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.
Inclusion 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
These are not written on J81.0, but they bind it: a note on a category applies to every code beneath it. Billing J81.0 with anything listed here is a denial.
Other codes that can never be billed with J81.0
These codes carry an Excludes1 note pointing at J81.0. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading J81.0 alone.
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.
Medicare coverage
J81.0 is named in 22 Medicare coverage policies — 20 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- 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
How J81.0 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 J81.0.
- Edema, edematous›lung›acute
Code history
J81.0 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.
Related codes at this level
Codes that share J81. If J81.0 is not quite right, the correct code is usually one of these.
Questions about J81.0
- Is J81.0 a billable ICD-10-CM code?
- Yes. J81.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does J81.0 sit in the tabular list?
- Diseases of the respiratory system (J00-J99), in the block Other respiratory diseases principally affecting the interstitium (J80-J84).
- What cannot be coded together with J81.0?
- J81.0 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above J81.0 (J81) and apply to it just the same.