ICD-10 J81
Non-Billable HeaderPulmonary edema
About ICD-10-CM J81
ICD-10-CM code J81 represents Pulmonary edema. This is a non-billable header code in the Respiratory System chapter (block J81). The 2026 edition of ICD-10-CM J81 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Type 1 Excludes
Pure excludes, these codes can never be coded together with J81. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- chemical (acute) pulmonary edema (J68.1)
- hypostatic pneumonia (J18.2)
- passive pneumonia (J18.2)
- pulmonary edema due to external agents (J60-J70)
- pulmonary edema with heart disease NOS (I50.1)
- pulmonary edema with heart failure (I50.1)
Use Additional Code
When coding J81, also report these additional codes when applicable.
- 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)
Medicare LCD Coverage for J81
Local Coverage Determinations (LCDs) from CMS MACs that list J81 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing J81.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but J81 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with J81
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.
Codes Adjacent To J81
Other codes in section J80-J84 (Other respiratory diseases principally affecting the interstitium).
ICD-10 J81, Billing FAQ
Is ICD-10 code J81 billable? +
No, J81 is a non-billable header code. Use a more specific child code from block J81 when submitting claims.
What codes are Type 1 Excludes for J81? +
Type 1 Excludes (never code together with J81): chemical (acute) pulmonary edema (J68.1); hypostatic pneumonia (J18.2); passive pneumonia (J18.2)
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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