ICD-10 J16
Non-Billable HeaderPneumonia due to other infectious organisms, not elsewhere classified
About ICD-10-CM J16
ICD-10-CM code J16 represents Pneumonia due to other infectious organisms, not elsewhere classified. This is a non-billable header code in the Respiratory System chapter (block J16). The 2026 edition of ICD-10-CM J16 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Type 1 Excludes
Pure excludes, these codes can never be coded together with J16. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- congenital pneumonia (P23.-)
- ornithosis (A70)
- pneumocystosis (B59)
- pneumonia NOS (J18.9)
Coding Notes
Code Also
- , if applicable, any associated condition such as:
- abscess (J85.1)
- aspiration pneumonia (J69.-)
Code First
- , if applicable, associated influenza (J09.X1, J10.0-, J11.0-)
Medicare LCD Coverage for J16
Local Coverage Determinations (LCDs) from CMS MACs that list J16 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing J16.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but J16 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with J16
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Codes Adjacent To J16
Other codes in section J09-J18 (Influenza and pneumonia).
ICD-10 J16, Billing FAQ
Is ICD-10 code J16 billable? +
No, J16 is a non-billable header code. Use a more specific child code from block J16 when submitting claims.
What codes are Type 1 Excludes for J16? +
Type 1 Excludes (never code together with J16): congenital pneumonia (P23.-); ornithosis (A70); pneumocystosis (B59)
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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