J81.0 — Acute pulmonary edema
J81.0 is a billable, specific ICD-10-CM code for acute pulmonary edema. It is valid for submission on a claim.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Acute edema of lung
Risk adjustment
J81.0 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 213 Cardio-Respiratory Failure and Shock0.370 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.
Medicare coverage
J81.0 is named in 22 Medicare coverage policies — 20 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A56566Billing and Coding: Outpatient Physical and Occupational Therapy Servicesnot covered
- A57067Billing and Coding: Outpatient Physical and Occupational Therapy Servicesnot covered
- A55354Billing and Coding: Frequency of Hemodialysis
- A55672Billing and Coding: Frequency of Hemodialysis
How J81.0 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to J81.0.
- Edema, edematous›lung›acute
Related codes at this level
Codes that share J81. If J81.0 is not quite right, the correct code is usually one of these.
Questions about J81.0
- Is J81.0 a billable ICD-10-CM code?
- Yes. J81.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does J81.0 sit in the tabular list?
- Diseases of the respiratory system (J00-J99), in the block Other respiratory diseases principally affecting the interstitium (J80-J84).