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ICD-10 Guide
ICD-10 CodesJ15.212

J15.212

Pneumonia due to Methicillin resistant Staphylococcus aureus

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

Code Description

ICD-10 J15.212 is a billable code used to indicate a diagnosis of pneumonia due to methicillin resistant staphylococcus aureus.

Key Diagnostic Point:

Pneumonia due to Methicillin-resistant Staphylococcus aureus (MRSA) is a serious lung infection caused by a strain of Staphylococcus aureus that is resistant to methicillin and other beta-lactam antibiotics. Clinically, patients may present with symptoms such as fever, cough, dyspnea, and chest pain. The infection primarily affects the lungs, leading to inflammation and consolidation of lung tissue, which can impair gas exchange. Disease progression can vary, with some patients experiencing rapid deterioration, particularly those with underlying health conditions or weakened immune systems. Diagnostic considerations include obtaining sputum cultures, blood cultures, and imaging studies such as chest X-rays or CT scans to confirm the presence of pneumonia and identify the causative organism. Early identification and appropriate antibiotic therapy are crucial for improving patient outcomes and reducing morbidity associated with this condition.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity: Requires microbiological testing and imaging.
  • Treatment complexity: Involves the use of specific antibiotics and may require hospitalization.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate from other types of pneumonia.

Audit Risk Factors

  • Common coding errors: Misclassification of pneumonia type or causative organism.
  • Documentation gaps: Incomplete clinical notes regarding the patient's history or treatment.
  • Billing challenges: Potential denials due to lack of specificity in documentation.

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 MRSA is a significant public health concern, contributing to increased morbidity and healthcare costs. The condition is associated with higher rates of hospitalization and can lead to severe complications, particularly in vulnerable populations. Understanding the epidemiology of MRSA pneumonia is crucial for developing effective prevention strategies and improving patient outcomes. Quality measures related to antibiotic stewardship and infection control are essential in managing this condition.

ICD-9 vs ICD-10

Pneumonia due to MRSA is a significant public health concern, contributing to increased morbidity and healthcare costs. The condition is associated with higher rates of hospitalization and can lead to severe complications, particularly in vulnerable populations. Understanding the epidemiology of MRSA pneumonia is crucial for developing effective prevention strategies and improving patient outcomes. Quality measures related to antibiotic stewardship and infection control are essential in managing this condition.

Reimbursement & Billing Impact

Reimbursement may be affected by the specificity of the diagnosis and the completeness of the documentation. Common denials can occur if the documentation does not clearly establish the presence of MRSA or if the treatment provided does not align with the diagnosis. Best practices include thorough clinical notes and timely submission of claims.

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 J15.212?

J15.212 specifically covers pneumonia caused by Methicillin-resistant Staphylococcus aureus (MRSA). This includes cases where MRSA is confirmed through culture or other diagnostic methods, and the pneumonia is clinically significant.

When should J15.212 be used instead of related codes?

J15.212 should be used when the pneumonia is specifically due to MRSA, as opposed to other bacterial or viral causes. It is important to differentiate this code from J15.211 (Pneumonia due to Staphylococcus aureus) when MRSA is confirmed.

What documentation supports J15.212?

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