J15.61 ICD-10-CM Code: Pneumonia due to Acinetobacter baumannii
J15.61 maps to CMS-HCC V28 282 (RAF 0.440). Documentation must support MEAT. 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)
J15.61
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePneumonia due to Acinetobacter baumannii
A serious lung infection caused by Acinetobacter baumannii, a gram-negative bacterium often resistant to multiple antibiotics.
Buddy Insight
Acinetobacter baumannii pneumonia is a highly resistant gram-negative infection predominantly occurring in healthcare settings, particularly intensive care units.
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 J15.61 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for J15.61 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for J15.61 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for J15.61 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for J15.61 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for J15.61 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for J15.61 in this effective period.
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 J15.61 an HCC code?
Yes. J15.61 (Pneumonia due to Acinetobacter baumannii) 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: J15.61 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
- J15.61
- Description
- Pneumonia due to Acinetobacter baumannii
- 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 J15.61 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for J15.61
For J15.61 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 J15.61 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
J15.61 is the ICD-10-CM diagnosis code for pneumonia due to acinetobacter baumannii. A serious lung infection caused by Acinetobacter baumannii, a gram-negative bacterium often resistant to multiple antibiotics. J15.61 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, J15.61 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, J15.61 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.
Document whether this is a healthcare-associated infection, as Acinetobacter baumannii is commonly nosocomial. Because J15.61 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 J15.61 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document whether this is a healthcare-associated infection, as Acinetobacter baumannii is commonly nosocomial
- •Verify antibiotic susceptibility results are documented, as resistance patterns affect treatment decisions
Clinical Significance
Acinetobacter baumannii pneumonia is a highly resistant gram-negative infection predominantly occurring in healthcare settings, particularly intensive care units. It is a major concern due to multi-drug resistance patterns and high mortality rates, and its presence typically indicates a critically ill patient with significant resource utilization.
Documentation Requirements
- ✓Culture identification confirming Acinetobacter baumannii as the causative pathogen
- ✓Clinical and radiographic evidence of pneumonia
- ✓Antibiotic sensitivity results and documentation of targeted antimicrobial therapy
- ✓Documentation of healthcare-associated acquisition if applicable (ventilator-associated pneumonia)
- ✓Severity indicators including ventilator status, ICU admission, sepsis screening
- ✓Any multi-drug resistance patterns documented
Commonly Confused Codes
- •J15.69: Pneumonia due to other Gram-negative bacteria: use for gram-negative organisms that are not specifically classified (Klebsiella, Serratia, etc.)
- •J15.5: Pneumonia due to Escherichia coli: use specifically for E. coli pneumonia
- •J15.1: Pneumonia due to Pseudomonas: separate code exists for Pseudomonas aeruginosa pneumonia
- •J95.851: Ventilator associated pneumonia: this is a complication code, code also the organism