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ICD-10 Guide
ICD-10 CodesJ15.211

J15.211

Pneumonia due to Methicillin susceptible Staphylococcus aureus

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

Code Description

ICD-10 J15.211 is a billable code used to indicate a diagnosis of pneumonia due to methicillin susceptible staphylococcus aureus.

Key Diagnostic Point:

Pneumonia due to Methicillin susceptible Staphylococcus aureus (MSSA) is a type of bacterial pneumonia characterized by the infection of lung tissue caused by MSSA. Clinically, patients may present with symptoms such as fever, cough, dyspnea, and chest pain. The infection can lead to inflammation of the alveoli, resulting in impaired gas exchange and respiratory distress. The anatomy involved primarily includes the lungs, specifically the bronchi and alveoli, where the bacteria can proliferate and cause localized inflammation. Disease progression can vary; in some cases, it may lead to severe pneumonia requiring hospitalization, especially in immunocompromised individuals or those with underlying lung conditions. Diagnostic considerations include chest X-rays or CT scans to identify infiltrates, along with sputum cultures to confirm the presence of MSSA. Blood cultures may also be performed to assess for systemic infection.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires specific microbiological testing to confirm MSSA.
  • Treatment complexity: May involve antibiotic therapy tailored to MSSA susceptibility.
  • Documentation requirements: Detailed clinical notes and lab results are essential.
  • Coding specificity: Requires precise coding to differentiate from other pneumonia types.

Audit Risk Factors

  • Common coding errors: Misidentification of the causative organism or using a more general pneumonia code.
  • Documentation gaps: Incomplete clinical notes or lack of lab results to support the diagnosis.
  • Billing challenges: Potential denials if documentation does not clearly support the diagnosis and treatment.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of J15.211 lies in its association with potentially severe respiratory illness, particularly in vulnerable populations. Understanding the epidemiology of MSSA pneumonia can inform public health strategies and improve patient outcomes. Quality measures may include tracking the incidence of MSSA pneumonia and ensuring appropriate antibiotic stewardship. Healthcare utilization patterns may reflect increased hospital admissions for pneumonia cases, emphasizing the need for effective management and prevention strategies.

ICD-9 vs ICD-10

The clinical significance of J15.211 lies in its association with potentially severe respiratory illness, particularly in vulnerable populations. Understanding the epidemiology of MSSA pneumonia can inform public health strategies and improve patient outcomes. Quality measures may include tracking the incidence of MSSA pneumonia and ensuring appropriate antibiotic stewardship. Healthcare utilization patterns may reflect increased hospital admissions for pneumonia cases, emphasizing the need for effective management and prevention strategies.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the coding aligns with the clinical documentation and that the treatment provided is justified. Common denials may arise from insufficient documentation or failure to demonstrate the medical necessity of the services rendered. Best practices include maintaining thorough clinical notes, ensuring lab results are included, and using the correct CPT codes for any procedures performed, such as chest X-rays or consultations.

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 J15.211?

J15.211 specifically covers pneumonia caused by Methicillin susceptible Staphylococcus aureus. It is important to differentiate this from pneumonia caused by other pathogens, such as Methicillin-resistant Staphylococcus aureus (MRSA) or other bacterial and viral causes.

When should J15.211 be used instead of related codes?

J15.211 should be used when pneumonia is confirmed to be due to MSSA, as evidenced by culture results. It is crucial to differentiate it from other pneumonia codes, such as J15.212 for MRSA pneumonia or J18.9 for unspecified pneumonia.

What documentation supports J15.211?

Documentation should include clinical findings, laboratory results confirming MSSA, imaging studies showing pneumonia, and treatment plans. Clear notes on the patient's history and any underlying conditions are also necessary.