2026 ICD-10-CM Diagnosis Code J15.69Pneumonia due to other Gram-negative bacteria
ICD-10-CM Codes›J00–J99›J09-J18›J15
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 282
- Not Chronic
J15.69 is a billable ICD-10-CM diagnosis code for pneumonia due to other Gram-negative bacteria. 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 125 closely related codes. 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, J15.69 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
J15.69 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.
- Achromobacter pneumonia
- Actinobacillus infection
- Bacterial infection caused by Proteus mirabilis
- Bacterial infection caused by Serratia
- Bronchopneumonia caused by Proteus mirabilis
- Enterobacter pneumonia
- Infection caused by Enterobacter
- Pneumonia caused by Gram negative bacteria
- Pneumonia caused by Proteus mirabilis
- Pneumonia caused by Serratia
- Proteus pneumonia
- Pulmonary actinobacillosis
Tabular List NotesGuidance
Coding notes and annotation back-references applicable to this code.
Inclusion Terms
- Pneumonia due to other aerobic Gram-negative bacteria
- Pneumonia due to Serratia marcescens
These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) J18.9
broncho-, bronchial (confluent) (croupous) (diffuse) (disseminated) (hemorrhagic) (involving lobes) (lobar) (terminal) J18.0
Proteus J15.69
Serratia marcescens J15.69
Enterobacter J15.69
gram-negative bacteria NEC J15.69
Bacterium anitratum J15.69
Enterobacter J15.69
Herellea J15.69
Proteus J15.69
Serratia marcescens J15.69
lobar (disseminated) (double) (interstitial) J18.1
Proteus J15.69
Proteus J15.69
Serratia marcescens J15.69
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Pneumonia
Pneumonia is an infection in one or both of your lungs. It causes the air sacs of your lungs to fill up with fluid or pus. Pneumonia can range from mild to severe, depending on what caused it, your age, and your overall health.
The full article covers:
- What is pneumonia?
- What causes pneumonia?
- Who is more likely to develop pneumonia?
- What are the symptoms of pneumonia?
- What other problems can pneumonia cause?
- How is pneumonia diagnosed?
- What are the treatments for pneumonia?
- Can pneumonia be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Code History & ChangesHistory
Replacement J15.69 replaces the following previously assigned code(s):
- J15.6 - Pneumonia due to other aerobic Gram-negative bacteria
- J15.6 - Pneumonia due to other Gram-negative bacteria
Questions About J15.69Overview
What is the ICD-10 code for pneumonia due to other Gram-negative bacteria?
The ICD-10-CM code for pneumonia due to other Gram-negative bacteria is J15.69 (sometimes written as J1569). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
Is J15.69 (Pneumonia due to other Gram-negative bacteria) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report pneumonia due to other Gram-negative bacteria on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does J15.69 group to?
When pneumonia due to other Gram-negative bacteria 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 J15.69 a CC or MCC?
CMS lists J15.69 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 125 closely related codes in its exclusion list.
What HCC is J15.69?
J15.69 (pneumonia due to other Gram-negative bacteria) 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 J15.69 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, J15.69 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.
