2026 ICD-10-CM Diagnosis Code J15.212Pneumonia due to Methicillin resistant Staphylococcus aureus
ICD-10-CM Codes›J00–J99›J09-J18›J15
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 282
- Not Chronic
J15.212 is a billable ICD-10-CM diagnosis code for pneumonia due to Methicillin resistant Staphylococcus aureus. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 177 through 179, 791, 793, 974 through 976. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 129 closely related codes. Coders also document this condition as bronchopneumonia caused by methicillin resistant Staphylococcus aureus. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Bacterial infections and Pneumonia (except that caused by tuberculosis).
For Medicare Advantage risk adjustment, J15.212 maps to CMS-HCC Category 282 (Aspiration and Specified Bacterial Pneumonias) under the V28 model, adding a risk factor of about 0.440 for a community, non-dual, aged beneficiary in payment year 2026.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
J15.212 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2026.
Source: CMS Payment Year 2026 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Bronchopneumonia caused by methicillin resistant Staphylococcus aureus
- Bronchopneumonia caused by Staphylococcus
- Bronchopneumonia caused by Staphylococcus aureus
- Methicillin resistant Staphylococcus aureus infection
- Pneumonia caused by methicillin resistant Staphylococcus aureus
- Pneumonia caused by Staphylococcus aureus
- Staphylococcal pneumonia
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Antibiotic Resistance
Antibiotics are medicines that treat bacterial infections in humans and animals. They work by killing the bacteria or making it hard for the bacteria to grow and multiply. When used properly, antibiotics can save lives. But there is a growing problem of antibiotic resistance.
The full article covers:
- What are antibiotics?
- What is antibiotic resistance?
- How do bacteria become resistant to antibiotics?
- Who is more likely to develop an antibiotic-resistant infection?
- How can antibiotic resistance be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert J15.212 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About J15.212Overview
What is the ICD-10 code for pneumonia due to Methicillin resistant Staphylococcus aureus?
The ICD-10-CM code for pneumonia due to Methicillin resistant Staphylococcus aureus is J15.212 (sometimes written as J15212). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
Is J15.212 (Pneumonia due to staphylococcus aureus) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report pneumonia due to Methicillin resistant Staphylococcus aureus on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does J15.212 group to?
When pneumonia due to Methicillin resistant Staphylococcus aureus is the principal diagnosis on an inpatient stay, it groups to MS-DRG 177, 178, 179, 791, 793, 974, 975, 976, with relative weights from 0.7550 to 4.1696 depending on complications. Higher weights mean higher Medicare reimbursement.
Is J15.212 a CC or MCC?
CMS lists J15.212 as an MCC (major complication or comorbidity) for FY 2026. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 129 closely related codes in its exclusion list.
What is the ICD-9 equivalent of J15.212?
Under the General Equivalence Mappings, pneumonia due to Methicillin resistant Staphylococcus aureus converts to ICD-9-CM 482.42 (meth res pneu d/t Staph). The mapping is a direct match.
What HCC is J15.212?
J15.212 (pneumonia due to Methicillin resistant Staphylococcus aureus) maps to CMS-HCC Category 282 (Aspiration and Specified Bacterial Pneumonias), commonly written as HCC 282, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It mapped to HCC 114 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does J15.212 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, J15.212 adds a risk adjustment factor of about 0.440 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.173 to 0.538 depending on the payment segment). HCC 282 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 282 category page.
