2027 ICD-10-CM Diagnosis Code J68.1Pulmonary edema due to chemicals, gases, fumes and vapors
ICD-10-CM Codes›J00–J99›J60-J70›J68
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 280
- Not Chronic
J68.1 is a billable ICD-10-CM diagnosis code for pulmonary edema due to chemicals, gases, fumes and vapors. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 189. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 125 closely related codes. Coders also document this condition as acute edema. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Lung disease due to external agents.
For Medicare Advantage risk adjustment, J68.1 maps to CMS-HCC Category 280 (Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders) under the V28 model, adding a risk factor of about 0.319 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
J68.1 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Acute edema
- Acute pulmonary edema
- Acute pulmonary edema caused by fume
- Acute pulmonary edema caused by vapor
- Chemical-induced pulmonary edema
- Oxygen-induced pulmonary edema
- Pulmonary edema caused by chemical fumes
- Respiratory condition caused by vapor
- Toxic pulmonary edema
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to J68.1: its own notes plus those printed at J68, block J60-J70, and Chapter 10. A note printed at a category, block or chapter applies to every code under it.
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Chemical pulmonary edema (acute) (chronic)
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- pulmonary edema (acute) (chronic) NOS (J81.-)
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- smoke inhalation (T59.81-)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Code First
The underlying condition named in the note is sequenced before this code.
Use Additional Code
Add a second code, after this one, to fully describe the condition.
- code to identify associated respiratory conditions, such as:
- acute respiratory failure (J96.0-)
Notes
General instructions on how these codes are used.
- When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name J68.1, its category, or a range that includes it.
Excludes1 3
These codes carry an Excludes1 note naming J68.1: they are not reported together with it, unless the two conditions are unrelated.
Excludes2 5
These codes carry an Excludes2 note naming J68.1: its condition is not part of those codes, and both may be reported when the patient has both.
Code First 1
These codes say to code first a condition named in the note, and J68.1 is one of the conditions named.
- J84.170 Interstitial lung disease with progressive fibrotic phenotype in diseases classified elsewhere
Use Additional Code 1
These codes say to use an additional code from the note, and J68.1 is one of the codes named.
- Block T51-T65 Toxic effects of substances chiefly nonmedicinal as to source
Index to Diseases and InjuriesGuidance
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Interstitial Lung Diseases
Interstitial lung disease is the name for a large group of diseases that inflame or scar the lungs. The inflammation and scarring make it hard to get enough oxygen. The scarring is called pulmonary fibrosis.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert J68.1 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About J68.1Overview
What is the ICD-10 code for pulmonary edema due to chemicals, gases, fumes and vapors?
The ICD-10-CM code for pulmonary edema due to chemicals, gases, fumes and vapors is J68.1 (sometimes written as J681). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is J68.1 a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report pulmonary edema due to chemicals, gases, fumes and vapors on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does J68.1 group to?
When pulmonary edema due to chemicals, gases, fumes and vapors is the principal diagnosis on an inpatient stay, it groups to MS-DRG 189 (pulmonary Edema and Respiratory Failure), which carries a relative weight of 1.2107. Higher weights mean higher Medicare reimbursement.
Is J68.1 a CC or MCC?
CMS lists J68.1 as an MCC (major complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 125 closely related codes in its exclusion list.
Can J68.1 be reported with a code from J81?
Not as a rule. The Excludes1 note on J68.1 lists "pulmonary edema (acute) (chronic) NOS (J81.-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What HCC is J68.1?
J68.1 (pulmonary edema due to chemicals, gases, fumes and vapors) maps to CMS-HCC Category 280 (Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders), commonly written as HCC 280, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 112 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does J68.1 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, J68.1 adds a risk adjustment factor of about 0.319 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.209 to 0.390 depending on the payment segment). A more severe related category (HCC 276, HCC 277, HCC 278, and HCC 279) supersedes it when both are reported. See the full factor table on the HCC 280 category page.
