J15.3
BillablePneumonia due to streptococcus, group B
HCC Category Mapping
V24HCC 115 — Pneumococcal Pneumonia, Empyema, Lung Abscess
0.339ESRDHCC 115 — Pneumococcal Pneumonia, Empyema, Lung Abscess
0.000What This Code Means
A lung infection caused by Group B Streptococcus bacteria, which can be particularly serious in newborns and pregnant women.
Coding Tips
- •Verify documentation specifies Group B Streptococcus (GBS) to distinguish from other streptococcal pneumonias
- •Consider if patient is a newborn, as GBS pneumonia in neonates may require additional coding for the underlying condition
Clinical Significance
Group B Streptococcal pneumonia is a serious bacterial lung infection that carries significant morbidity and mortality, particularly in neonates, pregnant women, and immunocompromised adults. For risk adjustment, this specified bacterial pneumonia maps to a higher-value HCC than unspecified pneumonia, rewarding precise organism identification in documentation.
Documentation Requirements
- ✓Identification of causative organism as Group B Streptococcus (Streptococcus agalactiae) confirmed by culture, PCR, or clinical suspicion
- ✓Clinical findings consistent with pneumonia: fever, cough, dyspnea, abnormal breath sounds
- ✓Chest imaging (X-ray or CT) showing infiltrate or consolidation
- ✓Treatment plan including appropriate antibiotic therapy
- ✓Severity indicators: oxygen requirements, respiratory status, hospitalization if applicable
Commonly Confused Codes
J15.4 — Pneumonia due to other streptococci: use when streptococcal species is identified but is not Group B (e.g., Group A, Group C)J13 — Pneumonia due to Streptococcus pneumoniae: use for pneumococcal pneumonia specifically, not Group B strepJ15.9 — Unspecified bacterial pneumonia: use only when organism is not identified; always code to specificity when culture results availableJ18.9 — Pneumonia, unspecified: nonspecific code that should not be used when organism is knownP23.3 — Congenital pneumonia due to streptococcus, group B: use for neonatal GBS pneumonia acquired during birth