2027 ICD-10-CM Diagnosis Code J81.0Acute pulmonary edema
ICD-10-CM Codes›J00–J99›J80-J84›J81
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 213
- Not Chronic
J81.0 is a billable ICD-10-CM diagnosis code for acute pulmonary edema. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 189, 791, 793. 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 33 closely related codes. Coders also document this condition as acute cardiac pulmonary edema. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Other specified and unspecified lower respiratory disease.
For Medicare Advantage risk adjustment, J81.0 maps to CMS-HCC Category 213 (Cardio-Respiratory Failure and Shock) under the V28 model, adding a risk factor of about 0.370 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
J81.0 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 cardiac pulmonary edema
- Acute edema
- Acute pulmonary edema
- Fluid overload pulmonary edema
- Immersion pulmonary edema
- Negative pressure pulmonary edema
- Post-upper airway obstruction pulmonary edema
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to J81.0: its own notes plus those printed at J81 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.
- Acute edema of lung
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
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)
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 J81.0, its category, or a range that includes it.
Excludes1 4
These codes carry an Excludes1 note naming J81.0: they are not reported together with it, unless the two conditions are unrelated.
- I50.1 Left ventricular failure, unspecifiededema of lung without heart disease or heart failure (J81.-) names J81.-, which includes this code
- I50.1 Left ventricular failure, unspecifiedpulmonary edema without heart disease or failure (J81.-) names J81.-, which includes this code
- J68.1 Pulmonary edema due to chemicals, gases, fumes and vaporspulmonary edema (acute) (chronic) NOS (J81.-) names J81.-, which includes this code
- R60 Edema, not elsewhere classifiedpulmonary edema (J81.-) names J81.-, which includes this code
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Acute Pulmonary Edema
rapid or severe onset or rapid progression of pulmonary edema causing significant hypoxemia or the need for supplemental oxygen.Pulmonary Edema
excessive accumulation of extravascular fluid in the lung, an indication of a serious underlying disease or disorder. pulmonary edema prevents efficient pulmonary gas exchange in the pulmonary alveoli, and can be life-threatening.
Patient EducationClinical
Lung Diseases
When you breathe, your lungs take in oxygen from the air and deliver it to the bloodstream. The cells in your body need oxygen to work and grow. During a normal day, you breathe nearly 25,000 times. People with lung disease have difficulty breathing. Millions of people in the U.S. have lung disease.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert J81.0 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About J81.0Overview
What is the ICD-10 code for acute pulmonary edema?
The ICD-10-CM code for acute pulmonary edema is J81.0 (sometimes written as J810). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is J81.0 (Pulmonary edema) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report acute pulmonary edema on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does J81.0 group to?
When acute pulmonary edema is the principal diagnosis on an inpatient stay, it groups to MS-DRG 793, 791, 189, with relative weights from 1.2107 to 4.2192 depending on complications. Higher weights mean higher Medicare reimbursement.
Is J81.0 a CC or MCC?
CMS lists J81.0 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 33 closely related codes in its exclusion list.
Can J81.0 be reported with J68.1?
Not as a rule. The Excludes1 note at J81, which applies to J81.0, lists "chemical (acute) pulmonary edema (J68.1)". 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 J81.0?
J81.0 (acute pulmonary edema) maps to CMS-HCC Category 213 (Cardio-Respiratory Failure and Shock), commonly written as HCC 213, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 84 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 J81.0 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, J81.0 adds a risk adjustment factor of about 0.370 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.258 to 0.662 depending on the payment segment). A more severe related category (HCC 211 and HCC 212) supersedes it when both are reported. See the full factor table on the HCC 213 category page.
