J13 Pneumonia due to Streptococcus pneumoniae

The ICD-10-CM code for Pneumonia due to Streptococcus pneumoniae is J13 (FY2026). It is a billable, claim-ready diagnosis code.

Classification

Chapter

10: Diseases of the respiratory system (J00-J99)

Section

J09-J18: Influenza and pneumonia (J09-J18)

Category J13

1 code (1 billable)

FY2026 Status

Stable since FY2024

Also Known As

ICD-10-CM Alphabetic Index entries that lead to J13:

• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › Streptococcus pneumoniae
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › pneumococcal (broncho) (lobar)
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › diplococcal, diplococcus (broncho-) (lobar)
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › in (due to) › pneumococcus
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › broncho-, bronchial (confluent) (croupous) (diffuse) (disseminated) (hemorrhagic) (involving lobes) (lobar) (terminal) › diplococcal
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › broncho-, bronchial (confluent) (croupous) (diffuse) (disseminated) (hemorrhagic) (involving lobes) (lobar) (terminal) › pneumococcal
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › in (due to) › Diplococcus (pneumoniae)
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › lobar (disseminated) (double) (interstitial) › pneumococcal

Inclusion Terms

• Bronchopneumonia due to S. pneumoniae

U.S. Hospital Utilization

• An estimated 40,180 U.S. inpatient stays in 2023 included J13 among the documented diagnoses.
• 7,190 stays listed it as the principal diagnosis.

Source: National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, 2016–2023. National survey-weighted estimates.

Official Coding Guidelines

VAP develops after admission—principal dx vs additional dx

2) Ventilator associated Pneumonia Develops after Admission A patient may be admitted with one type of pneumonia (e.g., code J13, Pneumonia due to Streptococcus pneumonia) and subsequently develop VAP. In this instance, the principal diagnosis would be the appropriate code from categories J12-J18 for the pneumonia diagnosed at the time of admission. Code J95.851, Ventilator associated pneumonia, would be assigned as an additional diagnosis when the provider has also documented the presence of ventilator associated pneumonia.

COPD/asthma: acute exacerbation vs uncomplicated

a. Chronic Obstructive Pulmonary Disease [COPD] and Asthma 1) Acute exacerbation of chronic obstructive bronchitis and asthma The codes in categories J44 and J45 distinguish between uncomplicated cases and those in acute exacerbation. An acute exacerbation is a worsening or a decompensation of a chronic condition. An acute exacerbation is not equivalent to an infection superimposed on a chronic condition, though an exacerbation may be triggered by an infection.

Source: CMS — ICD-10-CM Official Guidelines for Coding and Reporting, FY2026

References

• CMS — ICD-10-CM Official Code Set and Guidelines, FY2026
• CDC/NCHS — ICD-10-CM Files and Browser Tool
• AHRQ — HCUP National Inpatient Sample, Frequencies by Diagnosis Code (2016–2023)