ICD-10 J81.0
Billable / Specific HCC v28: 84 MCCAcute pulmonary edema
About ICD-10-CM J81.0
ICD-10-CM code J81.0 represents Acute pulmonary edema. This is a billable/specific code in the Respiratory System chapter (block J81). The 2026 edition of ICD-10-CM J81.0 became effective on October 1, 2025.
Coding Tips for J81.0
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
J81.0 is a CMS-HCC v28 risk-adjustment code (category 84). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
J81.0 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 J81.0. Per CMS ICD-10-CM Tabular 2026.
- Acute edema of lung
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, MCC
codes Acute pulmonary edema. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for J81.0
Local Coverage Determinations (LCDs) from CMS MACs that list J81.0 as a covered diagnosis.
Showing top 10 of 334 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing J81.0.
1 Aetna
1 Cigna
5 Medicare
CPT Codes Commonly Billed with J81.0
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 90999 CMS LCD: Billing and Coding: Frequency of Hemodialysis CMS LCD
Convert J81.0 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 |
|---|---|---|
| J81.0 | 5184 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To J81.0
Other codes in section J80-J84 (Other respiratory diseases principally affecting the interstitium).
ICD-10 J81.0, Billing FAQ
Is ICD-10 code J81.0 billable? +
Yes, J81.0 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 J81.0? +
ICD-10 J81.0 includes: Acute edema of lung.
Does J81.0 affect Medicare Advantage HCC risk adjustment? +
Yes. J81.0 maps to CMS-HCC v28 category 84. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is J81.0 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 CPT codes are commonly billed with J81.0? +
Procedures frequently paired with J81.0 include: 90999.
What ICD-9 codes does J81.0 map to? +
Per CMS GEMs, J81.0 maps to ICD-9 codes: 5184. 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 June 1, 2026.
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