Is ICD-10-CM code J11 billable?

No, J11 (Influenza due to unidentified influenza virus) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code J11 belong to?

J11 belongs to Chapter 10 of the ICD-10-CM tabular list: J00–J99 (Diseases of the Respiratory System).

J11Not billable, use a more specific code below

Influenza due to unidentified influenza virus

In Influenza and pneumonia (J09-J18), chapter 10: Diseases of the Respiratory System

8 billable codes under J11: 2 are an MCC; none map to an HCC.A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment.

Instructional notes

Also applies, from Influenza and pneumonia (J09-J18)

These notes sit on J09-J18 and apply to every code under it, including J11.

Excludes2: not included here, code separately if applicable

allergic or eosinophilic pneumonia (J82)
aspiration pneumonia NOS (J69.0)
meconium pneumonia (P24.01)
neonatal aspiration pneumonia (P24.-)
pneumonia due to solids and liquids (J69.-)
congenital pneumonia (P23.9)
lipid pneumonia (J69.1)
rheumatic pneumonia (I00)
ventilator associated pneumonia (J95.851)

Use additional code: add a second code for this, listed after this one

code, if applicable, to identify resistance to antimicrobial drugs (Z16.-)

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Covers COPD and asthma exacerbations, sequencing of acute respiratory failure, confirmed versus suspected identified influenza, ventilator associated pneumonia, and vaping-related disorders.

Chronic Obstructive Pulmonary Disease [COPD] and Asthma (page 56)
Acute Respiratory Failure (page 56)
Influenza due to certain identified influenza viruses (page 57)
Ventilator associated Pneumonia (page 57)
Vaping-related disorders (page 58)

Read Section I.C.10 (page 56)

All codes under J11

J11 can't be used on a claim. Pick a billable code below; grey headings group them.

J11 MS-DRGs

As the principal diagnosis, the billable codes under J11 group to these 10 MS-DRGs (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 865 Viral Illness with MCC (5 of 8 codes)
DRG 866 Viral Illness without MCC (5 of 8 codes)
DRG 177 Respiratory Infections and Inflammations with MCC (2 of 8 codes)
DRG 178 Respiratory Infections and Inflammations with CC (2 of 8 codes)
DRG 179 Respiratory Infections and Inflammations without CC/MCC (2 of 8 codes)
DRG 193 Simple Pneumonia and Pleurisy with MCC (2 of 8 codes)
DRG 194 Simple Pneumonia and Pleurisy with CC (2 of 8 codes)
DRG 195 Simple Pneumonia and Pleurisy without CC/MCC (2 of 8 codes)
DRG 152 Otitis Media and URI with MCC (1 of 8 codes)
DRG 153 Otitis Media and URI without MCC (1 of 8 codes)

Other codes that refer to J11

Notes on these codes point to J11.

J09 Excludes1: influenza due to unidentified influenza virus (J11.-)
J09 Excludes1: seasonal influenza due to unidentified influenza virus (J11.-)
J10 Excludes1: influenza due to unidentifed influenza virus (J11.-)

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Flu

The flu, also called influenza, is a respiratory infection caused by viruses. Each year, millions of Americans get sick with the flu. Sometimes it causes mild illness. But it can also be serious or even deadly, especially for people over 65, newborn babies, and people with certain chronic illnesses.

Pneumonia

Pneumonia is an infection in one or both of the lungs. It causes the air sacs of the lungs to fill up with fluid or pus. It can range from mild to severe, depending on the type of germ causing the infection, your age, and your overall health.

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.