J16.8 — Pneumonia due to other specified infectious organisms
Is J16.8 billable?
Yes, but J16.8 is an unspecified code. J16.8 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, J16.8 is an unspecified or catch-all code. Payers apply additional scrutiny to unspecified codes and many deny them when the medical record supports a more specific option, so check the documentation before selecting J16.8 — the more specific alternatives are listed below.
More specific alternatives
J16.8 at a glance
| Code | J16.8 |
|---|---|
| Description | Pneumonia due to other specified infectious organisms |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
Which MS-DRGs does J16.8 group to?
J16.8 sits in MDC 04 and helps define the logic of 3 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 193Simple Pneumonia and Pleurisy with MCCmedical
- 194Simple Pneumonia and Pleurisy with CCmedical
- 195Simple Pneumonia and Pleurisy without CC/MCCmedical
As a secondary diagnosis, J16.8 is a major complication or comorbidity (MCC), which can move a stay into a higher-paying DRG.
How is J16.8 listed in the Alphabetic Index?
These are the routes through the Alphabetic Index that lead to J16.8. They show the wording a clinician may have documented, which often differs from the Tabular description.
- Pneumonia › broncho-, bronchial › specified organism NEC (acute) (double) (migratory) (purulent) (septic) (unresolved)
- Pneumonia › lobar › specified organism NEC (acute) (double) (migratory) (purulent) (septic) (unresolved)
- Pneumonia › specified NEC › organism NEC (acute) (double) (migratory) (purulent) (septic) (unresolved)
- Pneumonia › in › specified › organism NEC (acute) (double) (migratory) (purulent) (septic) (unresolved)
Excludes1 — never code together — inherited from J16
The conditions below can never be reported together with J16.8 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
Code first — inherited from J16
The underlying condition below must be sequenced before J16.8. J16.8 describes a manifestation and cannot be the principal or first-listed diagnosis.
Use additional code — inherited from Chapter 10
Report an additional code alongside J16.8 to fully describe the condition. J16.8 is sequenced first.
Use additional code — inherited from J09-J18
Report an additional code alongside J16.8 to fully describe the condition. J16.8 is sequenced first.
- code, if applicable, to identify resistance to antimicrobial drugs (Z16.-)
Excludes2 — not included here — inherited from Chapter 10
The conditions below are not part of J16.8, but a patient may have both at the same time. When documentation supports it, J16.8 and the excluded code may both be reported.
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- smoke inhalation (T59.81-)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Excludes2 — not included here — inherited from J09-J18
The conditions below are not part of J16.8, but a patient may have both at the same time. When documentation supports it, J16.8 and the excluded code may both be reported.
Code also — inherited from J16
Two codes may be needed to describe the condition fully. Whether J16.8 is sequenced first depends on the reason for the encounter.
How long has J16.8 existed?
J16.8 has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.