2027 ICD-10-CM Diagnosis Code J13Pneumonia due to Streptococcus pneumoniae
ICD-10-CM Codes›J00–J99›J09-J18›J13
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Not Chronic
J13 is a billable ICD-10-CM diagnosis code for pneumonia due to Streptococcus pneumoniae. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 193 through 195, 791, 793, 974 through 976. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 129 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Bacterial infections and Pneumonia (except that caused by tuberculosis).
J13 no longer risk-adjusts for Medicare Advantage: it mapped to HCC 115 under the retired CMS-HCC V24 model through payment year 2025 but maps to no category in the live V28 model. It still risk-adjusts in the PACE (CMS-HCC V22) category 115, ESRD (V21) category 115, and ESRD (V24) category 115 for payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
J13 no longer risk-adjusts for Medicare Advantage: it maps to no payment category in the live CMS-HCC V28 model, although it still risk-adjusts in the other CMS models shown below.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Bacterial pneumonia co-occurrent with human immunodeficiency virus infection
- Bacterial pneumonia with AIDS
- Bronchopneumonia caused by Streptococcus
- Bronchopneumonia caused by Streptococcus pneumoniae
- Disorder of respiratory system co-occurrent with human immunodeficiency virus infection
- Lobar pneumonia
- Pneumococcal bronchitis
- Pneumococcal lobar pneumonia
- Pneumococcal pneumonia
- Pneumococcal pneumonia with AIDS
- Pneumonia with AIDS
- Respiratory disorder with AIDS
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to J13: its own notes plus those printed at block J09-J18 and Chapter 10. A note printed at a category, block or chapter applies to every code under it.
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Bronchopneumonia due to S. pneumoniae
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may 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)
Code First
The underlying condition named in the note is sequenced before this code.
Use Additional Code
Add a second code, after this one, to fully describe the condition.
- code, if applicable, to identify resistance to antimicrobial drugs (Z16.-)
Code Also
A second code may be needed to fully describe the condition; the note gives no sequencing direction.
Notes
General instructions on how these codes are used.
- When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name J13, its category, or a range that includes it.
Excludes1 1
These codes carry an Excludes1 note naming J13: they are not reported together with it, unless the two conditions are unrelated.
- J15.4 Pneumonia due to other streptococcipneumonia due to Streptococcus pneumoniae (J13)
Use Additional Code 2
These codes say to use an additional code from the note, and J13 is one of the codes named.
Code Also 2
These codes say J13 may also be needed to fully describe the condition. The note gives no sequencing direction.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) J18.9
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Pneumococcal Infections
Pneumococci are a type of streptococcus bacteria. The bacteria spread through contact with people who are ill or by healthy people who carry the bacteria in the back of their nose. Pneumococcal infections can be mild or severe. The most common types of infections are:
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert J13 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About J13Overview
What is the ICD-10 code for pneumonia due to Streptococcus pneumoniae?
The ICD-10-CM code for pneumonia due to Streptococcus pneumoniae is J13. It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is J13 (Pneumonia due to Streptococcus pneumoniae) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report pneumonia due to Streptococcus pneumoniae on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does J13 group to?
When pneumonia due to Streptococcus pneumoniae is the principal diagnosis on an inpatient stay, it groups to MS-DRG 195, 793, 791, 193, 194, 974, 976, 975, with relative weights from 0.6062 to 4.2192 depending on complications. Higher weights mean higher Medicare reimbursement.
Is J13 a CC or MCC?
CMS lists J13 as an MCC (major complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 129 closely related codes in its exclusion list.
Can J13 be reported with P23.6?
Not as a rule. The Excludes1 note on J13 lists "congenital pneumonia due to S. pneumoniae (P23.6)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
Does J13 risk-adjust for Medicare Advantage payment?
Not for Medicare Advantage. J13 mapped to HCC 115 in the retired CMS-HCC V24 model, which last determined payment in 2025, but it maps to no category in the live V28 model; see all codes that no longer risk-adjust. It still risk-adjusts in the PACE (CMS-HCC V22) category 115 (Pneumococcal Pneumonia/Empyema/Lung Abscess), ESRD (V21) category 115 (Pneumococcal Pneumonia/Empyema/Lung Abscess), and ESRD (V24) category 115 (Pneumococcal Pneumonia/Empyema/Lung Abscess).
