Community Acquired Pneumonia ICD-10-CM Codes

What ICD-10 codes are used for community acquired pneumonia?

Community acquired pneumonia (CAP) is a common respiratory infection acquired outside of healthcare settings. Accurate coding of CAP is crucial for proper diagnosis, treatment, and reimbursement.

The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) provides specific codes for CAP based on various factors such as etiology, severity, and anatomical location.

Here are some commonly used ICD-10-CM codes for CAP, along with their clinical descriptions:

J13 - Pneumonia due to Streptococcus pneumoniae

This code indicates pneumonia caused by the bacterium Streptococcus pneumoniae. It includes both typical and atypical presentations of pneumonia.

J18.1 - Lobar pneumonia, unspecified organism

This code is used when pneumonia affects a specific lung lobe, but the causative organism is unspecified. It denotes inflammation in a localized area of the lung.

J18.9 - Pneumonia, unspecified organism

This code is utilized when the organism causing unspecified pneumonia is not identified. It applies to cases where the specific infectious agent is unknown.

J18.0 - Bronchopneumonia, unspecified organism

This code denotes pneumonia affecting multiple lung areas, such as the bronchioles. The causative organism is not specified in this case.

J15.9 - Unspecified bacterial pneumonia

When the etiology of pneumonia cannot be determined or is unidentified, this code is used. It covers cases where the specific infectious agent is unknown or not documented.

J18.2 - Hypostatic pneumonia, unspecified organism

This code is employed when pneumonia develops in areas of the lung that have impaired ventilation due to conditions like congestive heart failure or immobility.

J18.8 - Other pneumonia, unspecified organism

This code is used for pneumonia cases caused by an organism that is not identified or specified. It includes other types of pneumonia not covered by the preceding codes.

J16.8 - Pneumonia due to other specified infectious organisms

This code is utilized for pneumonia caused by specific infectious agents not covered by the earlier codes, such as Haemophilus influenzae or Moraxella catarrhalis.

Which CAP ICD codes are billable?

All listed codes are valid and billable.

Clinical information

• Community acquired pneumonia refers to an acute respiratory infection contracted outside of healthcare settings.
• Bacteria, viruses, or atypical pathogens commonly cause CAP.
• Risk factors for CAP include advanced age, underlying chronic conditions (e.g., diabetes, heart disease), immunosuppression, smoking, and recent respiratory viral infections.
• Common presenting symptoms of CAP include cough, fever, dyspnea, chest pain, sputum production, fatigue, and confusion (particularly in the elderly).
• Physical examination findings may include increased respiratory rate, crackles or decreased breath sounds on lung auscultation, increased heart rate, and signs of respiratory distress.
• Diagnostic workup for CAP includes a thorough history and physical examination, chest X-ray, and laboratory tests (e.g., complete blood count, blood cultures, sputum culture).
• Empirical antibiotic treatment is initiated promptly based on the severity of the illness and local antibiotic resistance patterns.
• Vaccination against Streptococcus pneumoniae and influenza is recommended for preventing CAP in high-risk populations.
• Close monitoring, symptom management, and appropriate follow-up are essential for CAP patients.

Synonyms include

• Acute community acquired pneumonia
• Non-hospital acquired pneumonia
• Outpatient pneumonia
• Community onset pneumonia
• Primary pneumonia
• Infectious organisms pneumonia
• Pneumonia, unspecified organism
• Pneumonia due to other infectious organisms in the community