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ICD-10 Guide
ICD-10 CodesJ14

J14

Pneumonia due to Hemophilus influenzae

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 J14 is a billable code used to indicate a diagnosis of pneumonia due to hemophilus influenzae.

Key Diagnostic Point:

Pneumonia due to Hemophilus influenzae is a bacterial infection that primarily affects the lungs, leading to inflammation and consolidation of lung tissue. Clinically, patients may present with symptoms such as cough, fever, chills, chest pain, and difficulty breathing. The anatomy involved includes the bronchi, bronchioles, and alveoli, where the infection can cause significant respiratory distress. Disease progression can vary; in some cases, it may resolve with appropriate antibiotic treatment, while in others, it can lead to severe complications such as pleural effusion or respiratory failure. Diagnostic considerations include obtaining a thorough patient history, physical examination, and imaging studies such as chest X-rays or CT scans, alongside microbiological testing to confirm the presence of Hemophilus influenzae. Early diagnosis and treatment are crucial to prevent complications and improve patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires laboratory confirmation and clinical correlation.
  • Treatment complexity: May involve antibiotics and supportive care, with potential for hospitalization.
  • Documentation requirements: Detailed clinical notes and lab results are essential.
  • Coding specificity: Requires precise coding to differentiate from other types of pneumonia.

Audit Risk Factors

  • Common coding errors: Misidentifying the causative organism or using unspecified codes.
  • Documentation gaps: Lack of clear laboratory results or clinical notes supporting the diagnosis.
  • Billing challenges: Potential denials if documentation does not clearly support the diagnosis or treatment.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Pulmonology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Pneumonia due to Hemophilus influenzae is a significant public health concern, particularly in vulnerable populations such as children and the elderly. Its clinical significance lies in the potential for severe respiratory complications and increased healthcare utilization. Understanding the epidemiology of this infection can help in developing preventive strategies and improving quality measures in healthcare settings.

ICD-9 vs ICD-10

Pneumonia due to Hemophilus influenzae is a significant public health concern, particularly in vulnerable populations such as children and the elderly. Its clinical significance lies in the potential for severe respiratory complications and increased healthcare utilization. Understanding the epidemiology of this infection can help in developing preventive strategies and improving quality measures in healthcare settings.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the severity of the condition and the treatment provided. Common denials can occur if the documentation does not clearly establish the diagnosis or if the treatment provided does not align with the diagnosis. Best practices include thorough documentation and ensuring that all coding aligns with the clinical findings.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for J00-J99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for J00-J99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by J14?

J14 specifically covers pneumonia caused by Hemophilus influenzae, which can manifest as community-acquired pneumonia or secondary pneumonia in patients with underlying conditions. It is important to confirm the diagnosis through culture or PCR testing.

When should J14 be used instead of related codes?

J14 should be used when the pneumonia is specifically confirmed to be due to Hemophilus influenzae. If the causative organism is unknown or if the pneumonia is due to another pathogen, other codes such as J18 should be considered.

What documentation supports J14?

Documentation should include clinical findings, laboratory results confirming Hemophilus influenzae, imaging studies, and treatment plans. Clear notes on the patient's symptoms and response to treatment are also essential.