J81.1 — Chronic pulmonary edema
J81.1 is a billable, specific ICD-10-CM code for chronic 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.
- Pulmonary congestion (chronic) (passive)
- Pulmonary edema NOS
Risk adjustment
J81.1 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.
Medicare coverage
J81.1 is named in 11 Medicare coverage policies — 11 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A53058Billing and Coding: Home Health Physical Therapy
- A53065Billing and Coding: Outpatient Physical Therapy
- A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
- A56605Billing and Coding: B-type Natriuretic Peptide (BNP) Testing
How J81.1 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 J81.1.
- Edema, edematous›lung
- Edema, edematous›lung›chronic
Related codes at this level
Codes that share J81. If J81.1 is not quite right, the correct code is usually one of these.
Questions about J81.1
- Is J81.1 a billable ICD-10-CM code?
- Yes. J81.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does J81.1 sit in the tabular list?
- Diseases of the respiratory system (J00-J99), in the block Other respiratory diseases principally affecting the interstitium (J80-J84).