ICD-10 Coding for Streptococcus pneumoniae pneumonia(J13)
Complete ICD-10-CM coding and documentation guide for Streptococcus pneumoniae pneumonia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Streptococcus pneumoniae pneumonia
J12-J18Primary Range
Pneumonia due to specific infectious organisms
This range includes pneumonia caused by specific bacteria, including Streptococcus pneumoniae.
Key Information: ICD-10 code for Streptococcus pneumoniae
Essential facts and insights about Streptococcus pneumoniae pneumonia
Primary ICD-10-CM Code for streptococcus pneumonia
Decision Criteria
clinical Criteria
- Confirmed laboratory identification of Streptococcus pneumoniae
documentation Criteria
- Physician documentation specifying Streptococcus pneumoniae
Applicable To
- Pneumococcal pneumonia
Excludes
- Pneumonia due to other specified bacteria (J15.-)
Clinical Validation Requirements
- Sputum culture positive for Streptococcus pneumoniae
- Blood culture positive for Streptococcus pneumoniae
- Urinary antigen test positive for pneumococcal serotypes
Code-Specific Risks
- Incorrectly using J18.9 when the organism is identified
- Missing documentation of specific organism
Coding Notes
- Ensure documentation specifies Streptococcus pneumoniae as the causative organism.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Streptococcus pneumoniae pneumonia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code J13.
Impact
Clinical: May lead to inappropriate treatment choices., Regulatory: Non-compliance with ICD-10 coding standards., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Ensure lab results are reviewed and documented., Use standardized templates for documentation.
Impact
Reimbursement: Incorrect coding may lead to lower reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Use J13 when the organism is confirmed as Streptococcus pneumoniae.
Impact
Risk of audits if organism is not specified in documentation.
Mitigation Strategy
Ensure all cultures and lab results are documented.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Streptococcus pneumoniae pneumonia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Streptococcus pneumoniae pneumonia
Use these documentation templates to ensure complete and accurate documentation for Streptococcus pneumoniae pneumonia. These templates include all required elements for proper coding and billing.
Emergency Department Admission
Specialty: PulmonologyRequired Elements
- Patient history
- Physical examination findings
- Laboratory and imaging results
- Microbiology culture results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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