Not Valid for Submission
J15.21 is a non-specific and non-billable diagnosis code code, consider using a code with a higher level of specificity for a diagnosis of pneumonia due to staphylococcus aureus. The code is not specific and is NOT valid for the year 2022 for the submission of HIPAA-covered transactions. Category or Header define the heading of a category of codes that may be further subdivided by the use of 4th, 5th, 6th or 7th characters.
Specific Coding for Pneumonia due to staphylococcus aureus
Non-specific codes like J15.21 require more digits to indicate the appropriate level of specificity. Consider using any of the following ICD-10 codes with a higher level of specificity when coding for pneumonia due to staphylococcus aureus:
Information for Patients
What is pneumonia?
Pneumonia is an infection in one or both of the lungs. It causes the air sacs of the lungs to fill up with fluid or pus. It can range from mild to severe, depending on the type of germ causing the infection, your age, and your overall health.
What causes pneumonia?
Bacterial, viral, and fungal infections can cause pneumonia.
Bacteria are the most common cause. Bacterial pneumonia can occur on its own. It can also develop after you've had certain viral infections such as a cold or the flu. Several different types of bacteria can cause pneumonia, including
- Streptococcus pneumoniae
- Legionella pneumophila; this pneumonia is often called Legionnaires' disease
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- Haemophilus influenzae
Viruses that infect the respiratory tract may cause pneumonia. Viral pneumonia is often mild and goes away on its own within a few weeks. But sometimes it is serious enough that you need to get treatment in a hospital. If you have viral pneumonia, you are at risk of also getting bacterial pneumonia. The different viruses that can cause pneumonia include
- Respiratory syncytial virus (RSV)
- Some common cold and flu viruses
- SARS-CoV-2, the virus that causes COVID-19
Fungal pneumonia is more common in people who have chronic health problems or weakened immune systems. Some of the types include
- Pneumocystis pneumonia (PCP)
- Coccidioidomycosis, which causes valley fever
Who is at risk for pneumonia?
Anyone can get pneumonia, but certain factors can increase your risk:
- Age; the risk is higher for children who are age 2 and under and adults age 65 and older
- Exposure to certain chemicals, pollutants, or toxic fumes
- Lifestyle habits, such as smoking, heavy alcohol use, and malnourishment
- Being in a hospital, especially if you are in the ICU. Being sedated and/or on a ventilator raises the risk even more.
- Having a lung disease
- Having a weakened immune system
- Have trouble coughing or swallowing, from a stroke or other condition
- Recently being sick with a cold or the flu
What are the symptoms of pneumonia?
The symptoms of pneumonia can range from mild to severe and include
- Cough, usually with phlegm (a slimy substance from deep in your lungs)
- Shortness of breath
- Chest pain when you breathe or cough
- Nausea and/or vomiting
The symptoms can vary for different groups. Newborns and infants may not show any signs of the infection. Others may vomit and have a fever and cough. They might seem sick, with no energy, or be restless.
Older adults and people who have serious illnesses or weak immune systems may have fewer and milder symptoms. They may even have a lower than normal temperature. Older adults who have pneumonia sometimes have sudden changes in mental awareness.
What other problems can pneumonia cause?
Sometimes pneumonia can cause serious complications such as
- Bacteremia, which happens when the bacteria move into the bloodstream. It is serious and can lead to septic shock.
- Lung abscesses, which are collections of pus in cavities of the lungs
- Pleural disorders, which are conditions that affect the pleura. The pleura is the tissue that covers the outside of the lungs and lines the inside of your chest cavity.
- Kidney failure
- Respiratory failure
How is pneumonia diagnosed?
Sometimes pneumonia can be hard to diagnose. This is because it can cause some of the same symptoms as a cold or the flu. It may take time for you to realize that you have a more serious condition.
Your health care provider may use many tools to make a diagnosis:
- A medical history, which includes asking about your symptoms
- A physical exam, including listening to your lungs with a stethoscope
- Various tests, such as
- A chest x-ray
- Blood tests such as a complete blood count (CBC) to see if your immune system is actively fighting an infection
- A Blood culture to find out whether you have a bacterial infection that has spread to your bloodstream
If you are in the hospital, have serious symptoms, are older, or have other health problems, you may also have more tests, such as
- Sputum test, which checks for bacteria in a sample of your sputum (spit) or phlegm (slimy substance from deep in your lungs).
- Chest CT scan to see how much of your lungs is affected. It may also show if you have complications such as lung abscesses or pleural effusions.
- Pleural fluid culture, which checks for bacteria in a fluid sample that was taken from the pleural space
- Pulse oximetry or blood oxygen level test, to check how much oxygen is in your blood
- Bronchoscopy, a procedure used to look inside your lungs' airways
What are the treatments for pneumonia?
Treatment for pneumonia depends on the type of pneumonia, which germ is causing it, and how severe it is:
- Antibiotics treat bacterial pneumonia and some types of fungal pneumonia. They do not work for viral pneumonia.
- In some cases, your provider may prescribe antiviral medicines for viral pneumonia
- Antifungal medicines treat other types of fungal pneumonia
You may need to be treated in a hospital if your symptoms are severe or if you are at risk for complications. While there, you may get additional treatments. For example, if your blood oxygen level is low, you may receive oxygen therapy.
It may take time to recover from pneumonia. Some people feel better within a week. For other people, it can take a month or more.
Can pneumonia be prevented?
Vaccines can help prevent pneumonia caused by pneumococcal bacteria or the flu virus. Having good hygiene, not smoking, and having a healthy lifestyle may also help prevent pneumonia.
NIH: National Heart, Lung, and Blood Institute
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What are Staphylococcal (staph) infections?
Staphylococcus (staph) is a group of bacteria. There are more than 30 types. A type called Staphylococcus aureus causes most infections.
Staph bacteria can cause many different types of infections, including
- Skin infections, which are the most common types of staph infections
- Bacteremia, an infection of the bloodstream. This can lead to sepsis, a very serious immune response to infection.
- Bone infections
- Endocarditis, an infection of the inner lining of the heart chambers and valves
- Food poisoning
- Toxic shock syndrome (TSS), a life-threatening condition caused by toxins from certain types of bacteria
What causes staph infections?
Some people carry staph bacteria on their skin or in their noses, but they do not get an infection. But if they get a cut or wound, the bacteria can enter the body and cause an infection.
Staph bacteria can spread from person to person. They can also spread on objects, such as towels, clothing, door handles, athletic equipment, and remotes. If you have staph and do not handle food properly when you are preparing it, you can also spread staph to others.
Who is at risk for staph infections?
Anyone can develop a staph infection, but certain people are at greater risk, including those who
- Have a chronic condition such as diabetes, cancer, vascular disease, eczema, and lung disease
- Have a weakened immune system, such as from HIV/AIDS, medicines to prevent organ rejection, or chemotherapy
- Had surgery
- Use a catheter, breathing tube, or feeding tube
- Are on dialysis
- Inject illegal drugs
- Do contact sports, since you may have skin-to-skin contact with others or share equipment
What are the symptoms of staph infections?
The symptoms of a staph infection depend on the type of infection:
- Skin infections can look like pimples or boils. They may be red, swollen, and painful. Sometimes there is pus or other drainage. They can turn into impetigo, which turns into a crust on the skin, or cellulitis, a swollen, red area of skin that feels hot.
- Bone infections can cause pain, swelling, warmth, and redness in the infected area. You may also have chills and a fever.
- Endocarditis causes some flu-like symptoms: fever, chills, and fatigue. It also causes symptoms such as rapid heartbeat, shortness of breath, and fluid buildup in your arms or legs.
- Food poisoning typically causes nausea and vomiting, diarrhea, and a fever. If you lose too many fluids, you may also become dehydrated.
- Pneumonia symptoms include a high fever, chills, and cough that doesn't get better. You may also have chest pain and shortness of breath.
- Toxic shock syndrome (TSS) causes high fever, sudden low blood pressure, vomiting, diarrhea, and confusion. You may have a sunburn-like rash somewhere on your body. TSS can lead to organ failure.
How are staph infections diagnosed?
Your health care provider will do a physical exam and ask about your symptoms. Often, providers can tell if you have a staph skin infection by looking at it. To check for other types of staph infections, providers may do a culture, with a skin scraping, tissue sample, stool sample, or throat or nasal swabs. There may be other tests, such as imaging tests, depending on the type of infection.
What are the treatments for staph infections?
Treatment for staph infections is antibiotics. Depending on the type of infection, you may get a cream, ointment, medicines (to swallow), or intravenous (IV). If you have an infected wound, your provider might drain it. Sometimes you may need surgery for bone infections.
Some staph infections, such as MRSA (methicillin-resistant Staphylococcus aureus), are resistant to many antibiotics. There are still certain antibiotics that can treat these infections.
Can staph infections be prevented?
Certain steps can help to prevent staph infections:
- Use good hygiene, including washing your hands often
- Don't share towels, sheets, or clothing with someone who has a staph infection
- It's best not to share athletic equipment. If you do need to share, make sure that it properly cleaned and dried before you use it.
- Practice food safety, including not preparing food for others when you have a staph infection
- If you have a cut or wound, keep it covered
[Learn More in MedlinePlus]