Community Acquired Pneumonia ICD-10-CM Codes

Community Acquired Pneumonia ICD-10-CM Codes | 2023

Find accurate ICD-10-CM codes for Community Acquired Pneumonia. Ensure proper diagnosis and billing with comprehensive code reference.

By Chloe Smith on Jun 16, 2024.

Fact Checked by Ericka Pingol.

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What ICD-10 Codes are Used for Community Acquired Pneumonia? Which CAP ICD codes are Billable?Clinical Information Synonyms Include FAQS

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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:

J15.1 - 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.

J13 - Pneumonia due to Streptococcus pneumoniae

This code specifically represents pneumonia caused by the bacterium Streptococcus pneumoniae. It includes various manifestations and severities of the infection.

J18.9 - Pneumonia, unspecified organism

This code is utilized when the organism causing pneumonia is not identified or specified. 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 - Pneumonia due to unidentified organism

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, organism unspecified

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.

J18.9 - Pneumonia, unspecified organism

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

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Which CAP ICD codes are Billable?

J15.1 - Pneumonia due to Streptococcus pneumoniae:
Yes, billable. This code represents pneumonia caused by a specific organism, Streptococcus pneumoniae, which requires diagnosis and targeted treatment.

J18.1 - Lobar pneumonia, unspecified organism:
Yes, billable. While the causative organism is unspecified, lobar pneumonia signifies a specific anatomical location requiring medical attention and treatment.

J13 - Pneumonia due to Streptococcus pneumoniae:
Yes, billable. Similar to code J15.1, this code indicates pneumonia caused by Streptococcus pneumoniae, requiring diagnosis and specific treatment.

J18.9 - Pneumonia, unspecified organism:
Yes, billable. Although the causative organism is not identified, the code signifies the presence of pneumonia, which necessitates medical evaluation and management.

J18.0 - Bronchopneumonia, unspecified organism:
Yes, billable. Bronchopneumonia, even when the organism is unspecified, indicates a specific type of pneumonia that requires medical attention and treatment.

J15.9 - Pneumonia due to unidentified organism:
Yes, billable. This code signifies pneumonia where the specific causative organism cannot be determined, but the presence of pneumonia still requires medical assessment and care.

J18.2 - Hypostatic pneumonia, unspecified organism:
Yes, billable. Regardless of the unknown organism, hypostatic pneumonia implies lung inflammation related to certain conditions and requires medical attention.

J18.8 - Other pneumonia, organism unspecified:
Yes, billable. This code covers pneumonia cases caused by an unspecified organism, highlighting the presence of pneumonia and the need for medical evaluation and management.

J16.8 - Pneumonia due to other specified infectious organisms:
Yes, billable. This code accounts for pneumonia caused by specific infectious agents not covered by other codes, requiring diagnosis and targeted treatment.

‍J18.9 - Pneumonia, unspecified organism:
Yes, billable. Although the causative organism is not identified, pneumonia necessitates medical assessment and management.

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).
Severity assessment tools, such as the CURB-65 or PSI score, aid in determining the need for hospitalization or outpatient management.
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

Commonly asked questions

Can community-acquired pneumonia be prevented?

Yes, community-acquired pneumonia can be prevented to some extent. Vaccination against common pathogens, such as Streptococcus pneumoniae and influenza, is recommended, especially for high-risk individuals. Other preventive measures include good hand hygiene, avoiding close contact with sick individuals, and smoking cessation.

Is hospitalization necessary for all cases of community-acquired pneumonia?

Hospitalization for community-acquired pneumonia is typically required for severe cases, individuals with certain risk factors (e.g., older age, underlying comorbidities), or those who cannot manage the infection adequately at home. Mild to moderate cases can often be managed outpatient with oral antibiotics and close monitoring.

Are there any long-term complications associated with community-acquired pneumonia?

While most cases of community-acquired pneumonia resolve with appropriate treatment, there can be potential complications. These include lung abscesses, pleural effusion, respiratory failure, sepsis, and in some cases, long-term lung damage or scarring. Proper management and follow-up can help minimize the risk of complications.

Is community-acquired pneumonia contagious?

Community-acquired pneumonia can be contagious, especially if bacteria or viruses cause it. The infectious agents can be spread through respiratory droplets when an infected person coughs or sneezes. Taking precautions like covering the mouth when coughing and avoiding others when ill can help prevent transmission.