J15.0 ICD-10-CM Code: Pneumonia due to Klebsiella pneumoniae
HCC Buddy Code Card
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FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Influenza and pneumonia (J09-J18)
J15.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePneumonia due to Klebsiella pneumoniae
Pneumonia caused by Klebsiella pneumoniae bacteria, often associated with healthcare settings and immunocompromised patients.
Buddy Insight
Pneumonia due to Klebsiella pneumoniae is a significant bacterial respiratory infection that increases morbidity, particularly in elderly and immunocompromised patients.
CMS-HCC V28
MappedHCC 282
RAF 0.440
CMS-HCC V24
MappedHCC 114
RAF 0.517
ACA/HHS
MappedHCC 163
Varies by metal level
ESRD/PACE
MappedHCC 114
RAF 0.090
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for J15.0 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for J15.0 in this effective period.
Related Child Codes
Includes
Official- bronchopneumonia due to bacteria other than S. pneumoniae and H. influenzae
Excludes 1
Official- chlamydial pneumonia (J16.0)
- congenital pneumonia (P23.-)
- Legionnaires' disease (A48.1)
- spirochetal pneumonia (A69.8)
Code First
Official- , if applicable, associated influenza (J09.X1, J10.0-, J11.0-)
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for J15.0 in this effective period.
Code Also
Official- , if applicable, any associated condition such as:
- abscess (J85.1)
- aspiration pneumonia (J69.-)
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is J15.0 an HCC code?
Yes. J15.0 (Pneumonia due to Klebsiella pneumoniae) maps to Aspiration and Specified Bacterial Pneumonias under the CMS-HCC V28 risk adjustment model (and Aspiration and Specified Bacterial Pneumonias under V24), with a community non-dual aged RAF of 0.440. It is billable for payment year 2026.
Coder answer: J15.0 is billable and maps to V28 HCC 282, Aspiration and Specified Bacterial Pneumonias. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- J15.0
- Description
- Pneumonia due to Klebsiella pneumoniae
- HCC (V28)
- HCC 282 — Aspiration and Specified Bacterial Pneumonias
- RAF
- 0.440
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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 J15.0 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for J15.0
For J15.0 to 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 J15.0 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
J15.0 is the ICD-10-CM diagnosis code for pneumonia due to klebsiella pneumoniae. Pneumonia caused by Klebsiella pneumoniae bacteria, often associated with healthcare settings and immunocompromised patients. J15.0 sits in the ICD-10-CM chapter for diseases of the respiratory system (j00-j99), within the section covering influenza and pneumonia (j09-j18).
Under the CMS-HCC V28 risk adjustment model, J15.0 maps to Aspiration and Specified Bacterial Pneumonias (HCC 282) with a community, non-dual, aged base RAF weight of 0.440. Under the older V24 model, J15.0 mapped to the same category but with a base RAF weight of 0.517, V28 recalibrated weights across the entire model. 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.
This is a complete code requiring no additional characters. Because J15.0 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 J15.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a complete code requiring no additional characters
- •Document whether this is community-acquired or healthcare-associated pneumonia for clinical context
Clinical Significance
Pneumonia due to Klebsiella pneumoniae is a significant bacterial respiratory infection that increases morbidity, particularly in elderly and immunocompromised patients. Klebsiella pneumonia is often healthcare-associated and may present with cavitary lung lesions; it carries higher mortality rates than typical community-acquired pneumonia and frequently demonstrates antibiotic resistance. Accurate organism identification impacts treatment decisions, infection control measures, and risk stratification.
Documentation Requirements
- ✓Documentation of pneumonia diagnosis with causative organism identified as Klebsiella pneumoniae
- ✓Chest imaging (X-ray or CT) findings consistent with pneumonia
- ✓Clinical signs and symptoms documented (fever, cough, dyspnea, sputum production)
- ✓Culture, sputum, or molecular testing results confirming the specific organism
- ✓Antibiotic therapy prescribed and documented
- ✓Severity assessment (need for oxygen, hospitalization, intensive care)
- ✓Antibiotic susceptibility panel results, especially for resistant gram-negative patterns
Commonly Confused Codes
- •J15.1: Pneumonia due to Pseudomonas; different gram-negative organism
- •J15.5: Pneumonia due to Escherichia coli; different gram-negative organism requiring separate coding
- •J13: Pneumonia due to Streptococcus pneumoniae; gram-positive, not gram-negative
- •J18.9: Pneumonia, unspecified; do not use when the organism is identified