J15.1 ICD-10-CM Code: Pneumonia due to Pseudomonas
J15.1 maps to CMS-HCC V28 282. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Influenza and pneumonia (J09-J18)
J15.1
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePneumonia due to Pseudomonas
Pneumonia caused by Pseudomonas bacteria, typically a gram-negative organism found in healthcare and environmental settings.
Buddy Insight
Pneumonia due to Pseudomonas is a significant bacterial respiratory infection that increases morbidity, particularly in elderly and immunocompromised patients.
CMS-HCC V28
MappedHCC 282
Coefficient HCC 282: 0.440 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 163
Code-level coefficient reference
ESRD/PACE
MappedHCC 114
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for J15.1. Check the code and parent instructions in the Code Book.
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from J00-J99, J09-J18
- certain infectious and parasitic diseases (A00-B99)Inherited from J00-J99, J09-J18
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from J00-J99, J09-J18
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from J00-J99, J09-J18
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from J00-J99, J09-J18
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from J00-J99, J09-J18
- neoplasms (C00-D49)Inherited from J00-J99, J09-J18
- smoke inhalation (T59.81-)Inherited from J00-J99, J09-J18
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from J00-J99, J09-J18
- allergic or eosinophilic pneumonia (J82)Inherited from J00-J99, J09-J18
- aspiration pneumonia NOS (J69.0)Inherited from J00-J99, J09-J18
- meconium pneumonia (P24.01)Inherited from J00-J99, J09-J18
- neonatal aspiration pneumonia (P24.-)Inherited from J00-J99, J09-J18
- pneumonia due to solids and liquids (J69.-)Inherited from J00-J99, J09-J18
- congenital pneumonia (P23.9)Inherited from J00-J99, J09-J18
- lipid pneumonia (J69.1)Inherited from J00-J99, J09-J18
- rheumatic pneumonia (I00)Inherited from J00-J99, J09-J18
- ventilator associated pneumonia (J95.851)Inherited from J00-J99, J09-J18
Related Codes
Includes
Official- bronchopneumonia due to bacteria other than S. pneumoniae and H. influenzaeInherited from J15
Excludes 1
Official- chlamydial pneumonia (J16.0)Inherited from J15
- congenital pneumonia (P23.-)Inherited from J15
- Legionnaires' disease (A48.1)Inherited from J15
- spirochetal pneumonia (A69.8)Inherited from J15
Code First
Official- , if applicable, associated influenza (J09.X1, J10.0-, J11.0-)Inherited from J15
Use Additional
Official- code, where applicable, to identify:Inherited from J00-J99, J09-J18
- exposure to environmental tobacco smoke (Z77.22)Inherited from J00-J99, J09-J18
- exposure to tobacco smoke in the perinatal period (P96.81)Inherited from J00-J99, J09-J18
- history of tobacco dependence (Z87.891)Inherited from J00-J99, J09-J18
- occupational exposure to environmental tobacco smoke (Z57.31)Inherited from J00-J99, J09-J18
- tobacco dependence (F17.-)Inherited from J00-J99, J09-J18
- tobacco use (Z72.0)Inherited from J00-J99, J09-J18
- code, if applicable, to identify resistance to antimicrobial drugs (Z16.-)Inherited from J00-J99, J09-J18
Code Also
Official- , if applicable, any associated condition such as:Inherited from J15
- abscess (J85.1)Inherited from J15
- aspiration pneumonia (J69.-)Inherited from J15
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 J15.1 an HCC code?
Yes. J15.1 (Pneumonia due to Pseudomonas) maps to HCC 282, Aspiration and Specified Bacterial Pneumonias under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.440. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: J15.1 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
- J15.1
- Description
- Pneumonia due to Pseudomonas
- HCC (V28)
- HCC 282 — Aspiration and Specified Bacterial Pneumonias
- RAF reference coefficient
- 0.440
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work J15.1 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for J15.1
For J15.1, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
J15.1 is the ICD-10-CM diagnosis code for pneumonia due to pseudomonas. Pneumonia caused by Pseudomonas bacteria, typically a gram-negative organism found in healthcare and environmental settings. J15.1 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, J15.1 maps to Aspiration and Specified Bacterial Pneumonias (HCC 282) with a source-labeled community, non-dual, aged reference coefficient of 0.440. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
This code is complete and does not require further specification. For J15.1, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for J15.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code is complete and does not require further specification
- •Note any antibiotic resistance patterns documented in culture results
Clinical Significance
Pneumonia due to Pseudomonas is a significant bacterial respiratory infection that increases morbidity, particularly in elderly and immunocompromised patients. Pseudomonas pneumonia is frequently healthcare-associated and carries high mortality, particularly in ventilated patients and those with structural lung disease or immunosuppression. Accurate organism identification impacts treatment decisions, infection control measures, and risk stratification.
Documentation Requirements
- ✓Documentation of pneumonia diagnosis with causative organism identified as Pseudomonas
- ✓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
- •J15.0: Pneumonia due to Klebsiella; different gram-negative organism
- •J15.5: Pneumonia due to Escherichia coli; different gram-negative organism
- •J15.6: Pneumonia due to other aerobic gram-negative bacteria; use for other specified gram-negative organisms
- •J18.9: Pneumonia, unspecified; do not use when organism is confirmed as Pseudomonas