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ICD-10 Guide
ICD-10 CodesJ15.20

J15.20

Pneumonia due to staphylococcus, unspecified

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

Code Description

ICD-10 J15.20 is a billable code used to indicate a diagnosis of pneumonia due to staphylococcus, unspecified.

Key Diagnostic Point:

Pneumonia due to staphylococcus, unspecified, is a type of lung infection caused by Staphylococcus bacteria, which can lead to inflammation of the lung tissue. Clinically, patients may present with symptoms such as cough, fever, chills, chest pain, and difficulty breathing. The anatomy involved primarily includes the lungs, specifically the alveoli where gas exchange occurs. Disease progression can vary; it may start as a mild infection but can rapidly escalate to severe pneumonia, especially in immunocompromised individuals or those with underlying lung conditions. Diagnostic considerations include obtaining a thorough patient history, physical examination, and imaging studies such as chest X-rays or CT scans. Microbiological testing, including sputum cultures, is essential for confirming the presence of Staphylococcus species. Early diagnosis and treatment are crucial to prevent complications such as respiratory failure or sepsis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires microbiological confirmation and differentiation from other pneumonia types.
  • Treatment complexity: May involve antibiotics and supportive care, with potential for hospitalization.
  • Documentation requirements: Detailed clinical notes and lab results are necessary for accurate coding.
  • Coding specificity: Requires precise identification of the causative organism and clinical context.

Audit Risk Factors

  • Common coding errors: Misidentifying the causative organism or failing to document the specific type of pneumonia.
  • Documentation gaps: Incomplete clinical notes or lack of microbiological evidence can lead to denials.
  • Billing challenges: Incorrect coding can result in reimbursement issues, especially if the severity of the condition is not adequately documented.

Specialty Focus

Medical Specialties

Primary medical specialty: 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

Secondary specialty: 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

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 Staphylococcus has significant clinical implications, particularly in vulnerable populations such as the elderly or immunocompromised. It contributes to increased healthcare utilization, including hospital admissions and prolonged stays. Understanding the epidemiology of this condition can help in developing targeted public health interventions and quality measures aimed at reducing the incidence and improving outcomes for affected patients.

ICD-9 vs ICD-10

Pneumonia due to Staphylococcus has significant clinical implications, particularly in vulnerable populations such as the elderly or immunocompromised. It contributes to increased healthcare utilization, including hospital admissions and prolonged stays. Understanding the epidemiology of this condition can help in developing targeted public health interventions and quality measures aimed at reducing the incidence and improving outcomes for affected patients.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the illness and the necessity for hospitalization, which can affect payment rates. Common denials may arise from insufficient documentation or incorrect coding, so it is crucial to follow coding best practices and ensure that the documentation aligns with the diagnosis.

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 J15.20?

J15.20 covers pneumonia specifically caused by Staphylococcus bacteria, without further specification of the strain. It includes cases where the exact strain is not identified, but clinical evidence suggests a staphylococcal infection.

When should J15.20 be used instead of related codes?

J15.20 should be used when pneumonia is confirmed to be due to Staphylococcus but without specification of the strain, such as MRSA. If the strain is known, a more specific code should be selected.

What documentation supports J15.20?

Documentation should include clinical findings, laboratory results confirming Staphylococcus infection, imaging studies, and treatment plans. A thorough history and physical examination notes are essential.