2025 ICD-10-CM code J10.0
(Active) Effective Date: N/A Diseases of the respiratory system - Influenza and pneumonia (J09-J18) J00-J99 Feed
Influenza due to other identified influenza virus with pneumonia.
Medical necessity is established by the confirmed diagnosis of influenza due to a known virus, along with the presence of pneumonia, which requires medical intervention and treatment.
Physicians who diagnose and treat respiratory illnesses, including infectious disease specialists, pulmonologists, family medicine practitioners, internists, and pediatricians, are responsible for accurately documenting the diagnosis and applying this code.
In simple words: The patient has the flu, caused by a specific, known flu virus, and they also have pneumonia.
This code indicates that the patient has influenza caused by a known influenza virus other than novel influenza A or swine flu, and this influenza has led to pneumonia.It excludes avian influenza, swine flu, influenza due to unidentified influenza virus, allergic or eosinophilic pneumonia, aspiration pneumonia NOS, meconium pneumonia, neonatal aspiration pneumonia, pneumonia due to solids and liquids, congenital pneumonia, lipid pneumonia, rheumatic pneumonia, and ventilator-associated pneumonia.
Example 1: A patient presents with fever, cough, shortness of breath, and muscle aches.Testing confirms influenza B, and a chest x-ray reveals pneumonia. J10.0 would be used., A child with a history of asthma develops a high fever, cough, and difficulty breathing.Influenza C is confirmed, and the child is diagnosed with pneumonia. J10.0 is applicable., An elderly patient in a nursing home develops a cough, fever, and chills. Influenza A (non-novel) is diagnosed, and the patient subsequently develops pneumonia.J10.0 is the appropriate code.
Documentation should include the confirmed influenza virus type (e.g., influenza A, B, or C, but not novel or swine flu), signs and symptoms of influenza (such as fever, cough, muscle aches), and evidence of pneumonia from physical exam and imaging studies (like chest x-ray).
** It is crucial to distinguish J10.0 from codes for influenza due to novel influenza A (J09.X1) or swine flu (J09.X2 with pneumonia), as these are distinct conditions.Also, conditions like allergic or eosinophilic pneumonia (J82), aspiration pneumonia (J69.0), or ventilator-associated pneumonia (J95.851) are excluded from J10.0 and have their own specific codes.
- Specialties:Infectious Disease, Pulmonology, Family Medicine, Internal Medicine, Pediatrics, Geriatrics
- Place of Service:Inpatient Hospital, Emergency Room - Hospital, Office, Skilled Nursing Facility, Nursing Facility,Home