2025 ICD-10-CM code J13
(Valid) Effective Date: N/A Diseases of the respiratory system - Influenza and pneumonia (J09-J18) 10 Feed
Pneumonia due to Streptococcus pneumoniae. Bronchopneumonia due to S. pneumoniae.
Medical necessity for using J13 must be supported by evidence of a clinically diagnosed pneumonia infection specifically caused by Streptococcus pneumoniae, typically verified via laboratory testing, and requiring medical intervention such as antibiotic treatment and other supportive care.
Clinical responsibility includes diagnosing the specific type of pneumonia through physical examination, medical history review, and laboratory tests (like chest X-rays and sputum cultures), ensuring appropriate antibiotics or other medications are prescribed, and monitoring the patient's progress.
In simple words: Pneumonia caused by Streptococcus pneumoniae bacteria.This includes a type of pneumonia called bronchopneumonia.
Pneumonia due to Streptococcus pneumoniae.This code also encompasses bronchopneumonia caused by S. pneumoniae.If applicable, also code for any associated abscess (J85.1) and/or influenza (J09.X1, J10.0-, J11.0-).
Example 1: A patient presents with fever, cough, and difficulty breathing. A chest X-ray reveals consolidation consistent with pneumonia. Sputum cultures confirm Streptococcus pneumoniae as the causative agent. J13 is used for coding., An elderly patient residing in a nursing facility develops a cough and fever.Lab results and imaging indicate pneumonia caused by Streptococcus pneumoniae, without any other complications. J13 is the appropriate code., A child with a history of asthma presents with rapid breathing and chest pain.Following clinical evaluation and diagnostic testing confirming Streptococcus pneumoniae as the cause of the pneumonia, J13 is applied, along with a code specifying the asthmatic condition.
Documentation should include the diagnosis of pneumonia, the confirmed causative organism (Streptococcus pneumoniae) based on laboratory tests (e.g., culture, PCR), clinical findings such as fever, cough, chest pain, and difficulty breathing, as well as the type of pneumonia (e.g. bronchopneumonia, if applicable). If an abscess is present, it needs to be documented.
** For additional information regarding infections due to drug-resistant Streptococcus pneumoniae, consult current clinical guidelines and coding resources.
- Payment Status: Active
- Specialties:Pulmonology, Internal Medicine, Family Medicine, Infectious Disease, Pediatrics
- Place of Service:Inpatient Hospital, Office, Emergency Room - Hospital, Nursing Facility,Home