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ICD-10 Guide
ICD-10 CodesJ15.21

J15.21

Pneumonia due to staphylococcus aureus

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

Code Description

ICD-10 J15.21 is a used to indicate a diagnosis of pneumonia due to staphylococcus aureus.

Key Diagnostic Point:

Pneumonia due to Staphylococcus aureus is a type of lung infection characterized by inflammation of the lung parenchyma caused by the Staphylococcus aureus bacterium. Clinically, patients may present with symptoms such as fever, cough, chest pain, and difficulty breathing. The infection can be particularly severe in individuals with weakened immune systems, chronic lung diseases, or those who have recently undergone surgery. The anatomy involved primarily includes the alveoli and bronchi, where the infection leads to consolidation and impaired gas exchange. Disease progression can vary; it may start with mild symptoms but can rapidly escalate to severe respiratory distress, necessitating hospitalization. Diagnostic considerations include chest X-rays or CT scans to identify infiltrates, along with sputum cultures to confirm the presence of Staphylococcus aureus. Blood cultures may also be performed to detect bacteremia, which can occur in severe cases.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires specific laboratory tests and imaging studies for accurate diagnosis.
  • Treatment complexity: May involve antibiotics, hospitalization, and supportive care depending on severity.
  • Documentation requirements: Detailed clinical notes and lab results are essential for accurate coding.
  • Coding specificity: Requires precise coding to differentiate from other types of pneumonia.

Audit Risk Factors

  • Common coding errors: Misclassification with other pneumonia types, such as viral or atypical pneumonia.
  • Documentation gaps: Incomplete clinical notes regarding the causative organism or treatment plan.
  • Billing challenges: Potential denials if documentation does not support the severity or specific diagnosis.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Pneumonia due to Staphylococcus aureus has significant clinical implications, particularly in vulnerable populations such as the elderly and immunocompromised individuals. Its impact on population health is notable, as it can lead to increased hospitalizations and healthcare costs. Quality measures often focus on timely diagnosis and appropriate antibiotic therapy, which are critical for improving patient outcomes. Understanding the epidemiology of this condition helps in developing preventive strategies and managing healthcare resources effectively.

ICD-9 vs ICD-10

Pneumonia due to Staphylococcus aureus has significant clinical implications, particularly in vulnerable populations such as the elderly and immunocompromised individuals. Its impact on population health is notable, as it can lead to increased hospitalizations and healthcare costs. Quality measures often focus on timely diagnosis and appropriate antibiotic therapy, which are critical for improving patient outcomes. Understanding the epidemiology of this condition helps in developing preventive strategies and managing healthcare resources effectively.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the pneumonia and whether hospitalization is required. Common denials may arise from insufficient documentation or incorrect coding. Best practices include thorough clinical notes and ensuring that the diagnosis aligns with the services billed.

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 J15.21?

J15.21 specifically covers pneumonia caused by Staphylococcus aureus, which can manifest as community-acquired or hospital-acquired pneumonia, including cases associated with methicillin-resistant Staphylococcus aureus (MRSA).

When should J15.21 be used instead of related codes?

J15.21 should be used when the pneumonia is confirmed to be due to Staphylococcus aureus, as indicated by culture results. It should not be used for pneumonia caused by other organisms or when the causative agent is unknown.

What documentation supports J15.21?

Documentation should include clinical findings, laboratory results confirming Staphylococcus aureus, imaging studies showing pneumonia, and treatment plans. Clear notes on the patient's history and any comorbidities are also essential.