J14 vs P23.6
J14 and P23.6 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.
Pneumonia due to Hemophilus influenzae
- Chapter 10
- Diseases of the respiratory system
- Section
- J09-J18
- Bronchopneumonia due to H. influenzae
- Pneumonia › Hemophilus influenzae (broncho) (lobar)
- Pneumonia › broncho-, bronchial › Hemophilus influenzae
- Pneumonia › in › Hemophilus influenzae (H. influenzae)
- Pneumonia › lobar › Hemophilus influenzae
Congenital pneumonia due to other bacterial agents
- Chapter 16
- Certain conditions originating in the perinatal period
- Section
- P19-P29
- 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
- Pneumonia › congenital › due to › bacterium NEC
- Pneumonia › congenital › due to › Haemophilus influenzae
- Pneumonia › congenital › due to › Klebsiella pneumoniae
- Pneumonia › congenital › due to › Mycoplasma
- Pneumonia › congenital › due to › Streptococcus (except group B)
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