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ICD-10 Guide
ICD-10 CodesJ15.69

J15.69

Pneumonia due to other Gram-negative bacteria

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

Code Description

ICD-10 J15.69 is a billable code used to indicate a diagnosis of pneumonia due to other gram-negative bacteria.

Key Diagnostic Point:

Pneumonia due to other Gram-negative bacteria is a type of lung infection characterized by inflammation of the lung parenchyma caused by various Gram-negative organisms, excluding those specifically classified under other codes. Clinically, patients may present with symptoms such as cough, fever, chills, dyspnea, and chest pain. The anatomy involved primarily includes the lungs, specifically the alveoli and bronchi, where the infection leads to consolidation and impaired gas exchange. Disease progression can vary; in some cases, it may lead to severe respiratory distress or sepsis, particularly in immunocompromised individuals. Diagnostic considerations include obtaining a thorough patient history, physical examination, and imaging studies such as chest X-rays or CT scans, alongside microbiological testing to identify the causative organism. Cultures from sputum or blood may be necessary to confirm the diagnosis and guide appropriate antibiotic therapy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires microbiological testing and clinical correlation.
  • Treatment complexity: May involve broad-spectrum antibiotics and management of comorbidities.
  • Documentation requirements: Detailed clinical documentation is essential to support the diagnosis.
  • Coding specificity: Requires precise identification of the causative organism and exclusion of other pneumonia types.

Audit Risk Factors

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

Specialty Focus

Medical Specialties

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

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Pneumonia due to other Gram-negative bacteria poses significant clinical challenges, particularly in vulnerable populations such as the elderly and immunocompromised. The impact on population health is notable, as these infections can lead to increased morbidity, prolonged hospital stays, and higher healthcare costs. Quality measures related to pneumonia management focus on timely diagnosis and appropriate antibiotic stewardship, which are critical in reducing the incidence of resistant infections and improving overall healthcare utilization patterns.

ICD-9 vs ICD-10

Pneumonia due to other Gram-negative bacteria poses significant clinical challenges, particularly in vulnerable populations such as the elderly and immunocompromised. The impact on population health is notable, as these infections can lead to increased morbidity, prolonged hospital stays, and higher healthcare costs. Quality measures related to pneumonia management focus on timely diagnosis and appropriate antibiotic stewardship, which are critical in reducing the incidence of resistant infections and improving overall healthcare utilization patterns.

Reimbursement & Billing Impact

reimbursement and to ensure that the medical necessity for the services provided is clearly articulated in the documentation.

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 J15.69?

J15.69 covers pneumonia caused by various Gram-negative bacteria not classified elsewhere, such as Acinetobacter, Pseudomonas, and others. It is important to identify the specific organism for accurate coding.

When should J15.69 be used instead of related codes?

J15.69 should be used when pneumonia is confirmed to be due to Gram-negative bacteria other than those specified in other codes, ensuring that the causative organism is documented.

What documentation supports J15.69?

Documentation should include clinical findings, laboratory results confirming the presence of Gram-negative bacteria, treatment plans, and any imaging studies that support the diagnosis of pneumonia.