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J15.3 ICD-10-CM Code: Pneumonia due to streptococcus, group B

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 inclusion term · 4 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 v43, 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 J15.3 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on J15.3 itself; “inherited from” names the category or block whose note applies here.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • bronchopneumonia due to bacteria other than S. pneumoniae and H. influenzae

Source: inherited from J15

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).

Source: inherited from J15

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from J09-J18

Code First

Underlying conditions that must be sequenced before this code.

Source: inherited from J15

Code Also

Additional codes that may be required to fully describe the encounter.

  • Code also, if applicable, any associated condition such as:
  • abscess (J85.1)
  • aspiration pneumonia (J69.-)

Source: inherited from J15

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code, if applicable, to identify resistance to antimicrobial drugs (Z16.-)

Source: inherited from J09-J18

Coder workflow for J15.3

MedCoder structured workflow — derived from this code’s own official record

Before you code J15.3

  1. J15.3’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).

    Guide: Combination codes →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with J15.3. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in J15.3’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.

    ReviewJ16.0, P23, A48.1, A69.8

  2. Is the underlying (etiologic) condition the Code First note names documented?
    Yes → Sequence the underlying condition first, then J15.3.
    No → Continue; do not add an underlying condition the record does not document.

    ReviewJ09.X1, J10.0, J11.0

Consider J15.3. 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 J15.3(4 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with J15.3: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareJ16.0, P23, A48.1, A69.8

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of J15.3(9 notes)

    Coding workflow: The conditions named in this note are not included in J15.3. 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 J15.3. Do not add an underlying condition the record does not document.

    ReviewJ09.X1, J10.0, J11.0

    See the official tabular notes · Guidelines I.A.13

  • Use Additional Code — after identifying J15.3(1 note)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with J15.3 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.

    ReviewJ85.1, J69

    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 J15.3 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).

ReviewJ16.0, P23, A48.1, A69.8

Documentation: Only one of the components this code’s title joins is documented.

Coding question: Is J15.3 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).

ReviewJ09.X1, J10.0, J11.0

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

Pneumonia due to streptococcus, group B is a billable ICD-10-CM diagnosis code (J15.3).

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 (3)

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.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. Sequencing: 1 Code First instruction — the underlying condition is sequenced before this code when present. See the Code First notes
  2. 1 Use Additional Code instruction — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
  3. 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
  4. 4 Excludes1 entries — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  5. 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 (FY2026). 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 J15.3 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 2 Excludes1 notes: J13 — Pneumonia due to Streptococcus pneumoniae, 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 1 Use Additional Code instruction: J95.89 — Other postprocedural complications and disorders of respiratory system, not elsewhere classified (via J15.-).

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] (via J15.-), J69 — Pneumonitis due to solids and liquids (via J15.-).

These codes suggest coding this condition alongside when both are present.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 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.

J12.89 — Other viral pneumonia, J12.9 — Viral pneumonia, unspecified, J13 — Pneumonia due to Streptococcus pneumoniae, 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, J15.4 — Pneumonia due to other streptococci, J15.5 — Pneumonia due to Escherichia coli, J15.61 — Pneumonia due to Acinetobacter baumannii, J15.69 — Pneumonia due to other Gram-negative bacteria, J15.7 — Pneumonia due to Mycoplasma pneumoniae, J15.8 — Pneumonia due to other specified bacteria, J15.9 — Unspecified bacterial pneumonia, J16.0 — Chlamydial pneumonia, J16.8 — Pneumonia due to other specified infectious organisms, J18.0 — Bronchopneumonia, unspecified organism, +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).

J12.89 — Other viral pneumonia, J12.9 — Viral pneumonia, unspecified, J13 — Pneumonia due to Streptococcus pneumoniae, 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, J15.4 — Pneumonia due to other streptococci, J15.5 — Pneumonia due to Escherichia coli, J15.6 — Pneumonia due to other Gram-negative bacteria, J15.61 — Pneumonia due to Acinetobacter baumannii, J15.69 — Pneumonia due to other Gram-negative bacteria, J15.7 — Pneumonia due to Mycoplasma pneumoniae, J15.8 — Pneumonia due to other specified bacteria, J15.9 — Unspecified bacterial pneumonia, J16.0 — Chlamydial pneumonia, J16.8 — Pneumonia due to other specified infectious organisms, +418 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Pneumonia”; these codes share that main term but sit in a different category of the Tabular List.

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), J13 — Pneumonia due to Streptococcus pneumoniae (pneumococcal), J14 — Pneumonia due to Hemophilus influenzae (Hemophilus influenzae), J16.0 — Chlamydial pneumonia (chlamydial), J16.8 — Pneumonia due to other specified infectious organisms (specified NEC, organism NEC), J18.0 — Bronchopneumonia, unspecified organism (broncho-, bronchial), J18.1 — Lobar pneumonia, unspecified organism (lobar), J18.2 — Hypostatic pneumonia, unspecified organism (passive), J18.8 — Other pneumonia, unspecified organism (specified NEC), J18.9 — Pneumonia, unspecified organism, J68.0 — Bronchitis and pneumonitis due to chemicals, gases, fumes and vapors (nitrogen dioxide), J69.0 — Pneumonitis due to inhalation of food and vomit (aspiration), J69.1 — Pneumonitis due to inhalation of oils and essences (lipid, lipoid), +69 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.

Blood Glucose Test, HIV Screening Test

Contextual Map

Every relationship of J15.3 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 J15.3 with these 5 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Use Additional Code instructions

Referenced by Code Also instructions

Clinical classification (CCSR)

MS-DRG Grouper

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. 3,998 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026
  • 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 · FY2026

Index entries

  • Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), broncho-, bronchial (confluent) (croupous) (diffuse) (disseminated) (hemorrhagic) (involving lobes) (lobar) (terminal), streptococcal NEC, group B[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), in (due to), Streptococcus, group B[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), streptococcal NEC (broncho) (lobar), group, B[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (17)

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 FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 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 — v43 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. "J15.3 — Pneumonia due to streptococcus, group B." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/j15.3-pneumonia-due-to-streptococcus-group-b

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Pneumonia due to streptococcus, group B

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to J15.3 in its code family, with their registry titles.

View all codes in the J15 family