J15.3 vs J15.4
J15.3 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 J15.4
pneumonia due to streptococcus, group B (J15.3)
J15.3
Pneumonia due to streptococcus, group B
Billable
- Chapter 10
- Diseases of the respiratory system
- Section
- J09-J18
Indexed under
- Pneumonia › broncho-, bronchial › streptococcal NEC › group B (acute) (double) (migratory) (purulent) (septic) (unresolved)
- Pneumonia › in › Streptococcus › group B (acute) (double) (migratory) (purulent) (septic) (unresolved)
- Pneumonia › streptococcal NEC › group › B (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