J12 — Viral pneumonia, not elsewhere classified
J12 is a non-billable header ICD-10-CM code for viral pneumonia, not elsewhere classified. It cannot be billed on its own: choose one of the more specific child codes below.
Excludes2 — not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
- aspiration pneumonia due to anesthesia during labor and delivery (O74.0)
- aspiration pneumonia due to anesthesia during pregnancy (O29)
- aspiration pneumonia due to anesthesia during puerperium (O89.0)
- aspiration pneumonia due to solids and liquids (J69.-)
- aspiration pneumonia NOS (J69.0)
- congenital pneumonia (P23.0)
- congenital rubella pneumonitis (P35.0)
- interstitial pneumonia NOS (J84.9)
- lipid pneumonia (J69.1)
- neonatal aspiration pneumonia (P24.-)
Code first
The underlying condition must be sequenced before this code.
Code also
Both codes may be needed to describe the encounter fully. Sequencing depends on the reason for the visit.
- associated abscess, if applicable (J85.1)
Includes
Conditions this code covers.
- bronchopneumonia due to viruses other than influenza viruses
Other codes that can never be billed with J12
These codes carry an Excludes1 note pointing at J12. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading J12 alone.
Risk adjustment
J12 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Code to one of these instead J12
6 child codes. Green means billable.
Questions about J12
- Is J12 a billable ICD-10-CM code?
- No. J12 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
- Where does J12 sit in the tabular list?
- Diseases of the respiratory system (J00-J99), in the block Influenza and pneumonia (J09-J18).