J13 vs J18.1
J13 and J18.1 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
lobar pneumonia, unspecified organism (J18.1)
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)
J18.1
Lobar pneumonia, unspecified organism
BillableUnspecified
- Chapter 10
- Diseases of the respiratory system
- Section
- J09-J18
Indexed under
- Pneumonia › lobar (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