J13 vs P23.6
J13 and P23.6 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
congenital pneumonia due to S. pneumoniae (P23.6)
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)
P23.6
Congenital pneumonia due to other bacterial agents
Billable
- Chapter 16
- Certain conditions originating in the perinatal period
- Section
- P19-P29
Use when the record says
- Congenital pneumonia due to Hemophilus influenzae
- Congenital pneumonia due to Klebsiella pneumoniae
- Congenital pneumonia due to Mycoplasma
- Congenital pneumonia due to Streptococcus, except group B
Indexed under
- Pneumonia › congenital › due to › bacterium NEC (acute) (double) (migratory) (purulent) (septic) (unresolved)
- Pneumonia › congenital › due to › Haemophilus influenzae (acute) (double) (migratory) (purulent) (septic) (unresolved)
- Pneumonia › congenital › due to › Klebsiella pneumoniae (acute) (double) (migratory) (purulent) (septic) (unresolved)
- Pneumonia › congenital › due to › Mycoplasma (acute) (double) (migratory) (purulent) (septic) (unresolved)
- Pneumonia › congenital › due to › Streptococcus (acute) (double) (migratory) (purulent) (septic) (unresolved)
These two codes sit in different chapters of the Tabular List, which is usually the clearest signal that they describe different underlying processes rather than different degrees of the same one.
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