Medical Billing and Coding Blog | ECLAT Health Solutions

Coding Review: Viral vs. Bacterial Pneumonia

Written by ECLAT Health Solutions | Jan 1, 2025 2:15:00 PM

Pneumonia is defined as inflammation and fluid in the lungs caused by a bacterial, viral, or fungal infection.

The ICD-10 codes for viral and bacterial pneumonia are different: 

Viral pneumonia

 

The ICD-10 codes for viral pneumonia include:

  • J12.82: Pneumonia due to coronavirus disease 2019 
  • J12.89: Other viral pneumonia 
  • J12.9: Viral pneumonia, unspecified 

Bacterial pneumonia

The ICD-10 codes for bacterial pneumonia include:

  • J13: Pneumonia due to Streptococcus pneumonia 
  • J14: Pneumonia due to Hemophilus influenza 
  • J15: Bacterial pneumonia, not elsewhere classified 
  • J15.6: Pneumonia due to other gram-negative bacteria 
  • J15.8: Pneumonia due to other specified bacteria 
  • J15.9: Unspecified bacterial pneumonia

  

 

Bacterial pneumonia tends to be more common and more severe than viral pneumonia. Bacterial pneumonia is more likely to require a hospital stay for treatment with antibiotics. Viral pneumonia causes flu-like symptoms and is more likely to resolve on its own.

Symptoms that could be signs of pneumonia include:

  • Congestion or chest pain.
  • Difficulty breathing.
  • A fever of 102 degrees Fahrenheit (38.88 degrees Celsius) or higher.
  • Coughing up yellow, green, or bloody mucus or sputum.

Some types of pneumonia are contagious, meaning it spreads from person to person. Pneumonia is mostly spread when people that are infected cough, sneeze, or talk, but it can also be spread by touching an object or surface that has the germ on it and then touching your nose or mouth.

Hospital-acquired pneumonia (HAP) can occur while in a hospital or healthcare facility for another illness or procedure. Healthcare-associated pneumonia (HCAP) can be acquired while in a long-term care facility or nursing home, outpatient, or extended-stay clinic. Ventilator-associated pneumonia (VAP) can occur with the use of a respirator or breathing machine in a hospital. Aspiration pneumonia can occur when solid foods, liquids, or other liquids go down the trachea (windpipe) and into the lungs.

To diagnose pneumonia, providers take a patient’s health history and conduct a physical exam. Tests are often performed including chest x-rays, pulse oximetry, blood tests or sputum tests.

Treatment can include antibiotics, antifungals, and antiviral medications such as oseltamivir (Tamiflu), zanamivir (Relenza) and peramivir (Rapivab). If the patient is not getting enough oxygen, oxygen therapy may be initiated, and IV fluids may also be ordered.

The flu, COVID-19 and pneumococcal disease are common causes of pneumonia. There are two types of vaccines that prevent pneumonia by pneumococcal bacteria. Similar to a flu shot, these vaccines won’t protect against all types of pneumonia, but if you do get sick, it is less likely to be severe:

  • Pneumococcal vaccines: Pneumovax23 and Prevnar13 protect against pneumonia bacteria.
  • Vaccinations against viruses: Certain viruses can lead to pneumonia, so getting vaccinated against COVID-19 and the flue can help reduce your risk of getting pneumonia.

 

References:

American Lung Association, “What Causes Pneumonia”, Online article, 11/2024, lung.org.

Care at Cleveland Clinic, “Pneumonia” Online article, my.clevelandclinic.org, 11/2022.

Centers for Medicare & Medicaid Services, “Billing and Coding: Respiratory Pathogen Panel Testing” Online article, CMS.gov, 2023.

Pfizer Living and Wellbeing,” Viral vs. Bacterial Pneumonia: Understanding the Difference, Online article, Pfizer.com news.