FY2027 ICD-10-CM reference
J18.1: Lobar pneumonia, unspecified organism
By the HCC Buddy Coding Team
The official ICD-10-CM descriptor is Lobar pneumonia, unspecified organism. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.
Billable code. Verified against the official FY2027 order file.
FY2027 Tabular instructions
Instructions below include applicable chapter, section and parent-code notes. Each note identifies where it appears in the official source.
Instructional note
When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).
Source: J00-J99 (chapter, inherited).
Instructional note
code, where applicable, to identify:
Source: J00-J99 (chapter, inherited).
Instructional note
exposure to environmental tobacco smoke (Z77.22)
Source: J00-J99 (chapter, inherited).
Instructional note
exposure to tobacco smoke in the perinatal period (P96.81)
Source: J00-J99 (chapter, inherited).
Instructional note
history of tobacco dependence (Z87.891)
Source: J00-J99 (chapter, inherited).
Instructional note
occupational exposure to environmental tobacco smoke (Z57.31)
Source: J00-J99 (chapter, inherited).
Instructional note
tobacco dependence (F17.-)
Source: J00-J99 (chapter, inherited).
Instructional note
tobacco use (Z72.0)
Source: J00-J99 (chapter, inherited).
Excludes2
certain conditions originating in the perinatal period (P04-P96)
Source: J00-J99 (chapter, inherited).
Excludes2
certain infectious and parasitic diseases (A00-B99)
Source: J00-J99 (chapter, inherited).
Excludes2
complications of pregnancy, childbirth and the puerperium (O00-O9A)
Source: J00-J99 (chapter, inherited).
Excludes2
congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
Source: J00-J99 (chapter, inherited).
Excludes2
endocrine, nutritional and metabolic diseases (E00-E88)
Source: J00-J99 (chapter, inherited).
Excludes2
injury, poisoning and certain other consequences of external causes (S00-T88)
Source: J00-J99 (chapter, inherited).
Excludes2
neoplasms (C00-D49)
Source: J00-J99 (chapter, inherited).
Excludes2
smoke inhalation (T59.81-)
Source: J00-J99 (chapter, inherited).
Excludes2
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Source: J00-J99 (chapter, inherited).
Instructional note
code, if applicable, to identify resistance to antimicrobial drugs (Z16.-)
Source: J09-J18 (section, inherited).
Excludes2
allergic or eosinophilic pneumonia (J82)
Source: J09-J18 (section, inherited).
Excludes2
aspiration pneumonia NOS (J69.0)
Source: J09-J18 (section, inherited).
Excludes2
meconium pneumonia (P24.01)
Source: J09-J18 (section, inherited).
Excludes2
neonatal aspiration pneumonia (P24.-)
Source: J09-J18 (section, inherited).
Excludes2
pneumonia due to solids and liquids (J69.-)
Source: J09-J18 (section, inherited).
Excludes2
congenital pneumonia (P23.9)
Source: J09-J18 (section, inherited).
Excludes2
lipid pneumonia (J69.1)
Source: J09-J18 (section, inherited).
Excludes2
rheumatic pneumonia (I00)
Source: J09-J18 (section, inherited).
Excludes2
ventilator associated pneumonia (J95.851)
Source: J09-J18 (section, inherited).
Code first
, if applicable, associated influenza (J09.X1, J10.0-, J11.0-)
Source: J18 (category, inherited).
Code also
, if applicable, any associated condition such as:
Source: J18 (category, inherited).
Code also
aspiration pneumonia (J69.-)
Source: J18 (category, inherited).
Excludes1
congenital pneumonia (P23.0)
Source: J18 (category, inherited).
Excludes1
drug-induced interstitial lung disorder (J70.2-J70.4)
Source: J18 (category, inherited).
Excludes1
interstitial pneumonia NOS (J84.9)
Source: J18 (category, inherited).
Excludes1
neonatal aspiration pneumonia (P24.-)
Source: J18 (category, inherited).
Excludes1
pneumonitis due to fumes and vapors (J68.0)
Source: J18 (category, inherited).
Excludes1
usual interstitial pneumonia (J84.178)
Source: J18 (category, inherited).
Excludes2
abscess of lung with pneumonia (J85.1)
Source: J18 (category, inherited).
Excludes2
aspiration pneumonia due to anesthesia during labor and delivery (O74.0)
Source: J18 (category, inherited).
Excludes2
aspiration pneumonia due to anesthesia during pregnancy (O29)
Source: J18 (category, inherited).
Excludes2
aspiration pneumonia due to anesthesia during puerperium (O89.0)
Source: J18 (category, inherited).
Excludes2
aspiration pneumonia due to solids and liquids (J69.-)
Source: J18 (category, inherited).
Excludes2
aspiration pneumonia NOS (J69.0)
Source: J18 (category, inherited).
Excludes2
lipid pneumonia (J69.1)
Source: J18 (category, inherited).
Excludes2
pneumonitis due to external agents (J67-J70)
Source: J18 (category, inherited).
Compare the FY2027 additions, removals and billable-status changes
What does J18.1 mean in FY2027?
The official ICD-10-CM descriptor is Lobar pneumonia, unspecified organism. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.
Is J18.1 billable in FY2027?
The FY2027 order file marks J18.1 as billable. Check the complete Tabular instructions and documentation before assigning it.
Does J18.1 map to an HCC?
J18.1 has no CMS-HCC V28 category in the CMS 2027 Initial ICD-10-CM Mappings (payment year 2027, 2026 dates of service). Under the PY2026 CMS mapping; CMS 2027 initial file unchanged: ESRD HCC 115; no RxHCC category. Coefficients for these models are pending verification for payment year 2027. CMS-HCC V24: not used for payment year 2027 Medicare Advantage payment (CMS CY 2027 Rate Announcement). PACE and HHS-HCC mappings are still pending verification for FY2027.
Source: CMS FY2027 ICD-10-CM order file. Payment model: CMS CY 2027 Rate Announcement. Read the FY2027 Official Guidelines.
Review the FY2026 April edition