CAP ICD-10-CM Codes

Discover the comprehensive CAP ICD-10-CM Codes: accurate, efficient classification system for medical diagnoses. Enhance healthcare documentation now.

By Patricia Buenaventura on Aug 8, 2025.

Fact Checked by Karina Jimenea.

Use Code

What ICD-10 codes are used for CAP?

Community-acquired pneumonia (CAP) is a common infectious respiratory condition. The ICD-10-CM coding system provides specific codes to classify accurately and document CAP diagnoses. Here are commonly used codes for CAP, along with their clinical descriptions:

J13: Pneumonia due to Streptococcus pneumoniae

This code is used for streptococcus pneumoniae bronchopneumonia, when pneumonia is caused by Streptococcus pneumoniae, a bacterium commonly associated with CAP. It encompasses both lobar and bronchopneumonia caused by this organism.

J15.0: Pneumonia due to Klebiella pneumoniae

This code is for Klebsiella pneumoniae pneumonia, or pneumonia that's caused by Klebsiella pneumoniae. Although more frequently causes hospital-acquired pneumonia, it can also be acquired outside a hospital setting.

J15.5: Pneumonia due to Escherichia coli

This code is used for Escherichia coli pneumonia or when pneumonia is caused by Escherichia coli, a bacterium commonly associated with urinary tract infections but can also cause respiratory infections.

J15.212: Pneumonia due to Methicillin-resistant Staphylococcus aureus (MRSA)

This code is assigned for pneumonia caused by MRSA, a type of staph bacteria resistant to certain antibiotics. MRSA pneumonia can be severe and often requires specialized treatment.

J16.8:Pneumonia due to other specified infectious organisms

This code is assigned to infectious organisms pneumonia or when the pneumonia is caused by an organism not specifically listed elsewhere in the ICD-10-CM. It includes rare or uncommon pathogens that are known to cause pneumonia.

J18.0: Bronchopneumonia, unspecified organism

This code is assigned when pneumonia affects multiple lung areas, involving both the bronchi and alveoli, but the infectious organism is not identified or tested.

J18.1: Lobar pneumonia, unspecified organism

This code is used when pneumonia affects a specific lung lobe, but the infectious organism is not identified or tested. Lobar pneumonia refers to the consolidation of a whole lobe of the lung.

J18.2: Hypostatic pneumonia, unspecified organism

This code is used for pneumonia that develops due to stagnant fluids in the lungs, often occurring in individuals who are bedridden or have limited mobility. The specific infectious organism is not identified or tested.

J18.8: Other pneumonia, unspecified organism

This code is assigned when pneumonia does not fit into a specific category and the infectious organism is not identified. It includes cases where the causative agent is not tested or cannot be determined.

J18.9: Pneumonia, unspecified organism

This code is assigned when the specific infectious organism causing the pneumonia is not identified. It includes cases where the causative agent is not tested or cannot be determined.

Which CAP ICD codes are billable?

J13 - Pneumonia due to Streptococcus pneumoniae:

Yes, this code is billable as it signifies a confirmed diagnosis of pneumonia caused by Streptococcus pneumonia or Pneumococcal pneumonia, a common pathogen in CAP.

J15.5 - Pneumonia due to Escherichia coli:

Yes, this code is billable as it signifies pneumonia caused specifically by Escherichia coli, necessitating targeted treatment strategies.

J15.212 - Pneumonia due to Methicillin-resistant Staphylococcus aureus (MRSA):

Yes, this code is billable as it denotes pneumonia specifically caused by the resistant bacterium MRSA, requiring distinct treatment approaches.

J16.8 - Pneumonia due to other specified infectious organisms:

This code is billable as it signifies pneumonia caused by specific infectious organisms not listed elsewhere, requiring targeted treatment and management.

J18.0 - Bronchopneumonia, unspecified organism:

Yes, this code is billable as it denotes a specific diagnosis of bronchopneumonia, even if the exact causative organism is not identified.

J18.1 - Lobar pneumonia, unspecified organism:

Yes, this code is billable as it indicates a specific diagnosis of lobar pneumonia, even though the causative organism is not identified.

J18.2 - Hypostatic pneumonia, unspecified organism:

Yes, this code is billable as it denotes a specific diagnosis of hypostatic pneumonia, regardless of the identified causative organism.

J18.8 - Other pneumonia, unspecified organism:

Yes, this code is billable because it represents a confirmed diagnosis of pneumonia, even if the exact infectious organism is not identified.

J18.9 - Pneumonia, unspecified organism:

Yes, this code is billable because it represents a specific diagnosis of pneumonia, even though the exact causative organism is not identified.

Clinical information

Clinical information in CAP ICD codes provides crucial details about community-acquired pneumonia's nature, cause, and characteristics. Here are key clinical insights conveyed by CAP ICD codes:

Identification of specific organisms: Certain codes, such as J13 (pneumonia due to Streptococcus pneumoniae) and J15.212 (pneumonia due to MRSA), highlight the causative organisms associated with CAP. This information helps guide appropriate antibiotic selection and infection control measures.
Differentiation of pneumonia types: Codes like J18.1 (lobar pneumonia, unspecified organism) and J18.0 (bronchopneumonia, unspecified organism) distinguish between lobar and bronchopneumonia, providing insights into the anatomical extent and involvement of lung structures. This aids in determining the appropriate treatment approach.
Unspecified and unidentified organisms: Codes such as J18.9 (pneumonia, unspecified organism) and J15.9 (pneumonia due to unidentified organism) indicate cases where the exact infectious agent is not identified or tested. While these codes lack specific organism information, they still provide a diagnosis of pneumonia and are useful in clinical documentation.
Noteworthy pathogens: Codes like J15.5 (pneumonia due to Escherichia coli) and J16.8 (pneumonia due to other specified infectious organisms) highlight less common pathogens causing CAP. Identifying these pathogens can inform appropriate treatment and help monitor potential outbreaks.
Severity and complications: ICD codes alone may not capture the severity or complications of CAP. However, the specific organism-related codes (e.g., MRSA, Streptococcus pneumoniae) can indicate the potential for more severe disease or complications, influencing treatment decisions and patient management.

Synonyms include

Community-onset pneumonia
Non-hospital-acquired pneumonia
Ambulatory pneumonia
Outpatient pneumonia
Non-institutional pneumonia
Primary pneumonia
Non-nosocomial pneumonia
Atypical pneumonia
Walking pneumonia
Chest infection in the community

Commonly asked questions

Diagnosis of CAP typically involves a combination of assessment of symptoms like fever, chills, and chest pain; a physical examination; medical history review; chest X-ray or imaging studies; and laboratory tests, including sputum analysis and blood cultures. These help identify the causative organism and assess the severity of the infection.

The treatment for CAP depends on the causative agent, the severity of symptoms, and individual patient factors. It often involves antibiotic therapy for bacterial pneumonia, antiviral medications for viral infections, and supportive care measures such as rest, adequate hydration, and over-the-counter pain relievers.

Preventive measures for CAP include practicing good hand hygiene, getting vaccinated against influenza and Streptococcus pneumoniae, avoiding close contact with individuals with respiratory infections, and quitting smoking. Pneumococcal and influenza vaccines are particularly recommended for high-risk individuals.

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