Is J15.4 a billable ICD-10-CM code?

Yes. J15.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does J15.4 sit in the tabular list?

Diseases of the respiratory system (J00-J99), in the block Influenza and pneumonia (J09-J18).

What cannot be coded together with J15.4?

J15.4 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

J15.4

J15.4 — Pneumonia due to other streptococci

Billable / specific codeICD-10-CM

J15.4 is a billable, specific ICD-10-CM code for pneumonia due to other streptococci. It is valid for submission on a claim.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

pneumonia due to streptococcus, group B (J15.3)
pneumonia due to Streptococcus pneumoniae (J13)

Other codes that can never be billed with J15.4

These codes carry an Excludes1 note pointing at J15.4. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading J15.4 alone.

J13Pneumonia due to Streptococcus pneumoniae

Risk adjustment

J15.4 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

J15.4 is named in 14 Medicare coverage policies — 14 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A52466Nebulizers - Policy Article
A52466Nebulizers - Policy Article
A52466Nebulizers - Policy Article
A52466Nebulizers - Policy Article

How J15.4 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to J15.4.

Pneumonia›streptococcal NEC(broncho) (lobar)
Pneumonia›broncho-, bronchial›streptococcal NEC
Pneumonia›in›Streptococcus
Pneumonia›lobar›streptococcal NEC
Pneumonia›in›Streptococcus›specified NEC
Pneumonia›streptococcal NEC›group›A
Pneumonia›streptococcal NEC›group›specified NEC

Related codes at this level

Codes that share J15. If J15.4 is not quite right, the correct code is usually one of these.

Questions about J15.4

Is J15.4 a billable ICD-10-CM code?: Yes. J15.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does J15.4 sit in the tabular list?: Diseases of the respiratory system (J00-J99), in the block Influenza and pneumonia (J09-J18).
What cannot be coded together with J15.4?: J15.4 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.