J11.1

J11.1: Influenza due to unidentified influenza virus with other respiratory manifestations

Billable / specific codeICD-10-CM

J11.1 is a billable, specific ICD-10-CM code for influenza due to unidentified influenza virus with other respiratory manifestations. It is valid for submission on a claim.

Check J11.1 with the rest of the claim: free scrubber

Use additional code

Add a secondary code to capture the detail described below.

code for associated pleural effusion, if applicable (J91.8)
code for associated sinusitis, if applicable (J01.-)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Influenza NOS
Influenzal laryngitis NOS
Influenzal pharyngitis NOS
Influenza with upper respiratory symptoms NOS

Other codes that can never be billed with J11.1

Their own Excludes1 notes name this code, so the conflict is not listed above.

J00Acute nasopharyngitis [common cold]
J02.9Acute pharyngitis, unspecified
J03.9Acute tonsillitis, unspecified
J06Acute upper respiratory infections of multiple and unspecified sites
J09Influenza due to certain identified influenza viruses
J10Influenza due to other identified influenza virus

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

J11.1 is named in 9 Medicare coverage policies: 9 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52466Nebulizers - Policy Article
A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
A56717Billing and Coding: Respiratory Therapy (Respiratory Care)
A57205Billing and Coding: Oximetry Services

Alphabetic index entries that lead here

Influenza(bronchial) (epidemic) (respiratory (upper)) (unidentified influenza virus)
Influenza›with›laryngitis
Influenza›with›pharyngitis
Influenza›with›respiratory manifestations NEC