CAP ICD-10-CM Codes | 2023

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 6 to 10 commonly used codes for CAP, along with their clinical descriptions:

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.

J13 - Pneumonia due to Streptococcus pneumoniae:

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

J15.7 - 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.

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.

J18.8 - 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.

J18.2 - 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.

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

This code is assigned 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.

J15.9 - Pneumonia due to unidentified organism:

This code is used when the pneumonia is confirmed, but the infectious organism remains unidentified despite testing. It is assigned when no specific infectious agent is identified or tested.

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.

J18.5 - Pneumonia due to Escherichia coli:

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

Which CAP ICD codes are Billable? 

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.

J13 - Pneumonia due to Streptococcus pneumoniae:

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

J15.7 - 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.

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.

J18.8 - 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.

J18.2 - Hypostatic pneumonia, unspecified organism:

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

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.

J15.9 - Pneumonia due to unidentified organism:

Yes, this code is billable as it represents a confirmed diagnosis of pneumonia, even though the infectious organism remains unidentified.

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.

J18.5 - Pneumonia due to Escherichia coli:

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

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 J15.7 (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 J18.5 (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