ICD-10-CM Diagnosis code J13

Pneumonia due to Streptococcus pneumoniae

Code Hierarchy

Coding Guidelines for J13

J13 is a valid ICD-10-CM diagnosis code meaning 'Pneumonia due to Streptococcus pneumoniae'.

It is also suitable for:

  • Bronchopneumonia due to S. pneumoniae

Purely Excluded Conditions

These diag codes should never be used at the same time as J13 because these conditions cannot occur together:

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

Must Code Etiology Before Coding J13

Some conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation.

J13 is a manifestation code. For it to be valid, one of the following etiology codes must also be coded first:

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

Two Codes Required to Describe Condition

Two codes may be required to fully describe the patient's condition, but the sequencing of the two codes is discretionary, depending on the severity of the conditions and the reason for the patient encounter.

  • associated abscess, if applicable (J85.1)

Complications & Comorbid Conditions (CC/MCC) Rules for J13

When J13 is used as a secondary diagnostic code, the patient's visit may be considered to have Complications & Comorbid Conditions (CC) or Major Complications & Comorbid Conditions (MCC).

Exclusions apply. When the primary diagnostic code is is in the exclusion list, the patient visit CC/MCC does not qualify for a CC or MCC.

CC/MCC grouping rules are adjusted each year, so check the rules for the fiscal year of the patient's discharge date.

CC/MCC Rules for J13

DRG Mapping Rules for J13

Diagnostic codes are the first step in the DRG mapping process.

The patient's primary diagnostic code is the most important. Assuming the patient's primary diagnostic code is J13, look in the list below to see which MDC's "Assignment of Diagnosis Codes" is first. That is the MDC that the patient will be grouped into.

From there, check the subsections of the MDC listed. The patient will be mapped into the first subsection for which the treatment performed on the patient meet the listed requirements of that subsection.

DRG grouping rules are adjusted each year, so make sure to check the rules for the fiscal year of the patient's discharge date.

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