J11.1 — Influenza due to unidentified influenza virus with other respiratory manifestations
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.
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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
These codes carry an Excludes1 note pointing at J11.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading J11.1 alone.
Risk adjustment
J11.1 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
J11.1 is named in 13 Medicare coverage policies — 13 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52466Nebulizers - Policy Article
- A52466Nebulizers - Policy Article
- A52466Nebulizers - Policy Article
- A52466Nebulizers - Policy Article
How J11.1 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to J11.1.
- Influenza(bronchial) (epidemic) (respiratory (upper)) (unidentified influenza virus)
- Influenza›with›laryngitis
- Influenza›with›pharyngitis
- Influenza›with›respiratory manifestations NEC
Related codes at this level
Codes that share J11. If J11.1 is not quite right, the correct code is usually one of these.
Questions about J11.1
- Is J11.1 a billable ICD-10-CM code?
- Yes. J11.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does J11.1 sit in the tabular list?
- Diseases of the respiratory system (J00-J99), in the block Influenza and pneumonia (J09-J18).