Excludes1 pair
J13 vs J15.4
J13 and J15.4 are not coded together. ICD-10-CM declares them mutually exclusive with an Excludes1 note — the two conditions are not expected to occur together, so exactly one of them is normally correct for a given encounter. The Official Guidelines carve out one exception: if the two conditions are clearly unrelated to each other, both may be reported.
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 (broncho-) (lobar)
- Pneumonia › pneumococcal (broncho) (lobar)
- Pneumonia › Streptococcus pneumoniae
- Pneumonia › broncho-, bronchial › diplococcal
- Pneumonia › broncho-, bronchial › pneumococcal
J15.4
Pneumonia due to other streptococci
Billable
- Chapter 10
- Diseases of the respiratory system
- Section
- J09-J18
Indexed under
- Pneumonia › streptococcal NEC (broncho) (lobar)
- Pneumonia › broncho-, bronchial › streptococcal NEC
- Pneumonia › in › Streptococcus
- Pneumonia › lobar › streptococcal NEC
- Pneumonia › in › Streptococcus › specified NEC
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