October 1 update. Our PDGM and ICD-10 tools now use the FY2027 code set: 190 codes added, 30 deleted, and no existing code changed clinical group.

See what changed

ICD-10 · PDGM grouping

J18 Pneumonia, unspecified organism

All 5 codes in the J18 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.

ICD-10-CM FY2027 · CMS grouper v07.2.26

Codes in family

5

Can lead a claim

5

Cannot lead a claim

0

What CMS assigns to J18

All 5 codes group to MMTA - Respiratory. All 5 count toward the Whooping Cough and Pneumonia comorbidity subgroup. Every code can lead a claim. CMS attaches a code-first note to all 5.

  • Whooping Cough and Pneumonia: counts toward the high comorbidity tier only in an interaction pair.

Code first

CMS grouper convention 82, on all 5 codes. Code first:

  • associated influenza, if applicable (J09.X1, J10.0-, J11.0-)

Every code in J18

Descriptions are CDC’s FY2027 wording; where CMS’s grouper abbreviates one, its form is shown beneath.

CodeDescriptionPrimary positionClinical groupComorbidity subgroup
J18.0Bronchopneumonia, unspecified organismCan lead a claim, code first appliesLWhooping Cough and Pneumonia
J18.1Lobar pneumonia, unspecified organismCan lead a claim, code first appliesLWhooping Cough and Pneumonia
J18.2Hypostatic pneumonia, unspecified organismCan lead a claim, code first appliesLWhooping Cough and Pneumonia
J18.8Other pneumonia, unspecified organismCan lead a claim, code first appliesLWhooping Cough and Pneumonia
J18.9Pneumonia, unspecified organismCan lead a claim, code first appliesLWhooping 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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