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2025 ICD-10-CM code J18.1

Lobar pneumonia, where the specific causative organism is unknown.

Follow ICD-10-CM coding guidelines and official instructions.If the organism is identified, use the specific code. If only a lobe is specified and the organism is unknown, use J18.9 instead of J18.1.

Medical necessity for J18.1 is established by the presence of clinical symptoms and imaging evidence of pneumonia.Treatment typically involves antibiotics, supportive care, and monitoring.

Diagnosis and treatment of pneumonia by a physician (e.g., pulmonologist, internist).

IMPORTANT:If the causative organism is identified, code to the specific type of bacterial pneumonia.If pneumonia affects a specific lobe and the organism is unspecified, use J18.9 instead.Consider additional codes to specify contributing factors like tobacco use (Z72.0), history of tobacco dependence (Z87.891), or exposure to tobacco smoke (Z77.22).

In simple words: This code describes a lung infection (pneumonia) affecting a specific part of the lung, but the exact type of germ causing it is not known.Symptoms might include shortness of breath, cough, fever, chills, chest pain, and coughing up blood.

J18.1, Lobar pneumonia, unspecified organism, is an ICD-10-CM code representing a type of pneumonia affecting one or more lobes of the lung.The code is used when the specific causative organism cannot be identified.This condition typically presents with symptoms such as dyspnea (shortness of breath), productive cough, fever/chills, malaise, pleuritic chest pain, and hemoptysis (coughing up blood).Complications may include pleural effusion, parapneumonic effusion, and empyema.As of October 1, 2019, if the pneumonia affects a specific lobe but the organism is not specified, J18.9 (Pneumonia, unspecified organism) should be used instead of J18.1.The physician's clinical diagnosis is crucial for accurate coding.

Example 1: A 65-year-old male presents with a productive cough, fever, and shortness of breath. Chest X-ray reveals lobar consolidation in the right lower lobe.Cultures are pending. J18.1 is coded pending culture results., A 30-year-old female with a history of asthma is admitted with worsening dyspnea and a productive cough.Chest CT shows lobar consolidation in the left upper lobe, and no specific organism is identified. J18.1 is assigned, with additional codes for asthma., A 78-year-old patient with a history of heart failure is admitted for worsening shortness of breath and cough.The physician documents lobar pneumonia affecting the right middle lobe, but specifies that the causative organism is unknown. J18.1 is coded, along with the heart failure code.

Physician's documentation specifying lobar pneumonia, including clinical presentation (symptoms), imaging findings (e.g., chest X-ray, CT scan showing lobar consolidation), and any attempts to identify the causative organism.If the organism is identified, the specific code for that organism should be used instead.

** Always review the latest ICD-10-CM guidelines for any updates or clarifications.Pay close attention to the physician's documentation to ensure accurate coding.

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