Is ICD-10-CM code J81 billable?

No, J81 (Pulmonary edema) 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 J81 belong to?

J81 belongs to Chapter 10 of the ICD-10-CM tabular list: J00–J99 (Diseases of the Respiratory System).

J81Not billable, use a more specific code below

Pulmonary edema

In Other respiratory diseases principally affecting the interstitium (J80-J84), chapter 10: Diseases of the Respiratory System

2 billable codes under J81: 1 is an MCC, 1 is a CC; 1 map to HCC 213 (Cardio-Respiratory Failure and Shock).A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment. An HCC counts toward a Medicare Advantage patient's risk score.

Instructional notes

Excludes1: not coded here, use a different code

chemical (acute) pulmonary edema (J68.1)
hypostatic pneumonia (J18.2)
passive pneumonia (J18.2)
pulmonary edema due to external agents (J60-J70)
pulmonary edema with heart disease NOS (I50.1)
pulmonary edema with heart failure (I50.1)

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

code to identify:
exposure to environmental tobacco smoke (Z77.22)
history of tobacco dependence (Z87.891)
occupational exposure to environmental tobacco smoke (Z57.31)
tobacco dependence (F17.-)
tobacco use (Z72.0)

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 J81

J81 can't be used on a claim. Pick a billable code below; grey headings group them.

J81 MS-DRGs

As the principal diagnosis, the billable codes under J81 group to MS-DRG 189, 791, or 793 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 189 Pulmonary Edema and Respiratory Failure (2 of 2 codes)
DRG 791 Prematurity with Major Problems (1 of 2 codes)
DRG 793 Full Term Neonate with Major Problems (1 of 2 codes)

Other codes that refer to J81

Notes on these codes point to J81.

I50.1 Excludes1: edema of lung without heart disease or heart failure (J81.-)
I50.1 Excludes1: pulmonary edema without heart disease or failure (J81.-)
J68.1 Excludes1: pulmonary edema (acute) (chronic) NOS (J81.-)
R60 Excludes1: pulmonary edema (J81.-)

About the condition

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

Lung Diseases

When you breathe, your lungs take in oxygen from the air and deliver it to the bloodstream. The cells in your body need oxygen to work and grow. During a normal day, you breathe nearly 25,000 times. People with lung disease have difficulty breathing. Millions of people in the U.S. have lung disease. If all types of lung disease are lumped together, it is the number three killer in the United States.

Code history

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