Pneumonia due to Streptococcus pneumoniae
In Influenza and pneumonia (J09-J18), chapter 10: Diseases of the Respiratory System
- J13 is billable and valid on claims for FY 2027. If the record has more detail, check the other codes under J09-J18 below.
- As a secondary diagnosis it is an MCC (major complication), which can raise the MS-DRG payment. It doesn't count when the principal diagnosis is one of 129 closely related codes.
- Doesn't count toward a Medicare Advantage risk score (no HCC in V28; it was HCC 115 in V24).
- AHRQ's Chronic Condition Indicator classes it as not chronic (an acute or short-term condition).
- 297 US deaths in 2024 had an underlying cause in category J13, per the National Vital Statistics System on CDC WONDER. Death records use WHO ICD-10, so the count is for the whole category.
Also indexed as: Embolism, pyemic, pneumococcal, with pneumonia; Infection, pneumococcus, pneumococcal NEC, generalized, with pneumonia; Pneumonia, broncho-, bronchial, diplococcal; Pneumonia, broncho-, bronchial, pneumococcal; Pneumonia, broncho-, bronchial, streptococcal NEC, pneumoniae; Pneumonia, diplococcal, diplococcus; Pneumonia, in, Diplococcus; Pneumonia, in, pneumococcus; Pneumonia, in, Streptococcus, pneumoniae; Pneumonia, lobar, pneumococcal; Pneumonia, lobar, Streptococcus pneumoniae; Pneumonia, pneumococcal; Pneumonia, Streptococcus pneumoniae
Advertisements
Instructional notes
Includes: conditions that are coded here
- Bronchopneumonia due to S. pneumoniae
Excludes1: not coded here, use a different code
- 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: code the underlying condition first, then this code
Also applies, from Influenza and pneumonia (J09-J18)
These notes sit on J09-J18 and apply to every code under it, including J13.
Excludes2: not included here, code separately if applicable
Use additional code: add a second code for this, listed after this one
- code, if applicable, to identify resistance to antimicrobial drugs (Z16.-)
Official coding guidelines
From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.
Covers COPD and asthma exacerbations, sequencing of acute respiratory failure, confirmed versus suspected identified influenza, ventilator associated pneumonia, and vaping-related disorders.
- Chronic Obstructive Pulmonary Disease [COPD] and Asthma (page 56)
- Acute Respiratory Failure (page 56)
- Influenza due to certain identified influenza viruses (page 57)
- Ventilator associated Pneumonia (page 57)
- Vaping-related disorders (page 58)
Other codes under J09-J18
Influenza and pneumonia (J09-J18)
- J09Influenza due to certain identified influenza viruses
- J10Influenza due to other identified influenza virus
- J11Influenza due to unidentified influenza virus
- J12Viral pneumonia, not elsewhere classified
- J13Pneumonia due to Streptococcus pneumoniae(this code)
- J14Pneumonia due to Hemophilus influenzae
- J15Bacterial pneumonia, not elsewhere classified
- J16Pneumonia due to other infectious organisms, not elsewhere classified
- J17Pneumonia in diseases classified elsewhere
- J18Pneumonia, unspecified organism
J13 MS-DRGs
As the principal diagnosis, J13 groups to these 8 MS-DRGs (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.
- DRG 193 Simple Pneumonia and Pleurisy with MCC
- DRG 194 Simple Pneumonia and Pleurisy with CC
- DRG 195 Simple Pneumonia and Pleurisy without CC/MCC
- DRG 791 Prematurity with Major Problems
- DRG 793 Full Term Neonate with Major Problems
- DRG 974 HIV with Major Related Condition with MCC
- DRG 975 HIV with Major Related Condition with CC
- DRG 976 HIV with Major Related Condition without CC/MCC
Related conditions
Grouped by AHRQ's Clinical Classifications Software Refined (CCSR), which sorts every diagnosis code into clinically meaningful categories.
J13 is in Pneumonia (except that caused by tuberculosis) (RSP002, its default category), with 68 codes. Others in it:
J13 is in Bacterial infections (INF003), with 398 codes. Others in it:
Medicare coverage articles listing J13
These 6 Medicare billing and coding articles list J13 as a diagnosis that supports medical necessity for the services they cover. From the CMS Medicare Coverage Database; check your own contractor's article before billing.
Other codes that refer to J13
Notes on these codes point to J13.
About the condition
Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.
Pneumococcal Infections
Pneumococci are a type of streptococcus bacteria. The bacteria spread through contact with people who are ill or by healthy people who carry the bacteria in the back of their nose. Pneumococcal infections can be mild or severe. The most common types of infections are:
Read more about pneumococcal infections on MedlinePlusPneumonia
Pneumonia is an infection in one or both of the lungs. It causes the air sacs of the lungs to fill up with fluid or pus. It can range from mild to severe, depending on the type of germ causing the infection, your age, and your overall health.
Read more about pneumonia on MedlinePlusCode history
Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.
ICD-9-CM equivalent
Legacy crosswalk from the CMS General Equivalence Mappings (last updated 2018).
- 481 Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia] (approximate)