J81

J81: Pulmonary edema

Non-billable headerICD-10-CM

J81 is a non-billable header ICD-10-CM code for pulmonary edema. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1: never code together

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

chemical (acute) pulmonary edema (J68.1)
hypostatic pneumonia (J18.2)
passive pneumonia (J18.2)
pulmonary edema due to external agents (J60-J70)
pulmonary edema with heart disease NOS (I50.1)
pulmonary edema with heart failure (I50.1)

Use additional code

Add a secondary code to capture the detail described below.

code to identify:
exposure to environmental tobacco smoke (Z77.22)
history of tobacco dependence (Z87.891)
occupational exposure to environmental tobacco smoke (Z57.31)
tobacco dependence (F17.-)
tobacco use (Z72.0)

Other codes that can never be billed with J81

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

I50.1Left ventricular failure, unspecified
J68.1Pulmonary edema due to chemicals, gases, fumes and vapors
R60Edema, not elsewhere classified

Risk adjustment

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

Code history

Unchanged in every release from FY2024 to FY2027.

Code to one of these instead J81

2 child codes. Green means billable.