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) J18.9
    • broncho-, bronchial (confluent) (croupous) (diffuse) (disseminated) (hemorrhagic) (involving lobes) (lobar) (terminal) J18.0
      • diplococcal J13
      • pneumococcal J13
      • streptococcal NEC J15.4
        • pneumoniae J13
    • diplococcal, diplococcus (broncho-) (lobar) J13
    • in (due to)
      • Diplococcus (pneumoniae) J13
      • pneumococcus J13
      • Streptococcus J15.4
        • pneumoniae J13
    • lobar (disseminated) (double) (interstitial) J18.1
      • pneumococcal J13
      • Streptococcus pneumoniae J13
    • pneumococcal (broncho) (lobar) J13
    • Streptococcus pneumoniae J13
  • Embolism (multiple) (paradoxical) I74.9
    • pyemic (multiple) I76
  • Infection, infected, infective (opportunistic) B99.9
    • pneumococcus, pneumococcal NEC A49.1
      • generalized (purulent) A40.3
        • with pneumonia J13
Additional references
AHA Coding Clinic® Licence required

Official coding advice for this code. Published by the American Hospital Association. Not included in this installation.

Risk adjustment

CMS22HCC115 ESRD21HCC115 ESRD24HCC115

Presence is a property of the code. Untick a model to hide it everywhere.

This code

Billable
yes
Code set
FY2026
Block
J09-J18

Present FY2024–FY2027.