J15.9 ICD-10-CM Code: Unspecified bacterial pneumonia
J15.9 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · HCC Buddy coding tools
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FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Influenza and pneumonia (J09-J18)
J15.9
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceUnspecified bacterial pneumonia
A bacterial lung infection where the specific causative bacterium has not been identified or is unknown.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Pneumonia due to gram-positive bacteria
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for J15.9 in this effective period.
Related Child Codes
Includes
Official- bronchopneumonia due to bacteria other than S. pneumoniae and H. influenzae
Excludes 1
Official- chlamydial pneumonia (J16.0)
- congenital pneumonia (P23.-)
- Legionnaires' disease (A48.1)
- spirochetal pneumonia (A69.8)
Code First
Official- , if applicable, associated influenza (J09.X1, J10.0-, J11.0-)
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for J15.9 in this effective period.
Code Also
Official- , if applicable, any associated condition such as:
- abscess (J85.1)
- aspiration pneumonia (J69.-)
Buddy Documentation Tip
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 J15.9 an HCC code?
No. J15.9 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- J15.9
- Description
- Unspecified bacterial pneumonia
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
J15.9 is the ICD-10-CM diagnosis code for unspecified bacterial pneumonia. A bacterial lung infection where the specific causative bacterium has not been identified or is unknown. J15.9 sits in the ICD-10-CM chapter for diseases of the respiratory system (j00-j99), within the section covering influenza and pneumonia (j09-j18).
J15.9 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Use only when culture results are negative, pending, or not performed; avoid if organism is documented.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for J15.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use only when culture results are negative, pending, or not performed; avoid if organism is documented
- •Query the provider if bacterial pneumonia is documented but organism is not specified, as more specific coding may be possible