ICD-10 · PDGM grouping
J13 Pneumonia due to Streptococcus pneumoniae
The one code in the J13 family, with the PDGM clinical group, comorbidity subgroup and primary-position rule CMS assigns, read from the CMS grouper crosswalk v07.2.26 and the CDC FY2027 code file.
Codes in family
1
Can lead a claim
1
Cannot lead a claim
0
What CMS assigns to J13
This code groups to MMTA - Respiratory. It counts toward the Whooping Cough and Pneumonia comorbidity subgroup. It can lead a claim. CMS attaches a code-first note to it.
- Whooping Cough and Pneumonia: counts toward the high comorbidity tier only in an interaction pair.
Code first
CMS grouper convention 82. Code first:
- associated influenza, if applicable (J09.X1, J10.0-, J11.0-)
The J13 code
Descriptions are CDC’s FY2027 wording; where CMS’s grouper abbreviates one, its form is shown beneath.
| Code | Description | Primary position | Clinical group | Comorbidity subgroup |
|---|---|---|---|---|
| J13 | Pneumonia due to Streptococcus pneumoniae | Can lead a claim, code first applies | L | Whooping Cough and Pneumonia |
Sources: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01, for the clinical group, comorbidity subgroup, code-first conventions and primary-position flags; CDC NCHS ICD-10-CM FY2027 code descriptions for the family title and code wording. This is the crosswalk Medicare runs a claim through. Grouping also depends on admission source, timing, the OASIS functional items and the rest of the diagnosis list.
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