octoHealth

J12.9

Billable

Viral pneumonia, unspecified

Chapter 10: Diseases of the respiratory system

Additional Information

From parent codes: J00-J99 (Chapter 10)

Excludes 2 — Not Included HereFrom J00-J99

Excludes2 means 'NOT INCLUDED HERE!' An Excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time.

  • certain conditions originating in the perinatal period (P04-P96)
  • certain infectious and parasitic diseases (A00-B99)
  • complications of pregnancy, childbirth and the puerperium (O00-O9A)
  • congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
  • endocrine, nutritional and metabolic diseases (E00-E88)
  • injury, poisoning and certain other consequences of external causes (S00-T88)
  • neoplasms (C00-D49)
  • smoke inhalation (T59.81-)
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Use Additional CodeFrom J00-J99

The 'use additional code' note instructs that a secondary code should be added to provide more detail.

  • code, where applicable, to identify:
  • exposure to environmental tobacco smoke (Z77.22)
  • exposure to tobacco smoke in the perinatal period (P96.81)
  • history of tobacco dependence (Z87.891)
  • occupational exposure to environmental tobacco smoke (Z57.31)
  • tobacco dependence (F17.-)
  • tobacco use (Z72.0)
NotesFrom J00-J99

Additional notes from parent codes that apply to this code.

  • When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).

Inpatient DRG Payments

DRG 193136,649 discharges

Simple Pneumonia And Pleurisy With Mcc

Avg. Medicare Payment

$9,868

Total Payment$12,020
Patient Responsibility$2,153
Hospital Charge$60,101
DRG 19441,948 discharges

Simple Pneumonia And Pleurisy With Cc

Avg. Medicare Payment

$5,880

Total Payment$7,941
Patient Responsibility$2,061
Hospital Charge$38,636
DRG 1951,837 discharges

Simple Pneumonia And Pleurisy Without Cc/mcc

Avg. Medicare Payment

$4,015

Total Payment$6,019
Patient Responsibility$2,004
Hospital Charge$29,430
DRG 974404 discharges

Hiv With Major Related Condition With Mcc

Avg. Medicare Payment

$38,450

Total Payment$46,016
Patient Responsibility$7,566
Hospital Charge$220,691
DRG 97534 discharges

Hiv With Major Related Condition With Cc

Avg. Medicare Payment

$33,387

Total Payment$36,171
Patient Responsibility$2,784
Hospital Charge$86,733