J13 Pneumonia due to Streptococcus pneumoniae

Billable ICD-10-CM code, FY2026. Acts as a Major Complication or Comorbidity (MCC) as a secondary diagnosis.

Applicable to

• Bronchopneumonia due to S. pneumoniae

Excludes1 (never code together)

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

Code first

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

Code also

• , if applicable, any associated condition such as:
• abscess (J85.1)
• aspiration pneumonia (J69.-)

Applies from J13 Pneumonia due to Streptococcus pneumoniae

Applicable to

• Bronchopneumonia due to S. pneumoniae

Excludes1 (never code together)

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

Code first

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

Code also

• , if applicable, any associated condition such as:
• abscess (J85.1)
• aspiration pneumonia (J69.-)

Risk adjustment (HCC)

• CMS-HCC V22: HCC 115 — Pneumococcal Pneumonia, Empyema, Lung Abscess
• ESRD V24: HCC 115

MS-DRG index

Defines the logic of DRG(s) 193-195 in MDC 04.

Approximate ICD-9-CM (GEMs)

• 481 Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia] (approximate)

Code annotations containing back-references to J13

Back-references to J13

• Use Additional: D59.31 Infection-associated hemolytic-uremic syndrome ("Pneumococcal pneumonia (J13)")
• Code Also: D81.82 Activated Phosphoinositide 3-kinase Delta Syndrome [APDS] ("pneumonia (J12-J18)")
• Type 1 Excludes: J15.4 Pneumonia due to other streptococci ("pneumonia due to Streptococcus pneumoniae (J13)")
• Use Additional: J95.89 Other postprocedural complications and disorders of respiratory system, not elsewhere classified ("bacterial or viral pneumonia (J12-J18)")

Back-references to J13

• Use Additional: D59.31 Infection-associated hemolytic-uremic syndrome ("Pneumococcal pneumonia (J13)")
• Code Also: D81.82 Activated Phosphoinositide 3-kinase Delta Syndrome [APDS] ("pneumonia (J12-J18)")
• Type 1 Excludes: J15.4 Pneumonia due to other streptococci ("pneumonia due to Streptococcus pneumoniae (J13)")
• Use Additional: J95.89 Other postprocedural complications and disorders of respiratory system, not elsewhere classified ("bacterial or viral pneumonia (J12-J18)")

Diagnosis Index entries for J13

• Embolism (multiple) (paradoxical) › pyemic (multiple) › pneumococcal › with pneumonia
• Infection, infected, infective (opportunistic) › pneumococcus, pneumococcal NEC › generalized (purulent) › with pneumonia
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › broncho-, bronchial (confluent) (croupous) (diffuse) (disseminated) (hemorrhagic) (involving lobes) (lobar) (terminal) › diplococcal
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › broncho-, bronchial (confluent) (croupous) (diffuse) (disseminated) (hemorrhagic) (involving lobes) (lobar) (terminal) › pneumococcal
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › broncho-, bronchial (confluent) (croupous) (diffuse) (disseminated) (hemorrhagic) (involving lobes) (lobar) (terminal) › streptococcal NEC › pneumoniae
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › diplococcal, diplococcus (broncho-) (lobar)
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › in (due to) › Diplococcus (pneumoniae)
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › in (due to) › pneumococcus
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › in (due to) › Streptococcus › pneumoniae
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › lobar (disseminated) (double) (interstitial) › pneumococcal
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › lobar (disseminated) (double) (interstitial) › Streptococcus pneumoniae
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › pneumococcal (broncho) (lobar)
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › Streptococcus pneumoniae

Nearby codes

• J13 Pneumonia due to Streptococcus pneumoniae (this code)