2025 ICD-10-CM code J18
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Respiratory System - Influenza and pneumonia (J09-J18) Diseases of the respiratory system (J00-J99) Feed
Pneumonia, unspecified organism. Code first any associated influenza.
Modifiers may be applicable depending on the circumstances of service and the payer's guidelines. Consult your payer's specific guidelines for appropriate modifier use.
Medical necessity for coding J18 is established through clinical documentation supporting the diagnosis of pneumonia.This documentation must demonstrate the presence of symptoms, signs, and findings consistent with pneumonia, and the medical necessity for diagnostic and treatment interventions. Payers may have specific requirements for supporting medical necessity.
The clinical responsibility for coding J18 rests with the physician or qualified healthcare professional who diagnoses and manages the patient's pneumonia.Accurate coding requires detailed clinical documentation of symptoms, examination findings, diagnostic testing (e.g., chest x-ray, blood tests, cultures), and treatment provided.
In simple words: This code is for pneumonia when the doctor doesn't know what type of germ caused it.If the patient also has the flu, that needs to be coded first.
This code classifies pneumonia where the causative organism is not specified.It is crucial to code any associated influenza (J09.X1, J10.0-, J11.0-) first, if applicable.This code excludes specific types of pneumonia such as abscess of the lung with pneumonia, aspiration pneumonia due to various causes, congenital pneumonia, drug-induced interstitial lung disorder, interstitial pneumonia, lipid pneumonia, neonatal aspiration pneumonia, pneumonitis due to external agents, pneumonitis due to fumes and vapors, and usual interstitial pneumonia.
Example 1: A 65-year-old male presents with cough, fever, and shortness of breath. Chest x-ray reveals lobar consolidation consistent with pneumonia.The causative organism is not identified despite cultures.J18 is coded., A 78-year-old female with a history of heart failure is admitted with worsening shortness of breath and productive cough.She exhibits signs of pneumonia on physical examination, and chest x-ray reveals bilateral infiltrates. Cultures are pending.J18 is coded., A 30-year-old previously healthy male presents with acute onset of fever, chills, and productive cough.He has a history of recent influenza infection.A chest x-ray confirms pneumonia.The appropriate influenza code (e.g., J09-J11) is coded first, followed by J18.
Complete and accurate documentation is essential for proper coding of J18. This includes:* Patient history and physical examination findings indicating respiratory symptoms (cough, fever, dyspnea, etc.).* Chest x-ray report showing characteristic findings of pneumonia.* Results of any microbiological tests performed (e.g., sputum culture, blood cultures) to identify the causative organism.* Details of the treatment provided (e.g., antibiotics, oxygen therapy, supportive care).* Documentation of any other relevant diagnoses that may have influenced the development of pneumonia (e.g., underlying medical conditions such as heart failure, immunosuppression).
** When multiple respiratory conditions are present, code the lower anatomical site per the ICD-10 guidelines. If unsure about the causative organism, use J18.Always confirm with the latest ICD-10-CM coding guidelines for the most up-to-date information.
- Payment Status: Active
- Modifier TC rule: Not applicable to ICD-10 codes.
- Specialties:Pulmonology, Internal Medicine, Family Medicine, Emergency Medicine, Critical Care Medicine
- Place of Service:Inpatient Hospital, Outpatient Hospital, Emergency Room - Hospital, Office, Urgent Care Facility