J93.11 — Primary spontaneous pneumothorax
J93.11 is a billable, specific ICD-10-CM code for primary spontaneous pneumothorax. It is valid for submission on a claim.
Risk adjustment
J93.11 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
J93.11 is named in 4 Medicare coverage policies — 4 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
- A56717Billing and Coding: Respiratory Therapy (Respiratory Care)
- A57205Billing and Coding: Oximetry Services
- A57224Billing and Coding: Respiratory Care
How J93.11 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 J93.11.
- Pneumothorax NOS›spontaneous NOS›primary
Related codes at this level
Codes that share J93.1. If J93.11 is not quite right, the correct code is usually one of these.
Questions about J93.11
- Is J93.11 a billable ICD-10-CM code?
- Yes. J93.11 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does J93.11 sit in the tabular list?
- Diseases of the respiratory system (J00-J99), in the block Other diseases of the pleura (J90-J94).