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J81 ICD-10-CM Code: Pulmonary edema

Compare with another code for J81Check this code on a claim

Billing Status: NO. This is a non-billable ICD-10-CM code: report a more specific billable code beneath it.

Coding at a Glance

Official instructions
6 Excludes1 · 6 use-additional instructions

What these terms mean →

Category · FY2027A non-billable heading in the tabular list: report a more specific code beneath it.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too, and is marked with where it comes from.

Use additional codeReport with this code when documented
  • Use additional code to identify:
  • exposure to environmental tobacco smoke (Z77.22)
  • history of tobacco dependence (Z87.891)
  • occupational exposure to environmental tobacco smoke (Z57.31)

+2 more in Instructions

Excludes1Not reported with this code unless documented as unrelated
  • chemical (acute) pulmonary edema (J68.1)
  • hypostatic pneumonia (J18.2)
  • passive pneumonia (J18.2)
  • pulmonary edema due to external agents (J60-J70)

+2 more in Instructions

Where it sits Source: CMS/NCHS

Under:Chapter 10: Diseases of the Respiratory SystemJ80-J84 Other respiratory diseases principally affecting the interstitium

Codes under J81 (2)

  • J81.0Acute pulmonary edemaBillable
  • J81.1Chronic pulmonary edemaBillable

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for J81 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional 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)

Coder workflow for J81

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

Before you code J81

  1. J81 is not reportable as written. Select the more specific code beneath it that the documentation supports. Codes are reported to the highest level of specificity the classification provides (Guidelines I.B.2).

    ReviewJ81.0, J81.1

    See the relationships section · Guide: How to choose an ICD-10-CM code →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with the code beneath J81. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support one of the more specific codes beneath J81?
    Yes → Select that code and continue the checks below on its own page.
    No → J81 cannot be reported as written. Where the codes beneath it include an unspecified code, that code applies when the record goes no further; otherwise query for the missing detail.

    ReviewJ81.0, J81.1

  2. Does the documentation support a condition named in J81’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewJ68.1, J18.2, I50.1

Report the code beneath J81 that the documentation supports, not J81 itself. Then work the Use Additional Code note, and confirm that code is valid for the date of service on its own page.

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 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

  • Excludes1 — check before selecting J81(6 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with J81: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareJ68.1, J18.2, I50.1

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

  • Use Additional Code — after identifying J81(6 notes)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with J81 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewZ77.22, Z87.891, Z57.31, F17, Z72.0

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

Coding decision scenarios

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

Documentation: Both the condition J81 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewJ68.1, J18.2, I50.1

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with the code beneath J81?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

ReviewZ77.22, Z87.891, Z57.31, F17, Z72.0

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.

Don’t confuse J81 with…

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

The codes most likely to be picked instead of J81 — 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.

  • J68.1— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of chemical (acute) pulmonary edema moves the case to J68.1; the two are not reported together unless documented as unrelated.

    Full comparison: J81 vs J68.1 →

  • J18.2— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of hypostatic pneumonia moves the case to J18.2; the two are not reported together unless documented as unrelated.

    Full comparison: J81 vs J18.2 →

  • J60— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of pulmonary edema due to external agents moves the case to J60; the two are not reported together unless documented as unrelated.

    Full comparison: J81 vs J60 →

  • J70— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of pulmonary edema due to external agents moves the case to J70; the two are not reported together unless documented as unrelated.

    Full comparison: J81 vs J70 →

  • I50.1— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of pulmonary edema with heart disease NOS moves the case to I50.1; the two are not reported together unless documented as unrelated.

    Full comparison: J81 vs I50.1 →

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.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Pulmonary edema is a non-billable ICD-10-CM category code (J81). A more specific billable subcode must be selected for claims submission.

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Verify Before Coding

  • Not billable as written — a more specific code is required: J81.0, J81.1.

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-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name J81 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 3 Excludes1 notes across 3 chapters: I50.1 — Left ventricular failure, unspecified, J68.1 — Pulmonary edema due to chemicals, gases, fumes and vapors, R60 — Edema, not elsewhere classified.

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

Contextual Map

Every relationship of J81 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 J81 with these 15 related codes in Claim Check

Hierarchy

Excludes1 (14)

Use Additional Code

Referenced by Excludes1 notes

Nearest codes

Change history

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

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

Common coding questions

MedCoder editorial

Can J81 be billed directly?

No. J81 (Pulmonary edema) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

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 FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) 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-derived 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 editorial 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.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "J81 — Pulmonary edema." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/j81-pulmonary-edema

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Pulmonary edema

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to J81 in its code family, with their registry titles.