J15.20: Pneumonia due to staphylococcus, unspecified

Risk adjustment

J15.20 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 282 Aspiration and Specified Bacterial Pneumonias0.440 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

J15.20 is named in 9 Medicare coverage policies: 9 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A52466Nebulizers - Policy Article
• A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
• A56717Billing and Coding: Respiratory Therapy (Respiratory Care)
• A56730Billing and Coding: Respiratory Therapy and Oximetry Services