J13: Pneumonia due to Streptococcus pneumoniae
J13 is a billable, specific ICD-10-CM code for pneumonia due to streptococcus pneumoniae. It is valid for submission on a claim.
Check J13 with the rest of the claim: free scrubberExcludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
Code first
The underlying condition must be sequenced before this code.
Code also
Both codes may be needed to describe the encounter fully. Sequencing depends on the reason for the visit.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Bronchopneumonia due to S. pneumoniae
Other codes that can never be billed with J13
Their own Excludes1 notes name this code, so the conflict is not listed above.
- J15.4Pneumonia due to other streptococci
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
J13 is named in 9 Medicare coverage policies: 9 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A52466Nebulizers - Policy Article
- A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
- A56717Billing and Coding: Respiratory Therapy (Respiratory Care)
- A57205Billing and Coding: Oximetry Services
Alphabetic index entries that lead here
- Pneumonia›diplococcal, diplococcus(broncho-) (lobar)
- Pneumonia›pneumococcal(broncho) (lobar)
- Pneumonia›Streptococcus pneumoniae
- Pneumonia›broncho-, bronchial›diplococcal
- Pneumonia›broncho-, bronchial›pneumococcal
- Pneumonia›in›Diplococcus(pneumoniae)
- Pneumonia›in›pneumococcus
- Pneumonia›lobar›pneumococcal
- Pneumonia›lobar›Streptococcus pneumoniae
- Embolism›pyemic›pneumococcal›with pneumonia
- Infection, infected, infective›pneumococcus, pneumococcal NEC›generalized›with pneumonia
- Pneumonia›broncho-, bronchial›streptococcal NEC›pneumoniae
The condition this code belongs to
Code history
Unchanged in every release from FY2024 to FY2027.