J68.1

J68.1: Pulmonary edema due to chemicals, gases, fumes and vapors

Billable / specific codeICD-10-CM

J68.1 is a billable, specific ICD-10-CM code for pulmonary edema due to chemicals, gases, fumes and vapors. It is valid for submission on a claim.

Check J68.1 with the rest of the claim: free scrubber

Excludes1: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

pulmonary edema (acute) (chronic) NOS (J81.-)

Inclusion terms

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

Chemical pulmonary edema (acute) (chronic)

Other codes that can never be billed with J68.1

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

J68.4Chronic respiratory conditions due to chemicals, gases, fumes and vapors
J81Pulmonary edema

Risk adjustment

J68.1 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 280 Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders0.319 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

J68.1 is named in 7 Medicare coverage policies: 7 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

Silo-fillers' disease›pulmonary edema
Disease, diseased›silo-filler's›pulmonary edema
Edema, edematous›lung›chemical(acute)
Edema, edematous›lung›chemical›chronic
Edema, edematous›lung›due to›chemicals, fumes or vapors(inhalation)
Edema, edematous›lung›chronic›due to›chemicals, gases, fumes or vapors(inhalation)

Code history

Unchanged in every release from FY2024 to FY2027.