J13 diagnosis code · Billable category · FY2027

J13 Pneumonia due to Streptococcus pneumoniae

Billable
MCC
POA reported

J13 ICD-10 code: a billable diagnosis code in FY2027; the category has no subdivisions.

Where it sits

Chapter 10 Diseases of the respiratory system (J00-J99)
J09-J18 Influenza and pneumonia (J09-J18)
J13 Pneumonia due to Streptococcus pneumoniae

CC / MCC: MCC
MS-DRG: 193-195, 791, 793, 974-976
HCC V28: –
POA: Reported
Code Editor: –
Index entries: 13

Instructions

At J13

Inclusion terms

Bronchopneumonia due to S. pneumoniae

Excludes1

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

Code first

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

Code also

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

Notes that also apply

Block J09-J18 instructions (Excludes2 9, Use additional code 1): printed on the block page.

Chapter 10 instructions (Notes 1, Excludes2 9, Use additional code 7): printed on the chapter 10 page.

Index entries

Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved)diplococcal, diplococcus (broncho-) (lobar) → J13
Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved)pneumococcal (broncho) (lobar) → J13
Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved)Streptococcus pneumoniae → J13
Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved)broncho-, bronchial (confluent) (croupous) (diffuse) (disseminated) (hemorrhagic) (involving lobes) (lobar) (terminal)diplococcal → J13
Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved)broncho-, bronchial (confluent) (croupous) (diffuse) (disseminated) (hemorrhagic) (involving lobes) (lobar) (terminal)pneumococcal → J13
Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved)in (due to)Diplococcus (pneumoniae) → J13
Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved)in (due to)pneumococcus → J13
Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved)lobar (disseminated) (double) (interstitial)pneumococcal → J13
Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved)lobar (disseminated) (double) (interstitial)Streptococcus pneumoniae → J13
Embolism (multiple) (paradoxical)pyemic (multiple)pneumococcalwith pneumonia → J13
Infection, infected, infective (opportunistic)pneumococcus, pneumococcal NECgeneralized (purulent)with pneumonia → J13
Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved)broncho-, bronchial (confluent) (croupous) (diffuse) (disseminated) (hemorrhagic) (involving lobes) (lobar) (terminal)streptococcal NECpneumoniae → J13
Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved)in (due to)Streptococcuspneumoniae → J13

NCHS Alphabetic Index. Index first, then the Tabular List.

Medicare grouping and edits

CMS files for J13
CC / MCC	MCC
PDX exclusion list	0113 (129 codes)
Appendix B	MDC 04 Diseases and Disorders of the Respiratory System, MS-DRG 193-195 (Simple Pneumonia and Pleurisy with MCC…); MDC 15 Newborns and Other Neonates with Conditions Originating in Perinatal Period, MS-DRG 791 (Prematurity with Major Problems…); MDC 15 Newborns and Other Neonates with Conditions Originating in Perinatal Period, MS-DRG 793 (Full Term Neonate with Major Problems…); MDC 25 Human Immunodeficiency Virus Infections, MS-DRG 974-976 (HIV with Major Related Condition with MCC…)
Code Editor	–
POA	Reported
HCC V28	–

MCC as a secondary diagnosis, not when the principal diagnosis is on its PDX exclusion list.

CMS: MS-DRG v44 (Appendix B, C), MCE v44, POA list FY2027, 2027 Initial ICD-10-CM Mappings. What the rows mean.