J13
BillablePneumonia due to Streptococcus pneumoniae
HCC Category Mapping
V24HCC 115 — Pneumococcal Pneumonia, Empyema, Lung Abscess
0.339ESRDHCC 115 — Pneumococcal Pneumonia, Empyema, Lung Abscess
0.000What This Code Means
Pneumonia caused by Streptococcus pneumoniae bacteria, a common cause of bacterial pneumonia.
Coding Tips
- •No additional characters needed; this is a complete code
- •Verify culture or test results confirm pneumococcal infection before coding
Clinical Significance
Pneumonia due to Streptococcus pneumoniae (pneumococcus) is a significant bacterial respiratory infection that increases morbidity, particularly in elderly and immunocompromised patients. This organism is a leading cause of community-acquired pneumonia and carries specific vaccination and treatment protocol implications. Accurate organism identification impacts treatment decisions, infection control measures, and risk stratification.
Documentation Requirements
- ✓Documentation of pneumonia diagnosis with causative organism identified as Streptococcus pneumoniae (pneumococcus)
- ✓Chest imaging (X-ray or CT) findings consistent with pneumonia
- ✓Clinical signs and symptoms documented (fever, cough, dyspnea, sputum production)
- ✓Culture, sputum, or molecular testing results confirming the specific organism
- ✓Antibiotic therapy prescribed and documented
- ✓Severity assessment (need for oxygen, hospitalization, intensive care)
Excludes 1 — Do NOT code together
Code Also
Commonly Confused Codes
J15.0-J15.29 — Other specified bacterial pneumonias; ensure culture confirms pneumococcus specificallyJ18.1 — Lobar pneumonia, unspecified organism; if organism is not identified, this more general code appliesJ14 — Pneumonia due to Hemophilus influenzae; different organism despite similar clinical presentationJ15.4 — Pneumonia due to other streptococci; pneumococcus is S. pneumoniae specifically, not other streptococcal species
Code Hierarchy
└J13Pneumonia due to Streptococcus pneumoniae
└J13Pneumonia due to Streptococcus pneumoniae