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J95.3 ICD-10-CM Code: Chronic pulmonary insufficiency following surgery

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

Coding at a Glance

Tabular directives
5 Excludes2
Risk adjustment
CMS-HCC V22 category 84

Billable · FY2027A valid, specific ICD-10-CM code, reportable for dates of service in FY2027.

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; the Instructions section marks which is which.

Excludes2Not included here; may be reported together
  • Functional disturbances following cardiac surgery (I97.0, I97.1-)
  • aspiration pneumonia (J69.-)
  • emphysema (subcutaneous) resulting from a procedure (T81.82)
  • hypostatic pneumonia (J18.2)

+1 more in Instructions

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

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 v44, Appendix B.

  • MS-DRG 189 — PULMONARY EDEMA AND RESPIRATORY FAILURE (MDC 04)
  • MS-DRG 791 — PREMATURITY WITH MAJOR PROBLEMS (MDC 15)
  • MS-DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)
  • MS-DRG 928 — FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC (MDC 22)
  • MS-DRG 929 — FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC (MDC 22)

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 J95.3 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

Notes without a marker are published on J95.3 itself; “inherited from” names the category or block whose note applies here.

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Coder workflow for J95.3

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

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).

Official instructions as workflow

  • Excludes2 — not part of J95.3(5 notes)

    Coding workflow: The conditions named in this note are not included in J95.3. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareI97.0, I97.1, J69, T81.82, J18.2

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

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 J95.3 with…

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

The codes most likely to be picked instead of J95.3 — 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.

  • I97.0— 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 Functional disturbances following cardiac surgery adds I97.0; it is not part of this code and both may be reported when both are documented.

    Full comparison: J95.3 vs I97.0 →

  • I97.1— 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 Functional disturbances following cardiac surgery adds I97.1; it is not part of this code and both may be reported when both are documented.

    Full comparison: J95.3 vs I97.1 →

  • 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 adds J69; it is not part of this code and both may be reported when both are documented.

    Full comparison: J95.3 vs J69 →

  • T81.82— 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 emphysema (subcutaneous) resulting from a procedure adds T81.82; it is not part of this code and both may be reported when both are documented.

    Full comparison: J95.3 vs T81.82 →

  • J18.2— 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 hypostatic pneumonia adds J18.2; it is not part of this code and both may be reported when both are documented.

    Full comparison: J95.3 vs J18.2 →

  • J70.0— 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 pulmonary manifestations due to radiation adds J70.0; it is not part of this code and both may be reported when both are documented.

    Full comparison: J95.3 vs J70.0 →

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.

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

Chronic pulmonary insufficiency following surgery is a billable ICD-10-CM diagnosis code (J95.3).

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

  • MCC as a secondary diagnosis (FY2027). 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-derived relationships — computed from published CMS and AHRQ datasets

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 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 12 clinically related codes on its CMS exclusion list. Does not count toward severity when the stay groups to DRGs 928-929 (Full Thickness Burn with Skin Graft or Inhalation Injury).

Named in the grouper logic of 5 MS-DRGs: DRG 189 (MDC 04), DRG 791 (MDC 15), DRG 793 (MDC 15), DRG 928 (MDC 22), DRG 929 (MDC 22).

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

Clinical classification (AHRQ CCSR):RSP017 — Postprocedural or postoperative respiratory system complication (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 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.

J22 — Unspecified acute lower respiratory infection, J95.1 — Acute pulmonary insufficiency following thoracic surgery, J95.2 — Acute pulmonary insufficiency following nonthoracic surgery, J95.821 — Acute postprocedural respiratory failure, J95.822 — Acute and chronic postprocedural respiratory failure, J98.8 — Other specified respiratory disorders, J98.9 — Respiratory disorder, unspecified, N80.B1 — Endometriosis of pleura, N80.B31 — Superficial endometriosis of diaphragm, N80.B32 — Deep endometriosis of diaphragm, N80.B39 — Endometriosis of diaphragm, unspecified depth

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Postprocedural or postoperative respiratory system complication).

J95.00 — Unspecified tracheostomy complication, J95.01 — Hemorrhage from tracheostomy stoma, J95.02 — Infection of tracheostomy stoma, J95.03 — Malfunction of tracheostomy stoma, J95.04 — Tracheo-esophageal fistula following tracheostomy, J95.09 — Other tracheostomy complication, J95.1 — Acute pulmonary insufficiency following thoracic surgery, J95.2 — Acute pulmonary insufficiency following nonthoracic surgery, J95.4 — Chemical pneumonitis due to anesthesia, J95.5 — Postprocedural subglottic stenosis, J95.61 — Intraoperative hemorrhage and hematoma of a respiratory system organ or structure complicating a respiratory system procedure, J95.62 — Intraoperative hemorrhage and hematoma of a respiratory system organ or structure complicating other procedure, J95.71 — Accidental puncture and laceration of a respiratory system organ or structure during a respiratory system procedure, J95.72 — Accidental puncture and laceration of a respiratory system organ or structure during other procedure, J95.811 — Postprocedural pneumothorax, J95.812 — Postprocedural air leak, J95.821 — Acute postprocedural respiratory failure, J95.822 — Acute and chronic postprocedural respiratory failure, J95.830 — Postprocedural hemorrhage of a respiratory system organ or structure following a respiratory system procedure, J95.831 — Postprocedural hemorrhage of a respiratory system organ or structure following other procedure, +11 more

Same Index main term, other category

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

I37.1 — Nonrheumatic pulmonary valve insufficiency (pulmonary, valve), I37.2 — Nonrheumatic pulmonary valve stenosis with insufficiency (pulmonary, valve, with stenosis), I38 — Endocarditis, valve unspecified (valve, valvular), I50.9 — Heart failure, unspecified (myocardial, myocardium), I67.81 — Acute cerebrovascular insufficiency (cerebrovascular), I73.9 — Peripheral vascular disease, unspecified (peripheral vascular), I77.1 — Stricture of artery (arterial), I87.2 — Venous insufficiency (chronic) (peripheral) (venous), I97.11 — Postprocedural cardiac insufficiency (cardiac, postprocedural), I99.8 — Other disorder of circulatory system (vascular), J98.4 — Other disorders of lung (pulmonary), K08.89 — Other specified disorders of teeth and supporting structures (anatomic crown height), K13.79 — Other lesions of oral mucosa (velopharyngeal, acquired), K22.89 — Other specified disease of esophagus (gastroesophageal), K31.89 — Other diseases of stomach and duodenum (pyloric), K55.059 — Acute (reversible) ischemia of intestine, part and extent unspecified (vascular, intestine, acute), K55.1 — Chronic vascular disorders of intestine (mesenteric), K55.9 — Vascular disorder of intestine, unspecified (vascular, intestine), K62.89 — Other specified diseases of anus and rectum (anus), K83.8 — Other specified diseases of biliary tract (biliary), +73 more

Contextual Map

Every relationship of J95.3 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 J95.3 with these 2 related codes in Claim Check

Hierarchy

Excludes2

Clinical classification (CCSR)

MS-DRG Grouper

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. 4,000 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027
  • MDC 15 — Newborns and Other Neonates with Conditions Originating in Perinatal Period[MDC crossing]: “Newborns and Other Neonates with Conditions Originating in Perinatal Period — 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 · FY2027

Index entries

  • Complication (s) (from) (of), respiratory system, postoperative, pulmonary insufficiency (acute) (after nonthoracic surgery), chronic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Complication (s) (from) (of), surgical procedure (on), pulmonary insufficiency (acute), chronic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Insufficiency, insufficient, pulmonary, chronic, following surgery[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Nearest codes (40)

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.

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.

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
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 — v44 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 20, 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. "J95.3 — Chronic pulmonary insufficiency following surgery." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/j95.3-chronic-pulmonary-insufficiency-following-surgery

Change history

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

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 J95.3 in its code family, with their registry titles.

View all codes in the J95 family