Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesInfluenza and pneumoniaICD-10-CM j18-pneumonia-unspecified-organism
    Ask Trek AI about this page

    ICD-10-CM Code For Pneumonia Unspecified Organism: Group Overview

    The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code group J18 includes pneumonia diagnoses where the causative organism is not specified, covering clinical presentations of lobar, bronchopneumonia, or unspecified acute lower respiratory infection. These ICD-10-CM diagnosis codes are used to document episodes of pneumonia when laboratory or clinical documentation does not identify a specific bacterial, viral, or other pathogen, capturing disease location and acuity when specified. Accurate coding within the ICD-10-CM J18 group supports proper claim adjudication, complete clinical documentation, and appropriate reimbursement.

    Customize your policy alerts

    Sign up for ICD-10-CM Code For Pneumonia Unspecified Organism: Group Overview policy alerts

    Get alerted when relevant policies change without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    ICD-10-CM J18: Pneumonia, Unspecified Organism Overview

    The ICD-10-CM J18 diagnoses represent pneumonia cases where a specific causative organism is not identified or documented. These codes target lower respiratory tract infection affecting the lungs and alveoli and are used across inpatient and outpatient settings. Accurate coding matters for appropriate clinical documentation and reimbursement because it impacts case mix, severity assignment, and claim processing.

    Table of contents

    Progress1 / 6

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    When to Use

    Use a code from this group when a patient has clinical or radiographic evidence of pneumonia but the organism is not documented or test results are pending or unavailable. These codes apply across care settings when documentation does not specify bacterial, viral, fungal, or other etiologic agents.

    ICD-10-CM Codes

    5 rows

    ICD-10-CM CodeDescription
    J18.0Bronchopneumonia, unspecified organism
    J18.1Lobar pneumonia, unspecified organism
    J18.2Hypostatic pneumonia, unspecified organism
    J18.8Other pneumonia, unspecified organism
    J18.9Pneumonia, unspecified organism

    DRG Codes

    9 rows

    DRG CodeDescription
    189Pulmonary Edema and Respiratory Failure
    193Simple Pneumonia and Pleurisy with MCC
    194Simple Pneumonia and Pleurisy with CC
    195Simple Pneumonia and Pleurisy without CC/MCC
    791Prematurity with Major Problems
    793Full Term Neonate with Major Problems
    974HIV with Major Related Condition with MCC
    975HIV with Major Related Condition with CC
    976HIV with Major Related Condition without CC/MCC

    Typical Clinical Scenarios

    • An elderly patient with sudden onset fever, productive cough, pleuritic chest pain, and shortness of breath presents to the emergency department with hypoxia and a new lobar consolidation on chest radiograph; no specific organism is identified after initial sputum culture and rapid testing. Because the presentation is acute and radiographic evidence confirms pneumonia without a defined causative agent, an unspecified pneumonia code is assigned on admission for immediate management and billing. Typical codes: J18.1, J18.9
    • An adult patient with advanced COPD develops increasing cough, purulent sputum, and dyspnea over several days while living in a long-term care facility; chest x-ray shows patchy bilateral infiltrates but microbiologic studies are inconclusive or unavailable. In this setting of community-onset pneumonia occurring on a background of chronic lung disease where no organism is identified, a code for unspecified pneumonia is used as the principal respiratory diagnosis. Typical codes: J18.9, J18.2
    • A hospitalized patient recovering from influenza and mechanical ventilation develops new fever, leukocytosis, and new focal consolidation on chest imaging after 48 hours in the ICU; cultures are pending or nondiagnostic. When a nosocomial pneumonia is suspected clinically but a specific pathogen has not been confirmed, an unspecified pneumonia code is documented to capture the acute infectious complication while awaiting or despite negative microbiology. Typical codes: J18.0, J18.8

    Related Codes

    J09-INFLUENZA-DUE-TO-CERTAIN-IDENTIFIED-INFLUENZA-VIRUSES

    ICD-10-CM Code For Influenza Due To Certain Identified Influenza Viruses: Group Overview

    J10-INFLUENZA-DUE-TO-OTHER-IDENTIFIED-VIRUS

    ICD-10-CM Code For Influenza Due To Other Identified Influenza Virus: Group Overview

    J11-INFLUENZA-UNIDENTIFIED-VIRUS

    ICD-10-CM Code For Influenza Due To Unidentified Influenza Virus: Group Overview

    J12-VIRAL-PNEUMONIA-NOT-ELSEWHERE-CLASSIFIED

    ICD-10-CM Code For Viral Pneumonia Not Elsewhere Classified: Group Overview

    J13-PNEUMONIA-DUE-TO-STREPTOCOCCUS-PNEUMONIAE

    ICD-10-CM Code For Pneumonia Due To Streptococcus Pneumoniae: Group Overview

    J14-PNEUMONIA-DUE-TO-HEMOPHILUS-INFLUENZAE

    ICD-10-CM Code For Pneumonia Due To Hemophilus Influenzae: Group Overview

    J17-PNEUMONIA-IN-DISEASES-CLASSIFIED-ELSEWHERE

    ICD-10-CM Code For Pneumonia In Diseases Classified Elsewhere: Group Overview

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.