J16 — Pneumonia due to other infectious organisms, not elsewhere classified
J16 is a non-billable header ICD-10-CM code for pneumonia due to other infectious organisms, not elsewhere classified. It cannot be billed on its own: choose one of the more specific child codes below.
Excludes1 — 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.
Other codes that can never be billed with J16
These codes carry an Excludes1 note pointing at J16. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading J16 alone.
Risk adjustment
J16 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Code to one of these instead J16
2 child codes. Green means billable.
Questions about J16
- Is J16 a billable ICD-10-CM code?
- No. J16 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
- Where does J16 sit in the tabular list?
- Diseases of the respiratory system (J00-J99), in the block Influenza and pneumonia (J09-J18).
- What cannot be coded together with J16?
- J16 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.