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J95.851 ICD-10-CM Code: Ventilator associated pneumonia

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

Coding at a Glance

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 205 — OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC (MDC 04)
  • MS-DRG 206 — OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC (MDC 04)
  • MS-DRG 791 — PREMATURITY WITH MAJOR PROBLEMS (MDC 15)
  • MS-DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)

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.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 211 — Respirator Dependence/Tracheostomy Status/Complications (supersedes HCC 212, HCC 213)

Other models: CMS-HCC V22 HCC 114

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for J95.851 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 J95.851 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Ventilator associated pneumonitis

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).

Excludes2 — Not Included Here

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

Source: inherited from J95

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code to identify the organism, if known (B95.-, B96.-, B97.-)

Coder workflow for J95.851

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

Before you code J95.851

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with J95.851. 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 J95.851’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.

    ReviewP27.8

Consider J95.851. 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).
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 J95.851(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with J95.851: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareP27.8

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

  • Excludes2 — not part of J95.851(4 notes)

    Coding workflow: The conditions named in this note are not included in J95.851. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareJ69, T81.82, J18.2

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

  • Use Additional Code — after identifying J95.851(1 note)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with J95.851 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewB95, B96, B97

    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 J95.851 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).

ReviewP27.8

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

Coding question: Is a second code reported with J95.851?

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).

ReviewB95, B96, B97

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

Ventilator associated pneumonia is a billable ICD-10-CM diagnosis code (J95.851).

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 (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.

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.

Chapter 10: Diseases of the Respiratory System (J00-J99), U07.0 a. Chronic Obstructive Pulmonary Disease [COPD] and Asthma 1) Acute exacerbation of chronic obstructive bronchitis and asthma

Code J95.851, Ventilator associated pneumonia, should be assigned only when the provider has documented ventilator associated pneumonia (VAP). An additional code to identify the organism (e.g., Pseudomonas aeruginosa, code B96.5) should also be assigned. Do not assign an additional code from categories J12-J18 to identify the type of pneumonia.

Chapter 10: Diseases of the Respiratory System (J00-J99), U07.0 a. Chronic Obstructive Pulmonary Disease [COPD] and Asthma 1) Acute exacerbation of chronic obstructive bronchitis and asthma

Code J95.851 should not be assigned for cases where the patient has pneumonia and is on a mechanical ventilator and the provider has not specifically stated that the pneumonia is ventilator-associated pneumonia. If the documentation is unclear as to whether the patient has a pneumonia that is a complication attributable to the mechanical ventilator, query the provider.

Chapter 10: Diseases of the Respiratory System (J00-J99), U07.0 a. Chronic Obstructive Pulmonary Disease [COPD] and Asthma 1) Acute exacerbation of chronic obstructive bronchitis and asthma

2) Ventilator associated Pneumonia Develops after Admission A patient may be admitted with one type of pneumonia (e.g., code J13, Pneumonia due to Streptococcus pneumonia) and subsequently develop VAP. In this instance, the principal diagnosis would be the appropriate code from categories J12-J18 for the pneumonia diagnosed at the time of admission. Code J95.851, Ventilator associated pneumonia, would be assigned as an additional diagnosis when the provider has also documented the presence of ventilator associated pneumonia.

Decision Points

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

  1. 1 Use Additional Code instruction — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
  2. 1 Excludes1 entry — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  3. 4 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

  • 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 J95.851 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 21 Excludes2 notes across 2 chapters: J09 — Influenza due to certain identified influenza viruses, J09-J18 — Influenza and pneumonia (J09-J18), J10 — Influenza due to other identified influenza virus, J11 — Influenza due to unidentified influenza virus, J12 — Viral pneumonia, not elsewhere classified, J13 — Pneumonia due to Streptococcus pneumoniae, J14 — Pneumonia due to Hemophilus influenzae, J15 — Bacterial pneumonia, not elsewhere classified, J16 — Pneumonia due to other infectious organisms, not elsewhere classified, J17 — Pneumonia in diseases classified elsewhere, J18 — Pneumonia, unspecified organism, T80 — Complications following infusion, transfusion and therapeutic injection, T80-T88 — Complications of surgical and medical care, not elsewhere classified (T80-T88), T81 — Complications of procedures, not elsewhere classified, T82 — Complications of cardiac and vascular prosthetic devices, implants and grafts, T83 — Complications of genitourinary prosthetic devices, implants and grafts, T84 — Complications of internal orthopedic prosthetic devices, implants and grafts, T85 — Complications of other internal prosthetic devices, implants and grafts, T86 — Complications of transplanted organs and tissue, T87 — Complications peculiar to reattachment and amputation, +1 more.

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

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 53 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 4 MS-DRGs: DRG 205 (MDC 04), DRG 206 (MDC 04), DRG 791 (MDC 15), DRG 793 (MDC 15).

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); RSP002 — Pneumonia (except that caused by tuberculosis).

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.

H95.811 — Postprocedural stenosis of right external ear canal, H95.812 — Postprocedural stenosis of left external ear canal, H95.813 — Postprocedural stenosis of external ear canal, bilateral, H95.819 — Postprocedural stenosis of unspecified external ear canal, H95.88 — Other intraoperative complications and disorders of the ear and mastoid process, not elsewhere classified, H95.89 — Other postprocedural complications and disorders of the ear and mastoid process, not elsewhere classified, I97.3 — Postprocedural hypertension, J95.4 — Chemical pneumonitis due to anesthesia, J95.5 — Postprocedural subglottic stenosis, J95.84 — Transfusion-related acute lung injury (TRALI), J95.859 — Other complication of respirator [ventilator], J95.88 — Other intraoperative complications of respiratory system, not elsewhere classified, J95.89 — Other postprocedural complications and disorders of respiratory system, not elsewhere classified, L76.81 — Other intraoperative complications of skin and subcutaneous tissue, L76.82 — Other postprocedural complications of skin and subcutaneous tissue, M96.89 — Other intraoperative and postprocedural complications and disorders of the musculoskeletal system, N98.1 — Hyperstimulation of ovaries, N98.2 — Complications of attempted introduction of fertilized ovum following in vitro fertilization, N98.3 — Complications of attempted introduction of embryo in embryo transfer, N98.8 — Other complications associated with artificial fertilization, +32 more

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Respirator Dependence/Tracheostomy Status/Complications) for risk-adjusted payment.

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, J95.850 — Mechanical complication of respirator, J95.859 — Other complication of respirator [ventilator], Z43.0 — Encounter for attention to tracheostomy, Z93.0 — Tracheostomy status, Z99.11 — Dependence on respirator [ventilator] status, Z99.12 — Encounter for respirator [ventilator] dependence during power failure

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Respiratory Arrest, Cardio-Respiratory Failure and Shock

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Postprocedural or postoperative respiratory system complication, Pneumonia (except that caused by tuberculosis)).

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, J95.84 — Transfusion-related acute lung injury (TRALI), J95.850 — Mechanical complication of respirator, J95.859 — Other complication of respirator [ventilator], J95.860 — Postprocedural hematoma of a respiratory system organ or structure following a respiratory system procedure, J95.861 — Postprocedural hematoma of a respiratory system organ or structure following other procedure, J95.862 — Postprocedural seroma of a respiratory system organ or structure following a respiratory system procedure, J95.863 — Postprocedural seroma of a respiratory system organ or structure following other procedure, J95.87 — Transfusion-associated dyspnea (TAD), J95.88 — Other intraoperative complications of respiratory system, not elsewhere classified, J95.89 — Other postprocedural complications and disorders of respiratory system, not elsewhere classified, +79 more

Same Index main term, other category

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

J84.113 — Idiopathic non-specific interstitial pneumonitis (interstitial, non-specific, idiopathic), J84.114 — Acute interstitial pneumonitis (interstitial, acute), J84.116 — Cryptogenic organizing pneumonia (cryptogenic organizing), J84.117 — Desquamative interstitial pneumonia (desquamative interstitial), J84.178 — Other interstitial pulmonary diseases with fibrosis in diseases classified elsewhere (interstitial, lymphocytic), J84.2 — Lymphoid interstitial pneumonia (lymphoid interstitial), J84.89 — Other specified interstitial pulmonary diseases (organizing), J84.9 — Interstitial pulmonary disease, unspecified (interstitial), J85.0 — Gangrene and necrosis of lung (necrotic), J85.1 — Abscess of lung with pneumonia (with, lung abscess), J98.4 — Other disorders of lung, O29.01 — Aspiration pneumonitis due to anesthesia during pregnancy (postanesthetic, in pregnancy), O74.0 — Aspiration pneumonitis due to anesthesia during labor and delivery (aspiration, obstetric), O89.01 — Aspiration pneumonitis due to anesthesia during the puerperium (postanesthetic, postpartum, puerperal), P23.0 — Congenital pneumonia due to viral agent (viral, virus, congenital), P23.1 — Congenital pneumonia due to Chlamydia (chlamydial, congenital), P23.2 — Congenital pneumonia due to staphylococcus (congenital, due to, Staphylococcus), P23.3 — Congenital pneumonia due to streptococcus, group B (congenital, due to, Streptococcus, group B), P23.4 — Congenital pneumonia due to Escherichia coli (congenital, due to, Escherichia coli), P23.5 — Congenital pneumonia due to Pseudomonas (congenital, due to, Pseudomonas), +100 more

Contextual Map

Every relationship of J95.851 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 J95.851 with these 12 related codes in Claim Check

Hierarchy

Excludes1

Use Additional Code

Referenced by Excludes2 notes (21)

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 211 — Respirator Dependence/Tracheostomy Status/Complications [CMS-HCC]: “Respirator Dependence/Tracheostomy Status/Complications — supersedes HCC 212 (Respiratory Arrest), HCC 213 (Cardio-Respiratory Failure and Shock)”— CMS-HCC V28 · 2026

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. 3,998 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026
  • 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 · FY2026

Index entries

  • Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), ventilator associated[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Pneumonitis (acute) (primary), due to, ventilator[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Pneumonitis (acute) (primary), ventilator associated[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

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

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
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release 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. "J95.851 — Ventilator associated pneumonia." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/j95.851-ventilator-associated-pneumonia

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Ventilator associated pneumonia

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 J95.851 in its code family, with their registry titles.

View all codes in the J95 family