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.
Excludes1 — 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)
Other codes that can never be billed with J84.116
These codes carry an Excludes1 note pointing at J84.116. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading J84.116 alone.
- 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.
Medicare coverage
J84.116 is named in 18 Medicare coverage policies — 18 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- 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
How J84.116 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 J84.116.
- Pneumonia›cryptogenic organizing
Related codes at this level
Codes that share J84.11. If J84.116 is not quite right, the correct code is usually one of these.
Questions about J84.116
- Is J84.116 a billable ICD-10-CM code?
- Yes. J84.116 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does J84.116 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 J84.116?
- J84.116 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.