J84.116: Cryptogenic organizing pneumonia
J84.116 is a billable, specific ICD-10-CM code for cryptogenic organizing pneumonia. It is valid for submission on a claim.
Check J84.116 with the rest of the claim: free scrubberExcludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
- organizing pneumonia NOS, or due to known underlying cause (J84.89)
Excludes1 inherited from the categories above J84.116
A category’s note binds every code beneath it.
Written on J84.11: Idiopathic interstitial pneumonia
Excludes2 inherited from the categories above J84.116
Not part of this code, but both may be coded when both are present.
Other codes that can never be billed with J84.116
Their own Excludes1 notes name this code, so the conflict is not listed above.
- J84.89Other specified interstitial pulmonary diseases
Risk adjustment
J84.116 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
J84.116 is named in 18 Medicare coverage policies: 18 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A55639Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions
- A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
- A56717Billing and Coding: Respiratory Therapy (Respiratory Care)
- A56730Billing and Coding: Respiratory Therapy and Oximetry Services
Alphabetic index entries that lead here
- Pneumonia›cryptogenic organizing
Code history
Unchanged in every release from FY2024 to FY2027.