J15.212 — Pneumonia due to Methicillin resistant Staphylococcus aureus
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.
Other codes that can never be billed with J15.212
These codes carry an Excludes1 note pointing at J15.212. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading J15.212 alone.
- 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.
Medicare coverage
J15.212 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 J15.212 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 J15.212.
- Pneumonia›MRSA(Methicillin resistant Staphylococcus aureus)
- Pneumonia›staphylococcal›aureus›methicillin resistant(MRSA)
- Pneumonia›in›Staphylococcus›aureus›methicillin resistant(MRSA)
Related codes at this level
Codes that share J15.21. If J15.212 is not quite right, the correct code is usually one of these.
Questions about J15.212
- Is J15.212 a billable ICD-10-CM code?
- Yes. J15.212 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does J15.212 sit in the tabular list?
- Diseases of the respiratory system (J00-J99), in the block Influenza and pneumonia (J09-J18).