What is ICD-10 code A54.84?

A54.84 is the ICD-10-CM diagnosis code for Gonococcal pneumonia. A lung infection caused by the bacterium Neisseria gonorrhoeae, which is sexually transmitted. This condition occurs when the infection spreads from the genital area to the lungs, causing pneumonia. A54.84 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. A54.84 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. A54.84 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. A54.84 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for A54.84?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. A54.84 was a payment HCC under V24 (Pneumococcal Pneumonia, Empyema, Lung Abscess) but the V28 recalibration removed it from the risk adjustment model. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting A54.84?

Verify documentation confirms gonococcal infection of the lungs/respiratory system; do not assume pneumonia is gonococcal without explicit physician documentation This code is part of the gonococcal infection category (A54); ensure you are not confusing it with other bacterial pneumonias and that the causative organism is clearly identified as gonorrhea Because A54.84 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

A54.84: Gonococcal pneumonia — ICD-10 | Pneumococcal Pneumonia, Empyema, Lung Abscess

ICD-10-CM Code View

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Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupA54.84Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Infections with a predominantly sexual mode of transmission (A50-A64)

A54.84

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Gonococcal pneumonia

A lung infection caused by the bacterium Neisseria gonorrhoeae, which is sexually transmitted. This condition occurs when the infection spreads from the genital area to the lungs, causing pneumonia.

Buddy Insight

Gonococcal pneumonia is an extremely rare manifestation of disseminated gonococcal infection affecting the lungs, typically seen in severely immunocompromised patients.

CMS-HCC V28

Not risk-adjusted for this model/period.

RAF 0

CMS-HCC V24

Mapped

HCC 115

Pneumococcal Pneumonia, Empye...

RAF 0.339

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 115

Pneumococcal Pneumonia, Empye...

RAF 0.0

RXHCC

Not risk-adjusted for this model/period.

RAF 0

Code Trumping

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Code Book Path

Official

A54Gonococcal infection

A54.8Other gonococcal infections

A54.84Gonococcal pneumonia

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for A54.84 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for A54.84 in this effective period.

Related Child Codes

Official

A54.81Gonococcal meningitis

A54.82Gonococcal brain abscess

A54.83Gonococcal heart infection

A54.85Gonococcal peritonitis

A54.86Gonococcal sepsis

Includes

Official

ICD-10-CM does not list Includes notes for A54.84 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for A54.84 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for A54.84 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for A54.84 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for A54.84 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Confirmed Neisseria gonorrhoeae identification from respiratory specimen (sputum culture, bronchoalveolar lavage, or blood)

Chest imaging showing pneumonia pattern (infiltrates, consolidation)

Clinical symptoms: cough, dyspnea, fever, pleuritic chest pain

Exclusion of other more common pneumonia organisms

MEAT Support

HCC Buddy guidance

Confirmed Neisseria gonorrhoeae identification from respiratory specimen (sputum culture, bronchoalveolar lavage, or blood)

Chest imaging showing pneumonia pattern (infiltrates, consolidation)

Clinical symptoms: cough, dyspnea, fever, pleuritic chest pain

Exclusion of other more common pneumonia organisms

Audit Caution

HCC Buddy guidance

Coding generic bacterial pneumonia when gonococcal etiology is documented — this loses HCC capture

Assuming respiratory symptoms in a patient with gonorrhea are due to gonococcal pneumonia without culture confirmation

Not recognizing this as a disseminated gonococcal infection manifestation and missing other involved sites

Failing to code the underlying immunodeficiency that predisposed the patient to this rare presentation

Common Mistakes

HCC Buddy guidance

J15.8 (Pneumonia due to other specified bacteria) — General bacterial pneumonia; use A54.84 only when gonorrhea is the confirmed causative agent

J18.9 (Pneumonia, unspecified organism) — Do not use unspecified pneumonia codes when the gonococcal organism is identified

B25.0 (Cytomegaloviral pneumonitis) — Another opportunistic lung infection but caused by CMV, not gonorrhea

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is A54.84 an HCC code?

Yes. A54.84 maps to Pneumococcal Pneumonia, Empyema, Lung Abscess under the V24 model but is not retained in V28.

HCC Category Mapping

V24HCC 115, Pneumococcal Pneumonia, Empyema, Lung Abscess

0.339

ESRDHCC 115, Pneumococcal Pneumonia, Empyema, Lung Abscess

0.000

RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

Work A54.84 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for A54.84

For A54.84to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed A54.84 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

A54.84 is the ICD-10-CM diagnosis code for gonococcal pneumonia. A lung infection caused by the bacterium Neisseria gonorrhoeae, which is sexually transmitted. This condition occurs when the infection spreads from the genital area to the lungs, causing pneumonia. A54.84 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering infections with a predominantly sexual mode of transmission (a50-a64).

Under the older CMS-HCC V24 model, A54.84 maps to Pneumococcal Pneumonia, Empyema, Lung Abscess (HCC 115) with a community, non-dual, aged base RAF weight of 0.339. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

Verify documentation confirms gonococcal infection of the lungs/respiratory system; do not assume pneumonia is gonococcal without explicit physician documentation. Because A54.84 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for A54.84 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify documentation confirms gonococcal infection of the lungs/respiratory system; do not assume pneumonia is gonococcal without explicit physician documentation
•This code is part of the gonococcal infection category (A54); ensure you are not confusing it with other bacterial pneumonias and that the causative organism is clearly identified as gonorrhea

Clinical Significance

Gonococcal pneumonia is an extremely rare manifestation of disseminated gonococcal infection affecting the lungs, typically seen in severely immunocompromised patients. Its rarity makes accurate documentation and coding essential, as misidentification of the causative organism is a common error.

Documentation Requirements

✓Confirmed Neisseria gonorrhoeae identification from respiratory specimen (sputum culture, bronchoalveolar lavage, or blood)
✓Chest imaging showing pneumonia pattern (infiltrates, consolidation)
✓Clinical symptoms: cough, dyspnea, fever, pleuritic chest pain
✓Exclusion of other more common pneumonia organisms
✓Immunocompromised status documentation if applicable

Commonly Confused Codes

•J15.8 (Pneumonia due to other specified bacteria): General bacterial pneumonia; use A54.84 only when gonorrhea is the confirmed causative agent
•J18.9 (Pneumonia, unspecified organism): Do not use unspecified pneumonia codes when the gonococcal organism is identified
•B25.0 (Cytomegaloviral pneumonitis): Another opportunistic lung infection but caused by CMV, not gonorrhea