J81.0: Acute pulmonary edema
J81.0 is a billable, specific ICD-10-CM code for acute pulmonary edema. It is valid for submission on a claim.
Check J81.0 with the rest of the claim: free scrubberInclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Acute edema of lung
Excludes1 inherited from the categories above J81.0
A category’s note binds every code beneath it.
Other codes that can never be billed with J81.0
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
J81.0 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 213 Cardio-Respiratory Failure and Shock0.370 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
J81.0 is named in 21 Medicare coverage policies: 19 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which one applies depends on your Medicare contractor.
- A56566Billing and Coding: Outpatient Physical and Occupational Therapy Servicesnot covered
- A57067Billing and Coding: Outpatient Physical and Occupational Therapy Servicesnot covered
- A55354Billing and Coding: Frequency of Hemodialysis
- A55672Billing and Coding: Frequency of Hemodialysis
Alphabetic index entries that lead here
- Edema, edematous›lung›acute
Code history
Unchanged in every release from FY2024 to FY2027.