ICD-10 J11.00
Billable / Specific MCCInfluenza due to unidentified influenza virus with unspecified type of pneumonia
About ICD-10-CM J11.00
ICD-10-CM code J11.00 represents Influenza due to unidentified influenza virus with unspecified type of pneumonia. This is a billable/specific code in the Respiratory System chapter (block J11). The 2026 edition of ICD-10-CM J11.00 became effective on October 1, 2025.
Coding Tips for J11.00
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
J11.00 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under J11.00. Per CMS ICD-10-CM Tabular 2026.
- Influenza with pneumonia NOS
Inpatient DRG Impact, MCC
codes Influenza due to unidentified influenza virus with unspecified type of pneumonia. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for J11.00
Local Coverage Determinations (LCDs) from CMS MACs that list J11.00 as a covered diagnosis.
Showing top 10 of 47 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing J11.00.
5 Medicare
CPT Codes Commonly Billed with J11.00
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert J11.00 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| J11.00 | 4870 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To J11.00
Other codes in section J09-J18 (Influenza and pneumonia).
ICD-10 J11.00, Billing FAQ
Is ICD-10 code J11.00 billable? +
Yes, J11.00 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to J11.00? +
ICD-10 J11.00 includes: Influenza with pneumonia NOS.
Is J11.00 a CC or MCC for inpatient DRG? +
Yes, this code is designated as MCC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does J11.00 map to? +
Per CMS GEMs, J11.00 maps to ICD-9 codes: 4870. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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