J09-J18 — Influenza and pneumonia
ICD-10-CM codes J09-J18 cover influenza and pneumonia, within diseases of the respiratory system. The block holds 69 codes across 10 categories, of which 53 are billable and 16 are header codes that cannot be submitted on a claim.
Excludes2 — not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
Use additional code
Add a secondary code to capture the detail described below.
- code, if applicable, to identify resistance to antimicrobial drugs (Z16.-)
Risk adjustment in J09-J18
0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.
- HCC 282 Aspiration and Specified Bacterial Pneumonias
What else to watch in J09-J18
- 53 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.
Categories in J09-J18
- J09Influenza due to certain identified influenza viruses
- J10Influenza due to other identified influenza virus
- J11Influenza due to unidentified influenza virus
- J12Viral pneumonia, not elsewhere classified
- J13Pneumonia due to Streptococcus pneumoniae
- J14Pneumonia due to Hemophilus influenzae
- J15Bacterial pneumonia, not elsewhere classified
- J16Pneumonia due to other infectious organisms, not elsewhere classified
- J17Pneumonia in diseases classified elsewhere
- J18Pneumonia, unspecified organism