J95.1

J95.1: Acute pulmonary insufficiency following thoracic surgery

Billable / specific codeICD-10-CM

J95.1 is a billable, specific ICD-10-CM code for acute pulmonary insufficiency following thoracic surgery. It is valid for submission on a claim.

Check J95.1 with the rest of the claim: free scrubber

Excludes2: not included here, but may coexist

The excluded condition is not part of this code, but a patient can have both. You may code both.

Functional disturbances following cardiac surgery (I97.0, I97.1-)

Excludes2 inherited from the categories above J95.1

Not part of this code, but both may be coded when both are present.

Written on J95: Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified

aspiration pneumonia (J69.-)
emphysema (subcutaneous) resulting from a procedure (T81.82)
hypostatic pneumonia (J18.2)
pulmonary manifestations due to radiation (J70.0-J70.1)

Other codes that can never be billed with J95.1

Their own Excludes1 notes name this code, so the conflict is not listed above.

J98.4Other disorders of lung

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

J95.1 is named in 11 Medicare coverage policies: 11 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A56500Billing and Coding: Cardiac Catheterization and Coronary Angiography
A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
A56625Billing and Coding: Echocardiography
A56717Billing and Coding: Respiratory Therapy (Respiratory Care)

Alphabetic index entries that lead here

Complication›surgical procedure›pulmonary insufficiency›following thoracic surgery
Insufficiency, insufficient›pulmonary›acute, following surgery›thoracic
Complication›respiratory system›postoperative›pulmonary insufficiency›following thoracic surgery

Code history

Unchanged in every release from FY2024 to FY2027.