J14 ICD-10-CM Code: Pneumonia due to Hemophilus influenzae

Code

J14

Description

Pneumonia due to Hemophilus influenzae

HCC (V28)

No CMS-HCC V28 mapping

RAF reference coefficient

—

Billable

Yes

Payment year

2026

HCC Category Mapping

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work J14 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for J14

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for J14 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •This code is complete and does not require additional characters
• •Confirm the organism identification through culture or molecular testing documentation

Clinical Significance

Pneumonia due to Hemophilus influenzae is a significant bacterial respiratory infection that increases morbidity, particularly in elderly and immunocompromised patients. Hemophilus influenzae pneumonia can cause serious lower respiratory tract infection, particularly in patients with chronic lung disease or immunodeficiency. Accurate organism identification impacts treatment decisions, infection control measures, and risk stratification.

Documentation Requirements

• ✓Documentation of pneumonia diagnosis with causative organism identified as Hemophilus influenzae
• ✓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)

Commonly Confused Codes

• •J13: Pneumonia due to Streptococcus pneumoniae; different organism, similar presentation
• •J15.0-J15.29: Other specified bacterial pneumonias; ensure culture confirms Hemophilus specifically
• •J18.9: Pneumonia, unspecified; use only when the causative organism is not identified
• •J20.1: Acute bronchitis due to Hemophilus influenzae; lower respiratory infection but not pneumonia