J12.81 ICD-10-CM Code: Pneumonia due to SARS-associated coronavirus

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for J12.81 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on J12.81 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for J12.81

MedCoder structured workflow — derived from this code’s own official record

Before you code J12.81

1. J12.81’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

   Guide: Combination codes →

Choose the right path

1. Is the underlying (etiologic) condition the Code First note names documented?
   Yes → Sequence the underlying condition first, then J12.81.
   No → Continue; do not add an underlying condition the record does not document.

   ReviewJ09.X1, J10.0, J11.0

Consider J12.81. Then work the Use Additional Code note and review the Code Also note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement

Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

The associated condition or complication

Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).

The underlying (etiologic) condition

Named in the Code First note; sequenced before this code when documented (Guidelines I.A.13).

The conditions the Use Additional Code note names

Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.

Official instructions as workflow

• Excludes2 — not part of J12.81(16 notes)

  Coding workflow: The conditions named in this note are not included in J12.81. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareO74.0, O29, O89.0, J69, J69.0, P23.0

  See the official tabular notes · Guidelines I.A.12.b

• Code First — sequencing check(1 note)

  Coding workflow: Check whether the underlying or etiologic condition the note names is documented. When it is, sequence it before J12.81. Do not add an underlying condition the record does not document.

  ReviewJ09.X1, J10.0, J11.0

  See the official tabular notes · Guidelines I.A.13

• Use Additional Code — after identifying J12.81(1 note)

  Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with J12.81 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

  ReviewZ16

  See the official tabular notes · Guidelines I.A.13

• Code Also — related condition(1 note)

  Coding workflow: Review the related condition when both are documented and the instruction applies. A Code Also note does not fix sequencing; the order follows the circumstances of the encounter.

  ReviewJ85.1

  See the official tabular notes · Guidelines I.A.17

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Indexed Clinical Terms (3)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), SARS-associated coronavirus
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), viral, virus (broncho) (interstitial) (lobar), SARS-associated coronavirus
• Syndrome, severe acute respiratory (SARS)

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Don’t confuse J12.81 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of J12.81 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• O74.0— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of aspiration pneumonia due to anesthesia during labor and delivery adds O74.0; it is not part of this code and both may be reported when both are documented.

  Full comparison: J12.81 vs O74.0 →

• O29— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of aspiration pneumonia due to anesthesia during pregnancy adds O29; it is not part of this code and both may be reported when both are documented.

  Full comparison: J12.81 vs O29 →

• O89.0— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of aspiration pneumonia due to anesthesia during puerperium adds O89.0; it is not part of this code and both may be reported when both are documented.

  Full comparison: J12.81 vs O89.0 →

• J69— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of aspiration pneumonia due to solids and liquids adds J69; it is not part of this code and both may be reported when both are documented.

  Full comparison: J12.81 vs J69 →

• J69.0— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of aspiration pneumonia NOS adds J69.0; it is not part of this code and both may be reported when both are documented.

  Full comparison: J12.81 vs J69.0 →

• P23.0— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of congenital pneumonia adds P23.0; it is not part of this code and both may be reported when both are documented.

  Full comparison: J12.81 vs P23.0 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

1. Sequencing: 1 Code First instruction — the underlying condition is sequenced before this code when present. See the Code First notes
2. 1 Use Additional Code instruction — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
3. 1 Code Also note — a second code may apply; the guidelines leave its sequencing to the circumstances of the encounter. See the Code Also notes
4. 16 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

• MCC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name J12.81 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 2 Excludes1 notes: B34.2 — Coronavirus infection, unspecified, B97.21 — SARS-associated coronavirus as the cause of diseases classified elsewhere.

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 1 Excludes2 note: U07.1 — COVID-19.

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 1 Use Additional Code instruction: J95.89 — Other postprocedural complications and disorders of respiratory system, not elsewhere classified (via J12.-).

These codes instruct coders to additionally report this code when it applies.

Referenced by 2 Code Also instructions across 2 chapters: D81.82 — Activated Phosphoinositide 3-kinase Delta Syndrome [APDS] (via J12.-), J69 — Pneumonitis due to solids and liquids (via J12.-).

These codes suggest coding this condition alongside when both are present.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: MCC — Major Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 130 clinically related codes on its CMS exclusion list. Does not count toward severity when the stay groups to DRGs 974-976 (HIV with Major Related Condition).

Named in the grouper logic of 6 MS-DRGs: DRG 193 (MDC 04), DRG 194 (MDC 04), DRG 195 (MDC 04), DRG 974 (MDC 25), DRG 975 (MDC 25), DRG 976 (MDC 25).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):RSP002 — Pneumonia (except that caused by tuberculosis) (default); INF008 — Viral infection.

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as MCC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

J10.01 — Influenza due to other identified influenza virus with the same other identified influenza virus pneumonia, J10.08 — Influenza due to other identified influenza virus with other specified pneumonia, J10.1 — Influenza due to other identified influenza virus with other respiratory manifestations, J11.00 — Influenza due to unidentified influenza virus with unspecified type of pneumonia, J11.08 — Influenza due to unidentified influenza virus with specified pneumonia, J11.1 — Influenza due to unidentified influenza virus with other respiratory manifestations, J12.0 — Adenoviral pneumonia, J12.1 — Respiratory syncytial virus pneumonia, J12.2 — Parainfluenza virus pneumonia, J12.3 — Human metapneumovirus pneumonia, J12.89 — Other viral pneumonia, J12.9 — Viral pneumonia, unspecified, J13 — Pneumonia due to Streptococcus pneumoniae, J14 — Pneumonia due to Hemophilus influenzae, J15.0 — Pneumonia due to Klebsiella pneumoniae, J15.1 — Pneumonia due to Pseudomonas, J15.20 — Pneumonia due to staphylococcus, unspecified, J15.211 — Pneumonia due to Methicillin susceptible Staphylococcus aureus, J15.212 — Pneumonia due to Methicillin resistant Staphylococcus aureus, J15.29 — Pneumonia due to other staphylococcus, +109 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Pneumonia (except that caused by tuberculosis), Viral infection).

J09.X1 — Influenza due to identified novel influenza A virus with pneumonia, J10.00 — Influenza due to other identified influenza virus with unspecified type of pneumonia, J10.01 — Influenza due to other identified influenza virus with the same other identified influenza virus pneumonia, J10.08 — Influenza due to other identified influenza virus with other specified pneumonia, J11.00 — Influenza due to unidentified influenza virus with unspecified type of pneumonia, J11.08 — Influenza due to unidentified influenza virus with specified pneumonia, J12.0 — Adenoviral pneumonia, J12.1 — Respiratory syncytial virus pneumonia, J12.2 — Parainfluenza virus pneumonia, J12.3 — Human metapneumovirus pneumonia, J12.82 — Pneumonia due to coronavirus disease 2019, J12.89 — Other viral pneumonia, J12.9 — Viral pneumonia, unspecified, J13 — Pneumonia due to Streptococcus pneumoniae, J14 — Pneumonia due to Hemophilus influenzae, J15.0 — Pneumonia due to Klebsiella pneumoniae, J15.1 — Pneumonia due to Pseudomonas, J15.20 — Pneumonia due to staphylococcus, unspecified, J15.211 — Pneumonia due to Methicillin susceptible Staphylococcus aureus, J15.212 — Pneumonia due to Methicillin resistant Staphylococcus aureus, +347 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Pneumonia”; these codes share that main term but sit in a different category of the Tabular List.

B39.0 — Acute pulmonary histoplasmosis capsulati (in, histoplasmosis, acute), B39.1 — Chronic pulmonary histoplasmosis capsulati (in, histoplasmosis, chronic), B39.2 — Pulmonary histoplasmosis capsulati, unspecified (in, histoplasmosis), B44.9 — Aspergillosis, unspecified (in, aspergillosis), B58.3 — Pulmonary toxoplasmosis (in, toxoplasmosis), B59 — Pneumocystosis (plasma cell), B65.9 — Schistosomiasis, unspecified (in, schistosomiasis), B77.81 — Ascariasis pneumonia (Ascaris), B99 — Other and unspecified infectious diseases (postinfectional NEC), I00 — Rheumatic fever without heart involvement (rheumatic), J13 — Pneumonia due to Streptococcus pneumoniae (pneumococcal), J14 — Pneumonia due to Hemophilus influenzae (Hemophilus influenzae), J15.0 — Pneumonia due to Klebsiella pneumoniae (Klebsiella), J15.1 — Pneumonia due to Pseudomonas (Pseudomonas), J15.20 — Pneumonia due to staphylococcus, unspecified (staphylococcal), J15.211 — Pneumonia due to Methicillin susceptible Staphylococcus aureus (MSSA), J15.212 — Pneumonia due to Methicillin resistant Staphylococcus aureus (MRSA), J15.29 — Pneumonia due to other staphylococcus (staphylococcal, specified NEC), J15.3 — Pneumonia due to streptococcus, group B (in, Streptococcus, group B), J15.4 — Pneumonia due to other streptococci (streptococcal NEC), +75 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Blood Glucose Test

Contextual Map

Every relationship of J12.81 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run J12.81 with these 6 related codes in Claim Check

Hierarchy

• J00-J99 — Chapter 10: Diseases of the Respiratory System (J00-J99) (J00-J99)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• J09-J18 — Influenza and pneumonia[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Referenced by Excludes1 notes

• B34.2 — Coronavirus infection, unspecified[Excludes1]: “pneumonia due to SARS-associated coronavirus (J12.81)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• B97.21 — SARS-associated coronavirus as the cause of diseases classified elsewhere[Excludes1]: “pneumonia due to SARS-associated coronavirus (J12.81)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Excludes2 notes

• U07.1 — COVID-19[Excludes2]: “pneumonia due to SARS-associated coronavirus (J12.81)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Use Additional Code instructions

• J95.89 — Other postprocedural complications and disorders of respiratory system, not elsewhere classified[Use Additional Code](via J12.-): “bacterial or viral pneumonia (J12-J18)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Code Also instructions

• D81.82 — Activated Phosphoinositide 3-kinase Delta Syndrome [APDS][Code Also](via J12.-): “pneumonia (J12-J18)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• J69 — Pneumonitis due to solids and liquids[Code Also](via J12.-): “viral pneumonia (J12.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• RSP002 — Pneumonia (except that caused by tuberculosis)[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)
• INF008 — Viral infection[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

MS-DRG Grouper

• MCC — Major Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (MCC). Not counted when the stay groups to DRGs 974-976 (HIV with Major Related Condition).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2026
• DRG 193 — SIMPLE PNEUMONIA AND PLEURISY WITH MCC[MS-DRG]: “SIMPLE PNEUMONIA AND PLEURISY WITH MCC (MDC 04)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 194 — SIMPLE PNEUMONIA AND PLEURISY WITH CC[MS-DRG]: “SIMPLE PNEUMONIA AND PLEURISY WITH CC (MDC 04)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 195 — SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC[MS-DRG]: “SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC (MDC 04)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 974 — HIV WITH MAJOR RELATED CONDITION WITH MCC[MS-DRG]: “HIV WITH MAJOR RELATED CONDITION WITH MCC (MDC 25)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 975 — HIV WITH MAJOR RELATED CONDITION WITH CC[MS-DRG]: “HIV WITH MAJOR RELATED CONDITION WITH CC (MDC 25)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 976 — HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC[MS-DRG]: “HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC (MDC 25)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 04 — Diseases and Disorders of the Respiratory System[MDC crossing]: “Diseases and Disorders of the Respiratory System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 3,998 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026
• MDC 25 — Human Immunodeficiency Virus Infections[MDC crossing]: “Human Immunodeficiency Virus Infections — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), SARS-associated coronavirus[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), viral, virus (broncho) (interstitial) (lobar), SARS-associated coronavirus[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Syndrome, severe acute respiratory (SARS)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (9)

• J12 — Viral pneumonia, not elsewhere classified[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• J12.0 — Adenoviral pneumonia[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• J12.1 — Respiratory syncytial virus pneumonia[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• J12.2 — Parainfluenza virus pneumonia[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• J12.3 — Human metapneumovirus pneumonia[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• J12.8 — Other viral pneumonia[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• J12.82 — Pneumonia due to coronavirus disease 2019[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• J12.89 — Other viral pneumonia[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 1 more

Change history

• FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Relevant guides

• How Do I Code Pneumonia? Organism, Influenza First, Aspiration, and Ventilator-Associated →

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data

CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page

Coding guidelines Official source data

ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page

Claim edits Official source data

CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page

Inpatient payment groups Official source data

CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page

Change history and date-of-service validity Official source data

CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page

Comparisons, relationships and the contextual map MedCoder structured relationship

Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears

Summary and FAQ answers MedCoder explanation

Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Nearest Codes in This Family

Official ICD-10-CM classifications closest to J12.81 in its code family, with their registry titles.

• J12 — Viral pneumonia, not elsewhere classified
• J12.0 — Adenoviral pneumonia
• J12.1 — Respiratory syncytial virus pneumonia
• J12.2 — Parainfluenza virus pneumonia
• J12.3 — Human metapneumovirus pneumonia
• J12.8 — Other viral pneumonia
• J12.82 — Pneumonia due to coronavirus disease 2019
• J12.89 — Other viral pneumonia
• J12.9 — Viral pneumonia, unspecified

View all codes in the J12 family