ICD-10 · PDGM grouping
J09-J18 — Influenza and pneumonia
Every ICD-10-CM code in this range and the PDGM clinical group CMS assigns to it, read from the CMS grouper crosswalk v07.2.26.
ICD-10-CM FY2027 · CMS grouper v07.2.26
Codes in range
53
No clinical group
2
A period cannot be grouped from these.
Barred as primary
1
CMS rejects these in the primary position.
Where these codes group
47 of the 53 codes in J09-J18 group to MMTA - Respiratory, but the range is not uniform — it spreads across 2 clinical groups. A further 2 are assigned no clinical group at all, which means a 30-day period cannot be grouped from them.
Code families in J09-J18
One page per three-character family: every code in it, whether it can lead a claim, its clinical group and comorbidity subgroup.
- J09Influenza due to certain identified influenza viruses4 codes
- J10Influenza due to other identified influenza virus9 codes
- J11Influenza due to unidentified influenza virus8 codes
- J12Viral pneumonia, not elsewhere classified8 codes
- J13Pneumonia due to Streptococcus pneumoniae1 code
- J14Pneumonia due to Hemophilus influenzae1 code
- J15Bacterial pneumonia, not elsewhere classified14 codes
- J16Pneumonia due to other infectious organisms, not elsewhere classified2 codes
- J17Pneumonia in diseases classified elsewhere1 code
- J18Pneumonia, unspecified organism5 codes
Every code in J09-J18
Descriptions are CMS’s own, abbreviated as CMS abbreviates them.
| Code | Description | Clinical group | Primary position |
|---|---|---|---|
| J09X1 | Influenza due to ident novel influenza A virus w pneumonia | L | Can lead a claim |
| J09X2 | Flu due to ident novel influenza A virus w oth resp manifest | L | Can lead a claim |
| J09X3 | Influenza due to ident novel influenza A virus w GI manifest | L | Can lead a claim |
| J09X9 | Flu due to ident novel influenza A virus w oth manifest | L | Can lead a claim |
| J1000 | Flu due to oth ident flu virus w unsp type of pneumonia | L | Can lead a claim |
| J1001 | Flu due to oth ident flu virus w same oth ident flu virus pn | L | Can lead a claim |
| J1008 | Influenza due to oth ident influenza virus w oth pneumonia | L | Can lead a claim |
| J101 | Flu due to oth ident influenza virus w oth resp manifest | L | Can lead a claim |
| J102 | Influenza due to oth ident influenza virus w GI manifest | L | Can lead a claim |
| J1081 | Influenza due to oth ident influenza virus w encephalopathy | L | Can lead a claim |
| J1082 | Influenza due to oth ident influenza virus w myocarditis | A | Can lead a claim |
| J1083 | Influenza due to oth ident influenza virus w otitis media | A | Can lead a claim |
| J1089 | Influenza due to oth ident influenza virus w oth manifest | L | Can lead a claim |
| J1100 | Flu due to unidentified flu virus w unsp type of pneumonia | L | Can lead a claim |
| J1108 | Flu due to unidentified flu virus w specified pneumonia | L | Can lead a claim |
| J111 | Flu due to unidentified influenza virus w oth resp manifest | L | Can lead a claim |
| J112 | Influenza due to unidentified influenza virus w GI manifest | L | Can lead a claim |
| J1181 | Flu due to unidentified influenza virus w encephalopathy | L | Can lead a claim |
| J1182 | Influenza due to unidentified influenza virus w myocarditis | A | Can lead a claim |
| J1183 | Influenza due to unidentified influenza virus w otitis media | A | Can lead a claim |
| J1189 | Influenza due to unidentified influenza virus w oth manifest | L | Can lead a claim |
| J120 | Adenoviral pneumonia | L | Can lead a claim, code first applies |
| J121 | Respiratory syncytial virus pneumonia | L | Can lead a claim, code first applies |
| J122 | Parainfluenza virus pneumonia | L | Can lead a claim, code first applies |
| J123 | Human metapneumovirus pneumonia | L | Can lead a claim, code first applies |
| J1281 | Pneumonia due to SARS-associated coronavirus | L | Can lead a claim, code first applies |
| J1282 | Pneumonia due to coronavirus disease 2019 | None | Cannot lead a claim |
| J1289 | Other viral pneumonia | L | Can lead a claim, code first applies |
| J129 | Viral pneumonia, unspecified | L | Can lead a claim, code first applies |
| J13 | Pneumonia due to Streptococcus pneumoniae | L | Can lead a claim, code first applies |
| J14 | Pneumonia due to Hemophilus influenzae | L | Can lead a claim, code first applies |
| J150 | Pneumonia due to Klebsiella pneumoniae | L | Can lead a claim, code first applies |
| J151 | Pneumonia due to Pseudomonas | L | Can lead a claim, code first applies |
| J1520 | Pneumonia due to staphylococcus, unspecified | L | Can lead a claim, code first applies |
| J15211 | Pneumonia due to methicillin suscep staph | L | Can lead a claim, code first applies |
| J15212 | Pneumonia due to Methicillin resistant Staphylococcus aureus | L | Can lead a claim, code first applies |
| J1529 | Pneumonia due to other staphylococcus | L | Can lead a claim, code first applies |
| J153 | Pneumonia due to streptococcus, group B | L | Can lead a claim, code first applies |
| J154 | Pneumonia due to other streptococci | L | Can lead a claim, code first applies |
| J155 | Pneumonia due to Escherichia coli | L | Can lead a claim, code first applies |
| J1561 | Pneumonia due to Acinetobacter baumannii | L | Can lead a claim, code first applies |
| J1569 | Pneumonia due to other Gram-negative bacteria | L | Can lead a claim, code first applies |
| J157 | Pneumonia due to Mycoplasma pneumoniae | L | Can lead a claim, code first applies |
| J158 | Pneumonia due to other specified bacteria | L | Can lead a claim, code first applies |
| J159 | Unspecified bacterial pneumonia | L | Can lead a claim, code first applies |
| J160 | Chlamydial pneumonia | L | Can lead a claim, code first applies |
| J168 | Pneumonia due to other specified infectious organisms | L | Can lead a claim, code first applies |
| J17 | Pneumonia in diseases classified elsewhere | None | Cannot lead a claim |
| J180 | Bronchopneumonia, unspecified organism | L | Can lead a claim, code first applies |
| J181 | Lobar pneumonia, unspecified organism | L | Can lead a claim, code first applies |
| J182 | Hypostatic pneumonia, unspecified organism | L | Can lead a claim, code first applies |
| J188 | Other pneumonia, unspecified organism | L | Can lead a claim, code first applies |
| J189 | Pneumonia, unspecified organism | L | Can lead a claim, code first applies |
Source: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01. 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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