J15.212
J15.212: Pneumonia due to Methicillin resistant Staphylococcus aureus
Billable / specific codeICD-10-CM
J15.212 is a billable, specific ICD-10-CM code for pneumonia due to methicillin resistant staphylococcus aureus. It is valid for submission on a claim.
Check J15.212 with the rest of the claim: free scrubberOther codes that can never be billed with J15.212
Their own Excludes1 notes name this code, so the conflict is not listed above.
- Z16Resistance to antimicrobial drugs
Risk adjustment
J15.212 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
J15.212 is named in 10 Medicare coverage policies: 10 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
Alphabetic index entries that lead here
- Pneumonia›MRSA(Methicillin resistant Staphylococcus aureus)
- Pneumonia›staphylococcal›aureus›methicillin resistant(MRSA)
- Pneumonia›in›Staphylococcus›aureus›methicillin resistant(MRSA)
The condition this code belongs to
Code history
Unchanged in every release from FY2024 to FY2027.