ICD-10 J18.0
Billable / Specific MCCBronchopneumonia, unspecified organism
About ICD-10-CM J18.0
ICD-10-CM code J18.0 represents Bronchopneumonia, unspecified organism. This is a billable/specific code in the Respiratory System chapter (block J18). The 2026 edition of ICD-10-CM J18.0 became effective on October 1, 2025.
Coding Tips for J18.0
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
J18.0 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Type 1 Excludes
Pure excludes, these codes can never be coded together with J18.0. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- hypostatic bronchopneumonia (J18.2)
- lipid pneumonia (J69.1)
Type 2 Excludes
Not included here, the excluded code is not part of J18.0, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- acute bronchiolitis (J21.-)
- chronic bronchiolitis (J44.89)
- other specified chronic obstructive pulmonary disease (J44.89)
Inpatient DRG Impact, MCC
codes Bronchopneumonia, unspecified organism. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for J18.0
Local Coverage Determinations (LCDs) from CMS MACs that list J18.0 as a covered diagnosis.
Showing top 10 of 671 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing J18.0.
5 Medicare
CPT Codes Commonly Billed with J18.0
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.
Convert J18.0 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| J18.0 | 485 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To J18.0
Other codes in section J09-J18 (Influenza and pneumonia).
ICD-10 J18.0, Billing FAQ
Is ICD-10 code J18.0 billable? +
Yes, J18.0 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 1 Excludes for J18.0? +
Type 1 Excludes (never code together with J18.0): hypostatic bronchopneumonia (J18.2); lipid pneumonia (J69.1)
What codes are Type 2 Excludes for J18.0? +
Type 2 Excludes (may be coded together when both conditions exist): acute bronchiolitis (J21.-); chronic bronchiolitis (J44.89); other specified chronic obstructive pulmonary disease (J44.89)
Is J18.0 a CC or MCC for inpatient DRG? +
Yes, this code is designated as MCC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does J18.0 map to? +
Per CMS GEMs, J18.0 maps to ICD-9 codes: 485. Useful for legacy data review and historical claim analysis.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team