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J15.212 vs Z16.24

J15.212 (Pneumonia due to Methicillin resistant Staphylococcus aureus) compared with Z16.24 (Resistance to multiple antibiotics), from the official CMS tabular data.

Summary

These codes should not be reported together because Z16.24’s tabular entry lists J15.212 under Excludes1.

Official rule
What is different?

The conditions named and chapter.J15.212 is “Pneumonia due to Methicillin resistant Staphylococcus aureus”; Z16.24 is “Resistance to multiple antibiotics”. J15.212 sits in J00-J99 — Diseases of the Respiratory System (J00-J99); Z16.24 in Z00-Z99 — Factors Influencing Health Status and Contact with Health Services (Z00-Z99).

Registry fact

Can these codes be reported together?

No.Z16.24’s entry carries an Excludes1 note covering J15.212: “Methicillin resistant Staphylococcus aureus pneumonia (J15.212)”. Both may be reported only when the documentation shows the two conditions are unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

Yes.Z16.24’s tabular entry: “Methicillin resistant Staphylococcus aureus pneumonia (J15.212)”. The note covers J15.212.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes2 relationship?

None.Neither entry carries an Excludes2 note that names the other code. J15.212 carries 9 Excludes2 notes covering other codes; the side-by-side table quotes them.

Official rule

Is one more specific?

Not comparable.The codes sit in different categories; specificity is only comparable within one category.

Is one a parent or header code?

No.Both are billable codes, and neither contains the other.

Registry fact

Are there sequencing instructions?

Yes.J15.212 first, Z16.24 as an additional code: J15.212 carries a Use Additional Code instruction covering Z16.24 (“code, if applicable, to identify resistance to antimicrobial drugs (Z16.-)”).

Official ruleGuide: Code First vs Use Additional Code vs Code Also

Are there other coding relationships?

None found.No laterality, encounter-phase, Table of Neoplasms, Table of Drugs and Chemicals, or history-versus-active-disease relationship links these codes.

MedCoder-derived

Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels

Can these codes be reported together?

Excludes1 — generally not reported together

Excludes1 conflict

Z16.24
Resistance to multiple antibiotics
↔
J15.212
Pneumonia due to Methicillin resistant Staphylococcus aureus

What we found

No — do not report together.Z16.24 carries an Excludes1 note covering J15.212: “Methicillin resistant Staphylococcus aureus pneumonia (J15.212)”

Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

What to review

Report one of the two. Both may be reported only when the documentation shows the two conditions are unrelated to each other.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

An Excludes1 note means the two conditions are not ordinarily reported together for the same encounter, because the classification treats them as mutually exclusive forms of the same condition. The documented exception is when the two conditions are unrelated to each other.

Source / rule

CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a

Sequencing on the claim

Sequencing

Additional-code relationship

1st
J15.212
Pneumonia due to Methicillin resistant Staphylococcus aureus
→
then
Z16.24
Resistance to multiple antibiotics

What we found

J15.212 first, Z16.24 as an additional code

J15.212 carries a Use Additional Code instruction covering Z16.24: “code, if applicable, to identify resistance to antimicrobial drugs (Z16.-)”

What to review

Report Z16.24 after J15.212 when the documentation supports it.

Guide: Code First vs Use Additional Code vs Code Also

Why it matters

A "Use additional code" note means a secondary code should follow this one to fully describe the condition when the documentation supports it.

Source / rule

CMS ICD-10-CM tabular instructional notes

Official guidance behind these answers

  • Section I.A.12.a — Excludes1 · applies to: Excludes1

    A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider. For example, code F45.8, Other somatoform disorders, has an Excludes1 note for "sleep related teeth grinding (G47.63)," because "teeth grinding" is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However psychogenic dysmenorrhea is also an inclusion term under F45.8, and a patient could have both this condition and sleep related teeth grinding. In this case, the two conditions are clearly unrelated to each other, and so it would be appropriate to report F45.8 and G47.63 together.

    ICD-10-CM Official Guidelines FY2026

  • Section I.B.7 — Multiple coding for a single condition · applies to: Code first / Use additional code

    In addition to the etiology/manifestation convention that requires two codes to fully describe a single condition that affects multiple body systems, there are other single conditions that also require more than one code. “Use additional code” notes are found in the Tabular List at codes that are not part of an etiology/manifestation pair where a secondary code is useful to fully describe a condition. The sequencing rule is the same as the etiology/manifestation pair, “use additional code” indicates that a secondary code should be added, if known. For example, for bacterial infections that are not included in chapter 1, a secondary code from category B95, Streptococcus, Staphylococcus, and Enterococcus, as the cause of diseases classified elsewhere, or B96, Other bacterial agents as the cause of diseases classified elsewhere, may be required to identify the bacterial organism causing the infection. A “use additional code” note will normally be found at the infectious disease code, indicating a need for the organism code to be added as a secondary code. “Code first” notes are also under certain codes that are not specifically manifestation codes but may be due to an underlying cause. When there is a “code first” note and an underlying condition is present, the underlying condition should be sequenced first, if known. […]

    ICD-10-CM Official Guidelines FY2026

  • Section I.A.13 — Etiology/manifestation convention (“code first”, “use additional code” and “in diseases classified elsewhere” notes) · applies to: Etiology/manifestation convention

    Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first, if applicable, followed by the manifestation. Wherever such a combination exists, there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. In most cases the manifestation codes will have in the code title, “in diseases classified elsewhere.” Codes with this title are a component of the etiology/ manifestation convention. The code title indicates that it is a manifestation code. “In diseases classified elsewhere” codes are never permitted to be used as first listed or principal diagnosis codes. They must be used in conjunction with an underlying condition code and they must be listed following the underlying condition. See category F02, Dementia in other diseases classified elsewhere, for an example of this convention. There are manifestation codes that do not have “in diseases classified elsewhere” in the title. For such codes, there is a “use additional code” note at the etiology code and a “code first” note at the manifestation code, and the rules for sequencing apply. […]

    ICD-10-CM Official Guidelines FY2026

Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum

Side by side

J15.212Pneumonia due to Methicillin resistant Staphylococcus aureusZ16.24Resistance to multiple antibiotics
Billing statusBillableBillable
ClassificationJ00-J99 — Diseases of the Respiratory System (J00-J99)Z00-Z99 — Factors Influencing Health Status and Contact with Health Services (Z00-Z99)
DefinitionPneumonia due to Methicillin resistant Staphylococcus aureus is a billable ICD-10-CM diagnosis code (J15.212).Resistance to multiple antibiotics is a billable ICD-10-CM diagnosis code (Z16.24).
Includes
bronchopneumonia due to bacteria other than S. pneumoniae and H. influenzae
—
Excludes1
chlamydial pneumonia (J16.0)
congenital pneumonia (P23.-)
Legionnaires' disease (A48.1)
spirochetal pneumonia (A69.8)
Methicillin resistant Staphylococcus aureus infection (A49.02)
Methicillin resistant Staphylococcus aureus pneumonia (J15.212)
Sepsis due to Methicillin resistant Staphylococcus aureus (A41.02)
Excludes2
allergic or eosinophilic pneumonia (J82)
aspiration pneumonia NOS (J69.0)
meconium pneumonia (P24.01)
neonatal aspiration pneumonia (P24.-)
pneumonia due to solids and liquids (J69.-)
congenital pneumonia (P23.9)
lipid pneumonia (J69.1)
rheumatic pneumonia (I00)
ventilator associated pneumonia (J95.851)
—
Code first
, if applicable, associated influenza (J09.X1, J10.0-, J11.0-)
the infection
Use additional code
code, if applicable, to identify resistance to antimicrobial drugs (Z16.-)
—
Code also
, if applicable, any associated condition such as:
abscess (J85.1)
aspiration pneumonia (J69.-)
—

Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on.

Derived from the official CMS ICD-10-CM tabular data (FY2027). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources