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ICD-10 Guide
ICD-10 CodesJ15.4

J15.4

Pneumonia due to other streptococci

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

Code Description

ICD-10 J15.4 is a billable code used to indicate a diagnosis of pneumonia due to other streptococci.

Key Diagnostic Point:

Pneumonia due to other streptococci is a type of bacterial pneumonia caused by various species of streptococci, excluding Streptococcus pneumoniae. Clinically, patients may present with symptoms such as cough, fever, chills, chest pain, and difficulty breathing. The infection primarily affects the lungs, leading to inflammation of the alveoli and bronchi, which can result in impaired gas exchange. Disease progression can vary, with some patients experiencing rapid deterioration, particularly those with underlying health conditions or compromised immune systems. Diagnostic considerations include chest X-rays, sputum cultures, and blood tests to identify the specific streptococcal species responsible for the infection. Early identification and treatment are crucial to prevent complications such as pleural effusion or respiratory failure. Treatment typically involves antibiotics tailored to the identified organism, and supportive care may be necessary for severe cases.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires laboratory confirmation and differentiation from other pneumonia types.
  • Treatment complexity: May involve multiple antibiotics and supportive care, especially in severe cases.
  • Documentation requirements: Detailed clinical notes and laboratory results are essential for accurate coding.
  • Coding specificity: Requires precise identification of the causative organism for appropriate coding.

Audit Risk Factors

  • Common coding errors: Misidentification of the causative organism.
  • Documentation gaps: Incomplete clinical notes regarding the patient's history and treatment.
  • Billing challenges: Potential denials if documentation does not support the 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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Pneumonia due to other streptococci can significantly impact population health, particularly among vulnerable groups such as the elderly and immunocompromised individuals. Effective management of this condition is crucial for reducing healthcare utilization and improving quality measures related to respiratory diseases. Epidemiologically, understanding the prevalence and risk factors associated with this type of pneumonia can inform public health strategies and resource allocation.

ICD-9 vs ICD-10

Pneumonia due to other streptococci can significantly impact population health, particularly among vulnerable groups such as the elderly and immunocompromised individuals. Effective management of this condition is crucial for reducing healthcare utilization and improving quality measures related to respiratory diseases. Epidemiologically, understanding the prevalence and risk factors associated with this type of pneumonia can inform public health strategies and resource allocation.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the illness and the complexity of treatment provided. Common denials may arise from insufficient documentation linking the diagnosis to the services rendered. Best practices include ensuring that all clinical notes are thorough and that the coding accurately reflects the diagnosis and treatment provided to avoid potential audits and denials.

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 J15.4?

J15.4 covers pneumonia caused by various non-pneumococcal streptococci, including Streptococcus pyogenes and Streptococcus agalactiae. It is essential to confirm the specific organism through laboratory testing to ensure accurate coding.

When should J15.4 be used instead of related codes?

J15.4 should be used when pneumonia is specifically identified as being caused by other streptococci, as opposed to codes for pneumonia due to other pathogens like viruses or atypical bacteria. Accurate microbiological identification is key.

What documentation supports J15.4?

Documentation should include clinical findings, laboratory results confirming the presence of streptococci, treatment plans, and any relevant patient history that supports the diagnosis of pneumonia due to other streptococci.