J15.5 ICD-10-CM Code: Pneumonia due to Escherichia coli

Code

J15.5

Description

Pneumonia due to Escherichia coli

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 J15.5 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for J15.5

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for J15.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Verify the documentation specifically identifies E. coli as the causative organism; culture results or lab findings should support this diagnosis
• •Consider if this is healthcare-associated pneumonia (HAP) or ventilator-associated pneumonia (VAP), as these may require additional coding with the appropriate 7th character extension for specificity

Clinical Significance

Pneumonia caused by Escherichia coli is a gram-negative bacterial pneumonia that frequently occurs in healthcare-associated settings and carries higher mortality rates than typical community-acquired pneumonia. It is more common in elderly, debilitated, or immunocompromised patients and often indicates underlying comorbidity, making it highly relevant for risk adjustment.

Documentation Requirements

• ✓Culture or molecular identification confirming E. coli as the causative organism
• ✓Clinical signs and symptoms of pneumonia documented in the assessment
• ✓Chest imaging showing infiltrate, consolidation, or other pneumonia pattern
• ✓Antibiotic therapy plan, including consideration for gram-negative coverage and resistance patterns
• ✓Setting of acquisition (nosocomial vs. community-acquired) documented
• ✓Underlying conditions predisposing to gram-negative pneumonia (if applicable)

Commonly Confused Codes

• •J15.69: Pneumonia due to other Gram-negative bacteria: use when gram-negative organism is identified but is not E. coli
• •J15.61: Pneumonia due to Acinetobacter baumannii: use specifically for Acinetobacter infections
• •J15.8: Pneumonia due to other specified bacteria: use for non-gram-negative specified organisms not elsewhere classified
• •J15.9: Unspecified bacterial pneumonia: never use when the organism is known

Child Codes