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ICD-10 Guide
ICD-10 CodesJ15.61

J15.61

Pneumonia due to Acinetobacter baumannii

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

Code Description

ICD-10 J15.61 is a billable code used to indicate a diagnosis of pneumonia due to acinetobacter baumannii.

Key Diagnostic Point:

Pneumonia due to Acinetobacter baumannii is a severe lung infection caused by the Acinetobacter baumannii bacteria, which is known for its resistance to multiple antibiotics. Clinically, patients may present with symptoms such as cough, fever, chills, and difficulty breathing. The infection primarily affects the lower respiratory tract, leading to inflammation and consolidation of lung tissue. The disease progression can be rapid, especially in immunocompromised individuals or those with underlying lung conditions. 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. Given the virulence of Acinetobacter baumannii, timely diagnosis and appropriate antibiotic therapy are crucial to improving patient outcomes and preventing complications such as respiratory failure or sepsis.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misidentifying the causative organism or using a general pneumonia code.
  • Documentation gaps may arise if the specific pathogen is not clearly noted in the medical record.
  • Billing challenges can occur due to the need for detailed documentation to support the diagnosis and treatment plan.

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 Acinetobacter baumannii poses significant clinical challenges due to its antibiotic resistance and association with high morbidity and mortality rates. It impacts population health by increasing healthcare utilization, particularly in hospital settings, where outbreaks can occur. Quality measures focus on timely diagnosis and appropriate antibiotic stewardship to mitigate the spread of resistant strains, highlighting the importance of effective infection control practices.

ICD-9 vs ICD-10

Pneumonia due to Acinetobacter baumannii poses significant clinical challenges due to its antibiotic resistance and association with high morbidity and mortality rates. It impacts population health by increasing healthcare utilization, particularly in hospital settings, where outbreaks can occur. Quality measures focus on timely diagnosis and appropriate antibiotic stewardship to mitigate the spread of resistant strains, highlighting the importance of effective infection control practices.

Reimbursement & Billing Impact

Reimbursement considerations involve ensuring that the diagnosis is clearly linked to the services provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Best practices include thorough documentation of the clinical rationale for testing and treatment, as well as regular audits to ensure compliance with coding guidelines.

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 J15.61?

J15.61 specifically covers pneumonia caused by Acinetobacter baumannii, which is often associated with healthcare-associated infections and can occur in patients with underlying health issues or those on mechanical ventilation.

When should J15.61 be used instead of related codes?

J15.61 should be used when there is confirmed pneumonia due to Acinetobacter baumannii, as indicated by culture results. It should not be used for pneumonia caused by other organisms or when the specific pathogen is unknown.

What documentation supports J15.61?

Documentation should include positive culture results for Acinetobacter baumannii, clinical symptoms consistent with pneumonia, imaging studies showing lung involvement, and treatment plans that reflect the severity of the infection.