J13 vs J15.4
J13 and J15.4 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
The official note, declared on J13
pneumonia due to other streptococci (J15.3-J15.4)
J13
Pneumonia due to Streptococcus pneumoniae
Billable
- Chapter 10
- Diseases of the respiratory system
- Section
- J09-J18
Use when the record says
- Bronchopneumonia due to S. pneumoniae
Indexed under
- Pneumonia › diplococcal, diplococcus (acute) (double) (migratory) (purulent) (septic) (unresolved)
- Pneumonia › pneumococcal (acute) (double) (migratory) (purulent) (septic) (unresolved)
- Pneumonia › Streptococcus pneumoniae (acute) (double) (migratory) (purulent) (septic) (unresolved)
- Pneumonia › broncho-, bronchial › diplococcal (acute) (double) (migratory) (purulent) (septic) (unresolved)
- Pneumonia › broncho-, bronchial › pneumococcal (acute) (double) (migratory) (purulent) (septic) (unresolved)
J15.4
Pneumonia due to other streptococci
Billable
- Chapter 10
- Diseases of the respiratory system
- Section
- J09-J18
Indexed under
- Pneumonia › streptococcal NEC (acute) (double) (migratory) (purulent) (septic) (unresolved)
- Pneumonia › broncho-, bronchial › streptococcal NEC (acute) (double) (migratory) (purulent) (septic) (unresolved)
- Pneumonia › in › Streptococcus (acute) (double) (migratory) (purulent) (septic) (unresolved)
- Pneumonia › lobar › streptococcal NEC (acute) (double) (migratory) (purulent) (septic) (unresolved)
- Pneumonia › in › Streptococcus › specified NEC (acute) (double) (migratory) (purulent) (septic) (unresolved)
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027