Pulmonology Coding Alert

Question: A patient presented to our pulmonology practice with complaints of high fever, a cough with yellow sputum, headache, chills, and shortness of breath. The pulmonologist listened to the patient’s lungs and collected a sputum culture. The physician initially diagnosed the patient with pneumonia, and the sputum culture results indicated methicillin resistant staphylococcus aureus (MRSA) as the causative agent, which the provider documented in the chart.

How do I report the diagnosis?

North Dakota Subscriber

Answer: You’ll assign J15.212 (Pneumonia due to Methicillin resistant Staphylococcus aureus) to report the diagnosis. Some coders might be tempted to report separate pneumonia and MRSA codes, but that is incorrect because the ICD-10-CM code set contains a combination code that covers the condition and its cause.

In the Alphabetic Index, look for Pneumonia > MRSA (Methicillin resistant Staphylococcus aureus), which provides you with J15.212. You’ll then verify the code in the Tabular List.

Parent code notes: Parent code J15.- (Bacterial pneumonia, not elsewhere classified) features Code first and Code also notes for you to review. The Code first note instructs you to assign the associated influenza, such as J09.X1 (Influenza due to identified novel influenza A virus with pneumonia), J10.0- (Influenza due to other identified influenza virus with pneumonia), or J11.0- (Influenza due to unidentified influenza virus with pneumonia), if the provider documents the condition. A Code also note instructs you to assign an applicable code if the provider also documents that the patient is experiencing an abscess.