Valid for Submission
J11.00 is a billable diagnosis code used to specify a medical diagnosis of influenza due to unidentified influenza virus with unspecified type of pneumonia. The code J11.00 is valid during the fiscal year 2022 from October 01, 2021 through September 30, 2022 for the submission of HIPAA-covered transactions.
The ICD-10-CM code J11.00 might also be used to specify conditions or terms like pneumonia and influenza or pneumonia due to influenza.
Unspecified diagnosis codes like J11.00 are acceptable when clinical information is unknown or not available about a particular condition. Although a more specific code is preferable, unspecified codes should be used when such codes most accurately reflect what is known about a patient's condition. Specific diagnosis codes should not be used if not supported by the patient's medical record.
Tabular List of Diseases and Injuries
The Tabular List of Diseases and Injuries is a list of ICD-10 codes, organized "head to toe" into chapters and sections with coding notes and guidance for inclusions, exclusions, descriptions and more. The following references are applicable to the code J11.00:
Inclusion TermsInclusion Terms
These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
- Influenza with pneumonia NOS
Index to Diseases and Injuries
The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10 code(s). The following references for the code J11.00 are found in the index:
The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:
- Pneumonia and influenza
- Pneumonia due to influenza
Diagnostic Related Groups - MS-DRG Mapping
|MS-DRG||MS-DRG Title||MCD||Relative Weight|
|177||RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC||04||1.8453|
|178||RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC||04||1.2059|
|179||RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC||04||0.8711|
The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.
Convert J11.00 to ICD-9 Code
The General Equivalency Mapping (GEM) crosswalk indicates an approximate mapping between the ICD-10 code J11.00 its ICD-9 equivalent. The approximate mapping means there is not an exact match between the ICD-10 code and the ICD-9 code and the mapped code is not a precise representation of the original code.
Information for Patients
What is the flu?
The flu, also called influenza, is a respiratory infection caused by viruses. Each year, millions of Americans get sick with the flu. Sometimes it causes mild illness. But it can also be serious or even deadly, especially for people over 65, newborn babies, and people with certain chronic illnesses.
What causes the flu?
The flu is caused by flu viruses that spread from person to person. When someone with the flu coughs, sneezes, or talks, they spray tiny droplets. These droplets can land in the mouths or noses of people who are nearby. Less often, a person may get flu by touching a surface or object that has flu virus on it and then touching their own mouth, nose, or possibly their eyes.
What are the symptoms of the flu?
Symptoms of the flu come on suddenly and may include
- Fever or feeling feverish/chills
- Sore throat
- Runny or stuffy nose
- Muscle or body aches
- Fatigue (tiredness)
Some people may also have vomiting and diarrhea. This is more common in children.
Sometimes people have trouble figuring out whether they have a cold or the flu. There are differences between them. The symptoms of a cold usually come on more slowly and are less severe than symptoms of the flu. Colds rarely cause a fever or headaches.
Sometimes people say that they have a "flu" when they really have something else. For example, "stomach flu" isn't the flu; it's gastroenteritis.
What other problems can the flu cause?
Some people who get the flu will develop complications. Some of these complications can be serious or even life-threatening. They include
- Ear infection
- Sinus infection
- Inflammation of the heart (myocarditis), brain (encephalitis), or muscle tissues (myositis, rhabdomyolysis)
The flu also can make chronic health problems worse. For example, people with asthma may have asthma attacks while they have flu.
Certain people are more likely to have complications from the flu, including
- Adults 65 and older
- Pregnant women
- Children younger than 5
- People with certain chronic health conditions, such as asthma, diabetes, and heart disease
How is the flu diagnosed?
To diagnose the flu, health care providers will first do a medical history and ask about your symptoms. There are several tests for the flu. For the tests, your provider will swipe the inside of your nose or the back of your throat with a swab. Then the swab will be tested for the flu virus.
Some tests are quick and give results in 15-20 minutes. But these tests are not as accurate as other flu tests. These other tests can give you the results in one hour or several hours.
What are the treatments for the flu?
Most people with the flu recover on their own without medical care. People with mild cases of the flu should stay home and avoid contact with others, except to get medical care.
But if you have symptoms of flu and are in a high risk group or are very sick or worried about your illness, contact your health care provider. You might need antiviral medicines to treat your flu. Antiviral medicines can make the illness milder and shorten the time you are sick. They also can prevent serious flu complications. They usually work best when you start taking them within 2 days of getting sick.
Can the flu be prevented?
The best way to prevent the flu is to get flu vaccine every year. But it's also important to have good health habits like covering your cough and washing your hands often. This can help stop the spread of germs and prevent the flu.
Centers for Disease Control and Prevention
[Learn More in MedlinePlus]
What is pneumonia?
Pneumonia is an infection in one or both of the lungs. It causes the air sacs of the lungs to fill up with fluid or pus. It can range from mild to severe, depending on the type of germ causing the infection, your age, and your overall health.
What causes pneumonia?
Bacterial, viral, and fungal infections can cause pneumonia.
Bacteria are the most common cause. Bacterial pneumonia can occur on its own. It can also develop after you've had certain viral infections such as a cold or the flu. Several different types of bacteria can cause pneumonia, including
- Streptococcus pneumoniae
- Legionella pneumophila; this pneumonia is often called Legionnaires' disease
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- Haemophilus influenzae
Viruses that infect the respiratory tract may cause pneumonia. Viral pneumonia is often mild and goes away on its own within a few weeks. But sometimes it is serious enough that you need to get treatment in a hospital. If you have viral pneumonia, you are at risk of also getting bacterial pneumonia. The different viruses that can cause pneumonia include
- Respiratory syncytial virus (RSV)
- Some common cold and flu viruses
- SARS-CoV-2, the virus that causes COVID-19
Fungal pneumonia is more common in people who have chronic health problems or weakened immune systems. Some of the types include
- Pneumocystis pneumonia (PCP)
- Coccidioidomycosis, which causes valley fever
Who is at risk for pneumonia?
Anyone can get pneumonia, but certain factors can increase your risk:
- Age; the risk is higher for children who are age 2 and under and adults age 65 and older
- Exposure to certain chemicals, pollutants, or toxic fumes
- Lifestyle habits, such as smoking, heavy alcohol use, and malnourishment
- Being in a hospital, especially if you are in the ICU. Being sedated and/or on a ventilator raises the risk even more.
- Having a lung disease
- Having a weakened immune system
- Have trouble coughing or swallowing, from a stroke or other condition
- Recently being sick with a cold or the flu
What are the symptoms of pneumonia?
The symptoms of pneumonia can range from mild to severe and include
- Cough, usually with phlegm (a slimy substance from deep in your lungs)
- Shortness of breath
- Chest pain when you breathe or cough
- Nausea and/or vomiting
The symptoms can vary for different groups. Newborns and infants may not show any signs of the infection. Others may vomit and have a fever and cough. They might seem sick, with no energy, or be restless.
Older adults and people who have serious illnesses or weak immune systems may have fewer and milder symptoms. They may even have a lower than normal temperature. Older adults who have pneumonia sometimes have sudden changes in mental awareness.
What other problems can pneumonia cause?
Sometimes pneumonia can cause serious complications such as
- Bacteremia, which happens when the bacteria move into the bloodstream. It is serious and can lead to septic shock.
- Lung abscesses, which are collections of pus in cavities of the lungs
- Pleural disorders, which are conditions that affect the pleura. The pleura is the tissue that covers the outside of the lungs and lines the inside of your chest cavity.
- Kidney failure
- Respiratory failure
How is pneumonia diagnosed?
Sometimes pneumonia can be hard to diagnose. This is because it can cause some of the same symptoms as a cold or the flu. It may take time for you to realize that you have a more serious condition.
Your health care provider may use many tools to make a diagnosis:
- A medical history, which includes asking about your symptoms
- A physical exam, including listening to your lungs with a stethoscope
- Various tests, such as
- A chest x-ray
- Blood tests such as a complete blood count (CBC) to see if your immune system is actively fighting an infection
- A Blood culture to find out whether you have a bacterial infection that has spread to your bloodstream
If you are in the hospital, have serious symptoms, are older, or have other health problems, you may also have more tests, such as
- Sputum test, which checks for bacteria in a sample of your sputum (spit) or phlegm (slimy substance from deep in your lungs).
- Chest CT scan to see how much of your lungs is affected. It may also show if you have complications such as lung abscesses or pleural effusions.
- Pleural fluid culture, which checks for bacteria in a fluid sample that was taken from the pleural space
- Pulse oximetry or blood oxygen level test, to check how much oxygen is in your blood
- Bronchoscopy, a procedure used to look inside your lungs' airways
What are the treatments for pneumonia?
Treatment for pneumonia depends on the type of pneumonia, which germ is causing it, and how severe it is:
- Antibiotics treat bacterial pneumonia and some types of fungal pneumonia. They do not work for viral pneumonia.
- In some cases, your provider may prescribe antiviral medicines for viral pneumonia
- Antifungal medicines treat other types of fungal pneumonia
You may need to be treated in a hospital if your symptoms are severe or if you are at risk for complications. While there, you may get additional treatments. For example, if your blood oxygen level is low, you may receive oxygen therapy.
It may take time to recover from pneumonia. Some people feel better within a week. For other people, it can take a month or more.
Can pneumonia be prevented?
Vaccines can help prevent pneumonia caused by pneumococcal bacteria or the flu virus. Having good hygiene, not smoking, and having a healthy lifestyle may also help prevent pneumonia.
NIH: National Heart, Lung, and Blood Institute
[Learn More in MedlinePlus]