J15.212
BillablePneumonia due to Methicillin resistant Staphylococcus aureus
HCC Category Mapping
V28HCC 282 — Aspiration and Specified Bacterial Pneumonias
0.711V24HCC 114 — Aspiration and Specified Bacterial Pneumonias
0.339ESRDHCC 114 — Aspiration and Specified Bacterial Pneumonias
0.000What This Code Means
Pneumonia caused by Methicillin-resistant Staphylococcus aureus (MRSA), a strain of staph bacteria resistant to common antibiotics.
Coding Tips
- •Verify susceptibility testing confirms methicillin resistance before coding
- •MRSA pneumonia often requires specialized antibiotic therapy and may indicate healthcare-associated infection
Clinical Significance
Pneumonia due to Methicillin-resistant Staphylococcus aureus (MRSA) is a significant bacterial respiratory infection that increases morbidity, particularly in elderly and immunocompromised patients. MRSA pneumonia carries significant treatment challenges due to antibiotic resistance, requiring vancomycin or linezolid therapy, and is associated with higher mortality and longer hospital stays than MSSA pneumonia. Accurate organism identification impacts treatment decisions, infection control measures, and risk stratification.
Documentation Requirements
- ✓Documentation of pneumonia diagnosis with causative organism identified as Methicillin-resistant Staphylococcus aureus (MRSA)
- ✓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)
- ✓Susceptibility testing results documenting methicillin resistance or susceptibility
Commonly Confused Codes
J15.211 — MSSA pneumonia; susceptibility is the critical distinction — verify resistance testingJ15.20 — Staphylococcal pneumonia, unspecified; use only when resistance status is unknownJ15.29 — Pneumonia due to other staphylococcus; use for non-aureus speciesJ18.9 — Pneumonia, unspecified organism; do not use when the causative organism has been identified
Code Hierarchy
└J15Bacterial pneumonia, not elsewhere classified└J15.2Pneumonia due to staphylococcus└J15.21Pneumonia due to staphylococcus aureus└J15.212Pneumonia due to Methicillin resistant Staphylococcus aureus
└J15.212Pneumonia due to Methicillin resistant Staphylococcus aureus