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Find out how to code related conditions.

Bacterial pneumonia is the most common type of pneumonia, but figuring out which ICD-10-CM code to report can be tricky for even the most seasoned pulmonology coders. Revenue Cycle Insider examined the ICD-10-CM code book to give you the information you need to ensure your claim is accurate.

Familiarize yourself with the illness and learn which code applies to your encounter notes.

Understand Bacterial Pneumonia Symptoms

According to the Centers for Disease Control and Prevention (CDC), pneumonia causes more deaths globally than any other infectious disease. The condition is caused by several microorganisms, including fungi, viruses, and bacteria.

Typical bacterial pneumonia symptoms include:

• Cough with yellow, green, or blood-tinged mucus
• Headache
• High fever
• Lethargy
• Sudden onset of chills
• Shortness of breath (dyspnea)

A pulmonologist might suspect bacterial pneumonia when they listen to the lungs while the patient breathes and hears normal sounds on only one side.

Get to Know the Common Types of Bacterial Pneumonia

The ICD-10-CM code book features several codes listed under the J15.- (Bacterial pneumonia, not elsewhere classified) category, so you鈥檒l need to look at other categories for specific bacterial pneumonia diagnoses, such as pneumococcal pneumonia.

Pneumococcal pneumonia is one of the most common types of bacterial pneumonia, and according to the American Lung Association, the condition 鈥渋nfects over 900,000 Americans every year.鈥� Typically, pneumococcal pneumonia can occur on its own or develop after the patient has been sick with a viral infection, such as the flu, a cold, COVID-19, or respiratory syncytial virus (RSV).

You鈥檒l assign J13 (Pneumonia due to Streptococcus pneumoniae) to report a pneumococcal pneumonia diagnosis.

When the physician determines the patient鈥檚 pneumonia is a result of Hemophilus influenzae, or H. influenzae, infection, you鈥檒l assign J14 (Pneumonia due to Hemophilus influenzae) to report the diagnosis. The H. influenzae bacteria exists in the nose and throat and are harmless for the most part, but when the bacteria move to other body parts, infections can occur. If the H. influenzae bacteria makes its way to the lungs, then pneumonia can set in.

A form of 鈥渁typical鈥� pneumonia that tends to infect patients younger than 40 years old is caused by the mycoplasma pneumoniae bacterium, which is also known as walking pneumonia. This bacterial pneumonia can go undetected due to its mild conditions. The illness spreads in close quarters and working in crowded conditions. You鈥檒l use J15.7 (Pneumonia due to Mycoplasma pneumoniae) to report this diagnosis.

You鈥檒l assign J16.0 (Chlamydial pneumonia) to report when the physician diagnoses the patient with chlamydial pneumonia. This condition can cause mild pneumonia and bronchitis in teenagers and young adults, but older adults can experience more severe symptoms.

The most severe type of pneumonia is Legionnaires鈥� disease, which is caused by a legionella pneumophila infection. This illness isn鈥檛 spread from person to person, but outbreaks have been linked to exposure to contaminated water. Assign A48.1 (Legionnaires鈥� disease) to report this diagnosis.

Use J15.- Codes for Other Bacterial Pneumonia Cases

Under the J15.- category in the ICD-10-CM code book, you鈥檒l find several other bacterial pneumonia types depending on the causative organism.

Assign J15.0 (Pneumonia due to Klebsiella pneumoniae) when the physician diagnoses the patient with pneumonia caused by Klebsiella pneumoniae (K. pneumoniae). The patient inhales the oropharyngeal microbes in the lower respiratory tract.

Patients who are immunocompromised are at risk of developing pseudomonas pneumonia. The condition is caused by the Pseudomonas aeruginosa (P. aeruginosa) bacterium passing through certain hospital equipment, such as central lines and catheters. You鈥檒l assign J15.1 (Pneumonia due to Pseudomonas) to report the pseudomonas pneumonia diagnosis.

Report J15.5 (Pneumonia due to Escherichia coli) when the physician diagnoses the patient with pneumonia caused by an E. coli infection.

While the causal infection shares similar wording to J13鈥檚 bacterium, J15.3 (Pneumonia due to streptococcus, group B) applies to the group B streptococcal pneumonia illness. The infection most commonly occurs in newborns, as the illness is acquired during birth. On the other hand, you鈥檒l assign J15.4 (Pneumonia due to other streptococci) when the pulmonologist documents a certain streptococcus type, but a code doesn鈥檛 currently exist to identify the diagnosis.

The J15.2- (Pneumonia due to staphylococcus) subcategory is designated for diagnoses where a staphylococcus infection is causing the bacterial pneumonia illness in the patient. The subcategory requires at least a 5^th character to complete each code:

• J15.20 (Pneumonia due to staphylococcus, unspecified)
• J15.21- (Pneumonia due to staphylococcus aureus)
• J15.29 (Pneumonia due to other staphylococcus)

Furthermore, you need to append a 6^th character to J15.21- to specify the type of staphylococcus aureus infection:

• J15.211 (Pneumonia due to Methicillin susceptible Staphylococcus aureus)
• J15.212 (Pneumonia due to Methicillin resistant Staphylococcus aureus)

Patients who are suffering from a gram-negative bacterial infection can be at high risk of morbidity and mortality. This is because gram-negative bacteria have a high resistance to antibiotics. If a physician diagnoses a patient with pneumonia as a result of a gram-negative bacteria, you鈥檒l look to the J15.6- (Pneumonia due to other Gram-negative bacteria) subcategory.

• J15.61 (Pneumonia due to Acinetobacter baumannii)
• J15.69 (Pneumonia due to other Gram-negative bacteria)

Lastly, you鈥檒l assign J15.8 (Pneumonia due to other specified bacteria) if the physician documents a specific bacterial infection causing the pneumonia that doesn鈥檛 have a matching code yet. Code J15.9 (Unspecified bacterial pneumonia) applies to a bacterial pneumonia infection where the causative organism is unknown or not documented.

Don鈥檛 Forget to Review the Code Notes

Code categories J13-J16 feature 鈥淐ode first鈥� and 鈥淐ode also鈥� notes. The 鈥淐ode first鈥� note instructs you to assign one of the following influenza codes, if it applies:

• J09.X1 (Influenza due to identified novel influenza A virus with pneumonia)
• J10.0- (Influenza due to other identified influenza virus with pneumonia)
• J11.0- (Influenza due to unidentified influenza virus with pneumonia)

Next, the 鈥淐ode also鈥� note instructs you to report any associated conditions, like J85.1 (Abscess of lung with pneumonia) or J69.- (Pneumonitis due to solids and liquids).

Mike Shaughnessy, BA, CPC, Development Editor, AAPC