J81.1
J81.1: Chronic pulmonary edema
Billable / specific codeICD-10-CM
J81.1 is a billable, specific ICD-10-CM code for chronic pulmonary edema. It is valid for submission on a claim.
Check J81.1 with the rest of the claim: free scrubberInclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Pulmonary congestion (chronic) (passive)
- Pulmonary edema NOS
Excludes1 inherited from the categories above J81.1
A category’s note binds every code beneath it.
Other codes that can never be billed with J81.1
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
J81.1 is named in 11 Medicare coverage policies: 11 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A53058Billing and Coding: Home Health Physical Therapy
- A53065Billing and Coding: Outpatient Physical Therapy
- A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
- A56605Billing and Coding: B-type Natriuretic Peptide (BNP) Testing
Alphabetic index entries that lead here
- Edema, edematous›lung
- Edema, edematous›lung›chronic
Code history
Unchanged in every release from FY2024 to FY2027.