J95.851: Ventilator associated pneumonia
J95.851 is a billable, specific ICD-10-CM code for ventilator associated pneumonia. It is valid for submission on a claim.
Check J95.851 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.
- ventilator lung in newborn (P27.8)
Use additional code
Add a secondary code to capture the detail described below.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Ventilator associated pneumonitis
Excludes2 inherited from the categories above J95.851
Not part of this code, but both may be coded when both are present.
Risk adjustment
J95.851 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 211 Respirator Dependence/Tracheostomy Status/Complications0.879 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
J95.851 is named in 1 Medicare coverage policy: 1 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A57205Billing and Coding: Oximetry Services
Alphabetic index entries that lead here
- Pneumonia›ventilator associated
- Pneumonitis›ventilator associated
- Pneumonitis›due to›ventilator
Code history
Unchanged in every release from FY2024 to FY2027.