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J81.1 ICD-10-CM Code: Chronic pulmonary edema

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
2 inclusion terms · 6 Excludes1 · 6 use-additional codes

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 189 — PULMONARY EDEMA AND RESPIRATORY FAILURE (MDC 04)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for J81.1 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 J81.1 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Pulmonary congestion (chronic) (passive)
  • Pulmonary edema NOS

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).

Source: inherited from J81

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)

Source: inherited from J81

Coder workflow for J81.1

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

Before you code J81.1

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with J81.1. 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 a condition named in J81.1’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

Consider J81.1. Then work the Use Additional Code 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).
Acuity
Acute or chronic as documented; when both are documented and separate codes exist, both are reported with the acute code first (Guidelines I.B.8).
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 J81.1(6 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with J81.1: 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 J81.1(6 notes)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with J81.1 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 J81.1 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 J81.1?

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.

Code Overview

Chronic pulmonary edema is a billable ICD-10-CM diagnosis code (J81.1).

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

Indexed Clinical Terms (2)

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.

Verify Before Coding

  • CC 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 J81.1 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 (via J81.-), J68.1 — Pulmonary edema due to chemicals, gases, fumes and vapors (via J81.-), R60 — Edema, not elsewhere classified (via J81.-).

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

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: CC — 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 12 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 1 MS-DRG: DRG 189 (MDC 04).

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

Clinical classification (AHRQ CCSR):RSP016 — Other specified and unspecified lower respiratory disease (default).

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 CC — 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.

J18.2 — Hypostatic pneumonia, unspecified organism, J22 — Unspecified acute lower respiratory infection, J98.4 — Other disorders of lung, J98.8 — Other specified respiratory disorders, J98.9 — Respiratory disorder, unspecified, N80.B1 — Endometriosis of pleura, N80.B2 — Endometriosis of lung, N80.B31 — Superficial endometriosis of diaphragm, N80.B32 — Deep endometriosis of diaphragm, N80.B39 — Endometriosis of diaphragm, unspecified depth, R91.1 — Solitary pulmonary nodule

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Other specified and unspecified lower respiratory disease).

B42.0 — Pulmonary sporotrichosis, B44.0 — Invasive pulmonary aspergillosis, B44.1 — Other pulmonary aspergillosis, B45.0 — Pulmonary cryptococcosis, B46.0 — Pulmonary mucormycosis, B67.1 — Echinococcus granulosus infection of lung, J18.2 — Hypostatic pneumonia, unspecified organism, J22 — Unspecified acute lower respiratory infection, J4A.0 — Restrictive allograft syndrome, J81.0 — Acute pulmonary edema, J82 — Pulmonary eosinophilia, not elsewhere classified, J82.81 — Chronic eosinophilic pneumonia, J82.82 — Acute eosinophilic pneumonia, J82.83 — Eosinophilic asthma, J82.89 — Other pulmonary eosinophilia, not elsewhere classified, J84.01 — Alveolar proteinosis, J84.02 — Pulmonary alveolar microlithiasis, J84.03 — Idiopathic pulmonary hemosiderosis, J84.09 — Other alveolar and parieto-alveolar conditions, J84.10 — Pulmonary fibrosis, unspecified, +59 more

Same Index main term, other category

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

I87.1 — Compression of vein (legs, due to venous obstruction), I89.0 — Lymphedema, not elsewhere classified (lymphatic), I97.2 — Postmastectomy lymphedema syndrome (lymphatic, due to mastectomy), J38.4 — Edema of larynx (glottis, glottic, glottidis), J39.2 — Other diseases of pharynx (pharynx), J68.1 — Pulmonary edema due to chemicals, gases, fumes and vapors (lung, chemical), J70.0 — Acute pulmonary manifestations due to radiation (lung, due to, radiation), J70.1 — Chronic and other pulmonary manifestations due to radiation (lung, chronic, due to, radiation), J70.8 — Respiratory conditions due to other specified external agents (lung, due to, external agent, specified NEC), J70.9 — Respiratory conditions due to unspecified external agent (lung, due to, external agent), K86.89 — Other specified diseases of pancreas (pancreas), N44.8 — Other noninflammatory disorders of the testis (testis), N48.89 — Other specified disorders of penis (penis), N50.89 — Other specified disorders of the male genital organs (scrotum), N88.8 — Other specified noninflammatory disorders of cervix uteri (cervix), N90.89 — Other specified noninflammatory disorders of vulva and perineum (vulva), O90.89 — Other complications of the puerperium, not elsewhere classified (cervix, puerperal, postpartum), P11.0 — Cerebral edema due to birth injury (brain, due to birth injury), P29.0 — Neonatal cardiac failure (lung, with heart condition or failure, newborn), P52.4 — Intracerebral (nontraumatic) hemorrhage of newborn (brain, newborn), +34 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.

Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of J81.1 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 J81.1 with these 3 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Clinical classification (CCSR)

MS-DRG Grouper

  • CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2026
  • DRG 189 — PULMONARY EDEMA AND RESPIRATORY FAILURE[MS-DRG]: “PULMONARY EDEMA AND RESPIRATORY FAILURE (MDC 04)”— 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

Index entries

  • Edema, edematous (infectious) (pitting) (toxic), lung[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Edema, edematous (infectious) (pitting) (toxic), lung, chronic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes

Change history

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

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
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

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. "J81.1 — Chronic pulmonary edema." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/j81.1-chronic-pulmonary-edema

Change history

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

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), 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 J81.1 in its code family, with their registry titles.

View all codes in the J81 family