Pneumonia ICD-10 code
The ICD-10-CM code for pneumonia is J18.9 — pneumonia, unspecified organism. It is billable and valid for submission on a claim. There are 16 related codes, and which one you use depends on what the documentation supports.
Also written as community acquired pneumonia, cap, pneumococcal pneumonia, bronchopneumonia.
The mistake coders make here
J18.9 is the unspecified default and it is over-used. If the chart names the organism, ICD-10-CM has a code for it — J13 for Streptococcus pneumoniae, J15.- for other bacterial, J12.- for viral — and the organism-specific code is both more accurate and materially better for DRG assignment.
All ICD-10-CM codes for pneumonia
15 of 16 are billable. Green means you can submit it as-is.
| Code | Use it when |
|---|---|
| J18.9 | Pneumonia, unspecified organism |
| J13 | Pneumonia due to Streptococcus pneumoniae |
| J15.9 | Unspecified bacterial pneumonia |
| J12.9 | Viral pneumonia, unspecified |
| J18.1 | Lobar pneumonia, unspecified organism |
| J69.0 | Pneumonitis due to inhalation of food and vomit |
| J18 | Pneumonia, unspecified organismnot billable on its own |
| J18.8 | Other pneumonia, unspecified organism |
| J18.2 | Hypostatic pneumonia, unspecified organism |
| J18.0 | Bronchopneumonia, unspecified organism |
| A01.03 | Typhoid pneumonia |
| B06.81 | Rubella pneumonia |
| B01.2 | Varicella pneumonia |
| A02.22 | Salmonella pneumonia |
| A54.84 | Gonococcal pneumonia |
| B77.81 | Ascariasis pneumonia |
The organism decides the code, and it is usually documented
Pneumonia is one of the few diagnoses where the specificity is normally sitting in the chart and simply not carried through to the code. J18.9, pneumonia unspecified organism, is correct only when nothing identifies the organism. Streptococcus pneumoniae is J13 — one code, no fourth character, and it covers both pneumococcal pneumonia and bronchopneumonia due to S. pneumoniae. Haemophilus influenzae is J14. Other named bacteria live in J15.-, viral pneumonias in J12.-, and pneumonia in diseases classified elsewhere in J17. A positive culture alone is not enough to assign an organism-specific code; the provider has to link the organism to the pneumonia, and where the culture is positive but the link is not documented, that is a query.
Aspiration pneumonia is not in the pneumonia block
J69.0 is pneumonitis due to inhalation of food and vomit, and that is where aspiration pneumonia is coded — not J18.-. It is an easy one to miss because the chart says pneumonia and the coder reaches for the pneumonia block. If both an aspiration event and a bacterial pneumonia are documented as distinct, both can be coded; if the pneumonia is the consequence of the aspiration, J69.0 alone carries it.
Ventilator-associated and healthcare-associated pneumonia
J95.851 is ventilator-associated pneumonia, and it is assigned only when the provider explicitly documents that relationship — the mechanical ventilation being present is not enough. It is sequenced with a code for the organism where one is identified. Healthcare-associated pneumonia has no code of its own in ICD-10-CM at all; it is coded to the organism or to J18.9, with the healthcare association captured, if anywhere, by the encounter data rather than the diagnosis code.
Common questions
- What is the ICD-10 code for pneumococcal pneumonia?
- J13, pneumonia due to Streptococcus pneumoniae. It is a valid billable code with no further characters required, and it covers bronchopneumonia due to S. pneumoniae as well. Use it whenever the provider has documented the organism; J18.9 is only for pneumonia with no organism identified.
- What is the ICD-10 code for community-acquired pneumonia?
- There is no code for community-acquired pneumonia as such — ICD-10-CM classifies pneumonia by organism, not by where it was acquired. If the organism is documented, code it (J13, J14, J15.-, J12.-). If not, J18.9. The community-acquired distinction matters clinically and for treatment protocols, but it does not change the code.
- Does coding the specific organism change the DRG?
- It can, substantially. Several organism-specific pneumonias are complications or comorbidities that shift an admission between the with-CC and without-CC splits of a DRG, and the weight gap between those splits is often the reason a documentation query is worth raising. That is a payment consequence of a coding choice the chart usually already supports.