J13 ICD-10-CM Code: Pneumonia due to Streptococcus pneumoniae
Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.
Coding at a Glance
- Tabular directives
- 1 inclusion term · 3 Excludes1 · 9 Excludes2 · 1 use-additional code · 1 code-first instruction · 3 code-also instructions
- Risk adjustment
- CMS-HCC V22 category 115
Inpatient Payment Groups (MS-DRG)
Potential MS-DRG participation — not a DRG assignment.
MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.
- MS-DRG 193 — SIMPLE PNEUMONIA AND PLEURISY WITH MCC (MDC 04)
- MS-DRG 194 — SIMPLE PNEUMONIA AND PLEURISY WITH CC (MDC 04)
- MS-DRG 195 — SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC (MDC 04)
- MS-DRG 791 — PREMATURITY WITH MAJOR PROBLEMS (MDC 15)
- MS-DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)
- MS-DRG 974 — HIV WITH MAJOR RELATED CONDITION WITH MCC (MDC 25)
- MS-DRG 975 — HIV WITH MAJOR RELATED CONDITION WITH CC (MDC 25)
- MS-DRG 976 — HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC (MDC 25)
A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.
Coding instructions
Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for J13 in the official ICD-10-CM tabular list, quoted as published.
Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026
Trace:FY2027 changesChange historyRelease, file and checksum
Notes without a marker are published on J13 itself; “inherited from” names the category or block whose note applies here.
Inclusion Terms
Alternative terms the tabular list files under this code.
- Bronchopneumonia due to S. pneumoniae
Excludes1 — Not Coded Here
Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).
- congenital pneumonia due to S. pneumoniae (P23.6) Compare J13 vs P23.6 →
- lobar pneumonia, unspecified organism (J18.1) Compare J13 vs J18.1 →
- pneumonia due to other streptococci (J15.3-J15.4) Compare J13 vs J15.3 →
Excludes2 — Not Included Here
Conditions not covered by this code, but which may be reported alongside it when both are present.
- allergic or eosinophilic pneumonia (J82) Compare J13 vs J82 →
- aspiration pneumonia NOS (J69.0) Compare J13 vs J69.0 →
- meconium pneumonia (P24.01) Compare J13 vs P24.01 →
- neonatal aspiration pneumonia (P24.-) Compare J13 vs P24 →
- pneumonia due to solids and liquids (J69.-) Compare J13 vs J69 →
- congenital pneumonia (P23.9) Compare J13 vs P23.9 →
- lipid pneumonia (J69.1) Compare J13 vs J69.1 →
- rheumatic pneumonia (I00) Compare J13 vs I00 →
- ventilator associated pneumonia (J95.851) Compare J13 vs J95.851 →
Source: inherited from J09-J18
Code First
Underlying conditions that must be sequenced before this code.
Code Also
Additional codes that may be required to fully describe the encounter.
Coder workflow for J13
MedCoder structured workflow — derived from this code’s own official record
Before you code J13
- J13’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).
- Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with J13. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).
Choose the right path
- Does the documentation support a condition named in J13’s Excludes1 note?
Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
No → Continue. - Is the underlying (etiologic) condition the Code First note names documented?
Yes → Sequence the underlying condition first, then J13.
No → Continue; do not add an underlying condition the record does not document.
Consider J13. Then work the Use Additional Code note and review the Code Also note, and confirm the code is valid for the date of service in the Verify section.
Documentation check
- The provider’s diagnostic statement
- Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
- The associated condition or complication
- Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).
- The underlying (etiologic) condition
- Named in the Code First note; sequenced before this code when documented (Guidelines I.A.13).
- The conditions the Use Additional Code note names
- Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.
Official instructions as workflow
Excludes1 — check before selecting J13(3 notes)
Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with J13: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.
See the official tabular notes · Guidelines I.A.12.a
Excludes2 — not part of J13(9 notes)
Coding workflow: The conditions named in this note are not included in J13. When the record documents both, both may be reported; the note is a boundary, not a prohibition.
CompareJ82, J69.0, P24.01, P24, J69, P23.9
See the official tabular notes · Guidelines I.A.12.b
Code First — sequencing check(1 note)
Coding workflow: Check whether the underlying or etiologic condition the note names is documented. When it is, sequence it before J13. Do not add an underlying condition the record does not document.
See the official tabular notes · Guidelines I.A.13
Use Additional Code — after identifying J13(1 note)
Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with J13 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.
ReviewZ16
See the official tabular notes · Guidelines I.A.13
Code Also — related condition(3 notes)
Coding workflow: Review the related condition when both are documented and the instruction applies. A Code Also note does not fix sequencing; the order follows the circumstances of the encounter.
See the official tabular notes · Guidelines I.A.17
Coding decision scenarios
Pattern scenarios for this code’s structure — decision rules, not clinical cases
Documentation: Both the condition J13 describes and a condition named in its Excludes1 note are documented for the same encounter.
Coding question: Can both codes be reported?
Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.
Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).
Documentation: Only one of the components this code’s title joins is documented.
Coding question: Is J13 supported?
Path: Review the code for the documented component on its own.
Reason: A combination code is assigned only when it fully identifies the documented conditions; otherwise the documented component takes its own code (Guidelines I.B.9).
Documentation: The underlying condition the Code First note names is documented alongside this condition.
Coding question: How are the two sequenced?
Path: Review the Code First note.
Reason: The underlying condition is sequenced first and the manifestation follows (Guidelines I.A.13).
Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.
Code Overview
MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.
Indexed Clinical Terms (13)
Official source data — entries quoted as published, in the Index’s own lookup phrasing
Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.
- Embolism (multiple) (paradoxical), pyemic (multiple), pneumococcal, with pneumonia
- Infection, infected, infective (opportunistic), pneumococcus, pneumococcal NEC, generalized (purulent), with pneumonia
- Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), broncho-, bronchial (confluent) (croupous) (diffuse) (disseminated) (hemorrhagic) (involving lobes) (lobar) (terminal), diplococcal
- Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), broncho-, bronchial (confluent) (croupous) (diffuse) (disseminated) (hemorrhagic) (involving lobes) (lobar) (terminal), pneumococcal
- Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), broncho-, bronchial (confluent) (croupous) (diffuse) (disseminated) (hemorrhagic) (involving lobes) (lobar) (terminal), streptococcal NEC, pneumoniae
- Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), diplococcal, diplococcus (broncho-) (lobar)
- Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), in (due to), Diplococcus (pneumoniae)
- Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), in (due to), pneumococcus
- Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), in (due to), Streptococcus, pneumoniae
- Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), lobar (disseminated) (double) (interstitial), pneumococcal
- Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), lobar (disseminated) (double) (interstitial), Streptococcus pneumoniae
- Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), pneumococcal (broncho) (lobar)
- Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), Streptococcus pneumoniae
Official Coding Guidelines
Official source data — quoted verbatim from the CMS/NCHS Official Guidelines
Official source data — quoted verbatim from the CMS/NCHS Official Guidelines
Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.
Chapter 10: Diseases of the Respiratory System (J00-J99), U07.0 a. Chronic Obstructive Pulmonary Disease [COPD] and Asthma 1) Acute exacerbation of chronic obstructive bronchitis and asthma
2) Ventilator associated Pneumonia Develops after Admission A patient may be admitted with one type of pneumonia (e.g., code J13, Pneumonia due to Streptococcus pneumonia) and subsequently develop VAP. In this instance, the principal diagnosis would be the appropriate code from categories J12-J18 for the pneumonia diagnosed at the time of admission. Code J95.851, Ventilator associated pneumonia, would be assigned as an additional diagnosis when the provider has also documented the presence of ventilator associated pneumonia.
Decision Points
The directives on this code's own record, as a pre-claim checklist.
- Sequencing: 1 Code First instruction — the underlying condition is sequenced before this code when present. See the Code First notes
- 1 Use Additional Code instruction — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
- 3 Code Also notes — a second code may apply; the guidelines leave its sequencing to the circumstances of the encounter. See the Code Also notes
- 3 Excludes1 entries — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
- 9 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes
Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.
Verify Before Coding
- MCC as a secondary diagnosis (FY2027). Can raise the stay's MS-DRG severity tier.
From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.
Relationships & Classification
MedCoder structured relationships — computed from published CMS and AHRQ datasets
Other codes that name J13 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.
Referenced by 1 Excludes1 note: J15.4 — Pneumonia due to other streptococci.
These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.
Referenced by 2 Use Additional Code instructions across 2 chapters: D59.31 — Infection-associated hemolytic-uremic syndrome, J95.89 — Other postprocedural complications and disorders of respiratory system, not elsewhere classified.
These codes instruct coders to additionally report this code when it applies.
Referenced by 2 Code Also instructions across 2 chapters: D81.82 — Activated Phosphoinositide 3-kinase Delta Syndrome [APDS], J69 — Pneumonitis due to solids and liquids.
These codes suggest coding this condition alongside when both are present.
MS-DRG Grouper Relationships (FY2027)
Potential MS-DRG participation — not a DRG assignment.
FY2027 MS-DRG: MCC — Major Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 129 clinically related codes on its CMS exclusion list. Does not count toward severity when the stay groups to DRGs 974-976 (HIV with Major Related Condition).
Named in the grouper logic of 8 MS-DRGs: DRG 193 (MDC 04), DRG 194 (MDC 04), DRG 195 (MDC 04), DRG 791 (MDC 15), DRG 793 (MDC 15), DRG 974 (MDC 25), DRG 975 (MDC 25), DRG 976 (MDC 25).
From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.
Clinical classification (AHRQ CCSR):RSP002 — Pneumonia (except that caused by tuberculosis) (default); INF003 — Bacterial infections.
Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.
Related Codes
Same clinical process (MS-DRG)
Acts as MCC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.
J10.1 — Influenza due to other identified influenza virus with other respiratory manifestations, J11.00 — Influenza due to unidentified influenza virus with unspecified type of pneumonia, J11.08 — Influenza due to unidentified influenza virus with specified pneumonia, J11.1 — Influenza due to unidentified influenza virus with other respiratory manifestations, J12.0 — Adenoviral pneumonia, J12.1 — Respiratory syncytial virus pneumonia, J12.2 — Parainfluenza virus pneumonia, J12.3 — Human metapneumovirus pneumonia, J12.89 — Other viral pneumonia, J12.9 — Viral pneumonia, unspecified, J14 — Pneumonia due to Hemophilus influenzae, J15.0 — Pneumonia due to Klebsiella pneumoniae, J15.1 — Pneumonia due to Pseudomonas, J15.20 — Pneumonia due to staphylococcus, unspecified, J15.211 — Pneumonia due to Methicillin susceptible Staphylococcus aureus, J15.212 — Pneumonia due to Methicillin resistant Staphylococcus aureus, J15.29 — Pneumonia due to other staphylococcus, J15.3 — Pneumonia due to streptococcus, group B, J15.4 — Pneumonia due to other streptococci, J15.5 — Pneumonia due to Escherichia coli, +108 more
Same clinical category (CCSR)
AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Pneumonia (except that caused by tuberculosis), Bacterial infections).
J11.00 — Influenza due to unidentified influenza virus with unspecified type of pneumonia, J11.08 — Influenza due to unidentified influenza virus with specified pneumonia, J12.0 — Adenoviral pneumonia, J12.1 — Respiratory syncytial virus pneumonia, J12.2 — Parainfluenza virus pneumonia, J12.3 — Human metapneumovirus pneumonia, J12.81 — Pneumonia due to SARS-associated coronavirus, J12.82 — Pneumonia due to coronavirus disease 2019, J12.89 — Other viral pneumonia, J12.9 — Viral pneumonia, unspecified, J14 — Pneumonia due to Hemophilus influenzae, J15.0 — Pneumonia due to Klebsiella pneumoniae, J15.1 — Pneumonia due to Pseudomonas, J15.20 — Pneumonia due to staphylococcus, unspecified, J15.211 — Pneumonia due to Methicillin susceptible Staphylococcus aureus, J15.212 — Pneumonia due to Methicillin resistant Staphylococcus aureus, J15.29 — Pneumonia due to other staphylococcus, J15.3 — Pneumonia due to streptococcus, group B, J15.4 — Pneumonia due to other streptococci, J15.5 — Pneumonia due to Escherichia coli, +418 more
Same Index main term, other category
The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Pneumonia”, “Embolism”; these codes share that main term but sit in a different category of the Tabular List.
I82.C1 — Acute embolism and thrombosis of internal jugular vein (vein, internal jugular), I82.C2 — Chronic embolism and thrombosis of internal jugular vein (vein, internal jugular, chronic), J12.0 — Adenoviral pneumonia (adenoviral), J12.1 — Respiratory syncytial virus pneumonia (respiratory syncytial virus), J12.2 — Parainfluenza virus pneumonia (parainfluenza virus), J12.3 — Human metapneumovirus pneumonia (human metapneumovirus), J12.81 — Pneumonia due to SARS-associated coronavirus (SARS-associated coronavirus), J12.82 — Pneumonia due to coronavirus disease 2019 (COVID-19), J12.89 — Other viral pneumonia (specified NEC, virus NEC), J12.9 — Viral pneumonia, unspecified (viral, virus), J14 — Pneumonia due to Hemophilus influenzae (Hemophilus influenzae), J15.0 — Pneumonia due to Klebsiella pneumoniae (Klebsiella), J15.1 — Pneumonia due to Pseudomonas (Pseudomonas), J15.20 — Pneumonia due to staphylococcus, unspecified (staphylococcal), J15.211 — Pneumonia due to Methicillin susceptible Staphylococcus aureus (MSSA), J15.212 — Pneumonia due to Methicillin resistant Staphylococcus aureus (MRSA), J15.29 — Pneumonia due to other staphylococcus (staphylococcal, specified NEC), J15.3 — Pneumonia due to streptococcus, group B (in, Streptococcus, group B), J15.4 — Pneumonia due to other streptococci (streptococcal NEC), J15.5 — Pneumonia due to Escherichia coli (Escherichia coli), +206 more
Lab tests where this diagnosis supports Medicare coverage (NCD)
Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.
Contextual Map
Every relationship of J13 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.
Run J13 with these 20 related codes in Claim Check
Hierarchy
- J00-J99 — Chapter 10: Diseases of the Respiratory System (J00-J99) (J00-J99)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
- J09-J18 — Influenza and pneumonia[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
Excludes1
- J15.3 — Pneumonia due to streptococcus, group B[Excludes1]: “pneumonia due to other streptococci (J15.3-J15.4)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
- J15.4 — Pneumonia due to other streptococci[Excludes1]: “pneumonia due to other streptococci (J15.3-J15.4)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
- J18.1 — Lobar pneumonia, unspecified organism[Excludes1]: “lobar pneumonia, unspecified organism (J18.1)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
- P23.6 — Congenital pneumonia due to other bacterial agents[Excludes1]: “congenital pneumonia due to S. pneumoniae (P23.6)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
Excludes2 (9)
- I00 — Rheumatic fever without heart involvement[Excludes2]: “rheumatic pneumonia (I00)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
- J69 — Pneumonitis due to solids and liquids[Excludes2]: “pneumonia due to solids and liquids (J69.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
- J69.0 — Pneumonitis due to inhalation of food and vomit[Excludes2]: “aspiration pneumonia NOS (J69.0)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
- J69.1 — Pneumonitis due to inhalation of oils and essences[Excludes2]: “lipid pneumonia (J69.1)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
- J82 — Pulmonary eosinophilia, not elsewhere classified[Excludes2]: “allergic or eosinophilic pneumonia (J82)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
- J95.851 — Ventilator associated pneumonia[Excludes2]: “ventilator associated pneumonia (J95.851)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
- P23.9 — Congenital pneumonia, unspecified[Excludes2]: “congenital pneumonia (P23.9)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
- P24 — Neonatal aspiration[Excludes2]: “neonatal aspiration pneumonia (P24.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
- and 1 more
Code First
- J09.X1 — Influenza due to identified novel influenza A virus with pneumonia[Code First]: “, if applicable, associated influenza (J09.X1, J10.0-, J11.0-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
- J10.0 — Influenza due to other identified influenza virus with pneumonia[Code First]: “, if applicable, associated influenza (J09.X1, J10.0-, J11.0-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
- J11.0 — Influenza due to unidentified influenza virus with pneumonia[Code First]: “, if applicable, associated influenza (J09.X1, J10.0-, J11.0-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
Use Additional Code
- Z16 — Resistance to antimicrobial drugs[Use Additional Code]: “code, if applicable, to identify resistance to antimicrobial drugs (Z16.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
Code Also
- J69 — Pneumonitis due to solids and liquids[Code Also]: “aspiration pneumonia (J69.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
- J85.1 — Abscess of lung with pneumonia[Code Also]: “abscess (J85.1)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
Referenced by Excludes1 notes
- J15.4 — Pneumonia due to other streptococci[Excludes1]: “pneumonia due to Streptococcus pneumoniae (J13)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
Referenced by Use Additional Code instructions
- D59.31 — Infection-associated hemolytic-uremic syndrome[Use Additional Code]: “Pneumococcal pneumonia (J13)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
- J95.89 — Other postprocedural complications and disorders of respiratory system, not elsewhere classified[Use Additional Code]: “bacterial or viral pneumonia (J12-J18)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
Referenced by Code Also instructions
- D81.82 — Activated Phosphoinositide 3-kinase Delta Syndrome [APDS][Code Also]: “pneumonia (J12-J18)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
- J69 — Pneumonitis due to solids and liquids[Code Also]: “bacterial pneumonia (J13-J15.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
Clinical classification (CCSR)
- RSP002 — Pneumonia (except that caused by tuberculosis)[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)
- INF003 — Bacterial infections[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)
MS-DRG Grouper
- MCC — Major Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (MCC). Not counted when the stay groups to DRGs 974-976 (HIV with Major Related Condition).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2027
- DRG 193 — SIMPLE PNEUMONIA AND PLEURISY WITH MCC[MS-DRG]: “SIMPLE PNEUMONIA AND PLEURISY WITH MCC (MDC 04)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2027
- DRG 194 — SIMPLE PNEUMONIA AND PLEURISY WITH CC[MS-DRG]: “SIMPLE PNEUMONIA AND PLEURISY WITH CC (MDC 04)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2027
- DRG 195 — SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC[MS-DRG]: “SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC (MDC 04)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2027
- DRG 791 — PREMATURITY WITH MAJOR PROBLEMS[MS-DRG]: “PREMATURITY WITH MAJOR PROBLEMS (MDC 15)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2027
- DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS[MS-DRG]: “FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2027
- DRG 974 — HIV WITH MAJOR RELATED CONDITION WITH MCC[MS-DRG]: “HIV WITH MAJOR RELATED CONDITION WITH MCC (MDC 25)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2027
- DRG 975 — HIV WITH MAJOR RELATED CONDITION WITH CC[MS-DRG]: “HIV WITH MAJOR RELATED CONDITION WITH CC (MDC 25)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2027
- and 1 more
MDC crossing
- MDC 04 — Diseases and Disorders of the Respiratory System[MDC crossing]: “Diseases and Disorders of the Respiratory System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 4,000 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027
- MDC 15 — Newborns and Other Neonates with Conditions Originating in Perinatal Period[MDC crossing]: “Newborns and Other Neonates with Conditions Originating in Perinatal Period — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”— CMS MS-DRG Definitions Manual · FY2027
Index entries (13)
- Embolism (multiple) (paradoxical), pyemic (multiple), pneumococcal, with pneumonia[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
- Infection, infected, infective (opportunistic), pneumococcus, pneumococcal NEC, generalized (purulent), with pneumonia[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
- Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), broncho-, bronchial (confluent) (croupous) (diffuse) (disseminated) (hemorrhagic) (involving lobes) (lobar) (terminal), diplococcal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
- Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), broncho-, bronchial (confluent) (croupous) (diffuse) (disseminated) (hemorrhagic) (involving lobes) (lobar) (terminal), pneumococcal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
- Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), broncho-, bronchial (confluent) (croupous) (diffuse) (disseminated) (hemorrhagic) (involving lobes) (lobar) (terminal), streptococcal NEC, pneumoniae[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
- Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), diplococcal, diplococcus (broncho-) (lobar)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
- Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), in (due to), Diplococcus (pneumoniae)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
- Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), in (due to), pneumococcus[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
- and 5 more
Change history
- FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016
Sources for this page
Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.
- Code, title, tabular notes and index terms Official source data
- CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
- Coding guidelines Official source data
- ICD-10-CM Official Guidelines for Coding and Reporting (FY2027), quoted by section Release, file and checksum · Publisher’s page
- Claim edits Official source data
- CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
- Inpatient payment groups Official source data
- CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
- Change history and date-of-service validity Official source data
- CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
- Comparisons, relationships and the contextual map MedCoder structured relationship
- Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
- Summary and FAQ answers MedCoder explanation
- Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.
Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates
Cite this page
Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.
MedCoder.ai. "J13 — Pneumonia due to Streptococcus pneumoniae." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/j13-pneumonia-due-to-streptococcus-pneumoniae
Change history
- FY2016 — October 1, 2015In the code set at ICD-10-CM adoptionPneumonia due to Streptococcus pneumoniae
No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.