J15.69

HCC Category Mapping

What This Code Means

A bacterial lung infection caused by gram-negative bacteria other than Acinetobacter baumannii, such as Pseudomonas or Enterobacteriaceae.

Coding Tips

• •Ensure the specific gram-negative organism is documented; if identified, use a more specific code if available
• •This is a catch-all code, so verify no more specific bacterial pneumonia code applies

Clinical Significance

This code captures pneumonias caused by gram-negative bacteria other than those with their own specific codes (E. coli, Pseudomonas, Klebsiella, Acinetobacter). These infections often involve organisms like Serratia, Proteus, or Enterobacter and are typically healthcare-associated with significant antimicrobial resistance concerns.

Documentation Requirements

• ✓Identification of the specific gram-negative organism by culture or molecular testing
• ✓Documentation that the organism is the causative agent of the pneumonia
• ✓Clinical presentation and radiographic findings consistent with pneumonia
• ✓Antibiotic therapy plan with sensitivity-guided treatment
• ✓Healthcare-associated vs. community-acquired acquisition context

Commonly Confused Codes