What is ICD-10 code J14?

J14 is the ICD-10-CM diagnosis code for Pneumonia due to Hemophilus influenzae. Pneumonia caused by Hemophilus influenzae bacteria, which can cause serious respiratory infections. It belongs to the ICD-10-CM chapter for diseases of the respiratory system (j00-j99). J14 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. J14 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. J14 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. J14 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for J14?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. J14 was a payment HCC under V24 (Pneumococcal Pneumonia, Empyema, Lung Abscess) but the V28 recalibration removed it from the risk adjustment model. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting J14?

This code is complete and does not require additional characters Confirm the organism identification through culture or molecular testing documentation Because J14 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM J14: Pneumonia due to Hemophilus

ICD-10-CM Code View

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Code lookupJ14Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Influenza and pneumonia (J09-J18)

J14

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Pneumonia due to Hemophilus influenzae

Pneumonia caused by Hemophilus influenzae bacteria, which can cause serious respiratory infections.

Buddy Insight

Pneumonia due to Hemophilus influenzae is a significant bacterial respiratory infection that increases morbidity, particularly in elderly and immunocompromised patients.

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Mapped

HCC 115

Pneumococcal Pneumonia, Empye...

RAF 0.130

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

Mapped

HCC 115

Pneumococcal Pneumonia, Empye...

RAF 0.030

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

J1Influenza and pneumonia (J09-J18)

J14Pneumonia due to Hemophilus influenzae

Inclusion Terms

Official

Bronchopneumonia due to H. influenzae

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for J14 in this effective period.

Related Child Codes

Official

ICD-10-CM does not list child codes under J14 for this display context.

Includes

Official

ICD-10-CM does not list Includes notes for J14 in this effective period.

Excludes 1

Official

congenital pneumonia due to H. influenzae (P23.6)

Code First

Official

, if applicable, associated influenza (J09.X1, J10.0-, J11.0-)

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for J14 in this effective period.

Code Also

Official

, if applicable, any associated condition such as:
abscess (J85.1)
aspiration pneumonia (J69.-)

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Coding a specific organism pneumonia without supporting culture, sputum, or molecular test results — empiric treatment alone does not confirm the organism

Using unspecified pneumonia codes (J18.9) when the causative organism has been identified through testing

Failing to distinguish between pneumonia and lower respiratory tract infections such as acute bronchitis — pneumonia involves lung parenchyma infiltrate

Not coding associated conditions such as sepsis (A41.x), respiratory failure (J96.x), or acute respiratory distress syndrome (J80) when documented

Common Mistakes

HCC Buddy guidance

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

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is J14 an HCC code?

Yes. J14 maps to Pneumococcal Pneumonia, Empyema, Lung Abscess under the V24 model but is not retained in V28.

Code: J14
Description: Pneumonia due to Hemophilus influenzae
HCC (V28): No CMS-HCC V28 mapping
RAF: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

V24HCC 115, Pneumococcal Pneumonia, Empyema, Lung Abscess

0.130

ESRDHCC 115, Pneumococcal Pneumonia, Empyema, Lung Abscess

0.030

Each model's RAF is its CMS base weight for that model's standard population, so 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 segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

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

MEAT Criteria for J14

For J14 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed J14 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

J14 is the ICD-10-CM diagnosis code for pneumonia due to hemophilus influenzae. Pneumonia caused by Hemophilus influenzae bacteria, which can cause serious respiratory infections. J14 sits in the ICD-10-CM chapter for diseases of the respiratory system (j00-j99), within the section covering influenza and pneumonia (j09-j18).

Under the older CMS-HCC V24 model, J14 maps to Pneumococcal Pneumonia, Empyema, Lung Abscess (HCC 115) with a community, non-dual, aged base RAF weight of 0.130. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

This code is complete and does not require additional characters. Because J14 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, 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)

Excludes 1, Do NOT code together

congenital pneumonia due to H. influenzae (P23.6)

Code First

, if applicable, associated influenza (J09.X1, J10.0-, J11.0-)

Code Also

, if applicable, any associated condition such as:
abscess (J85.1)
aspiration pneumonia (J69.-)

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

Code Hierarchy

└J14Pneumonia due to Hemophilus influenzae

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

HCC Buddy Code Card

J14

Is J14 an HCC code?

HCC Category Mapping

MEAT Criteria for J14

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Clinical Significance

Documentation Requirements

Excludes 1, Do NOT code together

Code First

Code Also

Commonly Confused Codes

Code Hierarchy

Work J14 in HCC Buddy