2027 ICD-10-CM Diagnosis Code J95.1Acute pulmonary insufficiency following thoracic surgery
ICD-10-CM Codes›J00–J99›J95›J95
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Not Chronic
J95.1 is a billable ICD-10-CM diagnosis code for acute pulmonary insufficiency following thoracic surgery. 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, 928 through 929, 934. 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 13 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Postprocedural or postoperative respiratory system complication.
J95.1 no longer risk-adjusts for Medicare Advantage: it mapped to HCC 84 under the retired CMS-HCC V24 model through payment year 2025 but maps to no category in the live V28 model. It still risk-adjusts in the PACE (CMS-HCC V22) category 84, ESRD (V21) category 84, and ESRD (V24) category 84 for payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
J95.1 no longer risk-adjusts for Medicare Advantage: it maps to no payment category in the live CMS-HCC V28 model, although it still risk-adjusts in the other CMS models shown below.
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 pulmonary insufficiency following thoracic surgery
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to J95.1: its own notes plus those printed at J95 and Chapter 10. A note printed at a category, block or chapter applies to every code under it.
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 J95.1, its category, or a range that includes it.
Excludes1 1
These codes carry an Excludes1 note naming J95.1: they are not reported together with it, unless the two conditions are unrelated.
- J98.4 Other disorders of lung
Excludes2 4
These codes carry an Excludes2 note naming J95.1: its condition is not part of those codes, and both may be reported when the patient has both.
- I97.1 Other postprocedural cardiac functional disturbancesacute pulmonary insufficiency following thoracic surgery (J95.1)
- I97.7 Intraoperative cardiac functional disturbancesacute pulmonary insufficiency following thoracic surgery (J95.1)
- J95.89 Other postprocedural complications and disorders of respiratory system, not elsewhere classifiedacute pulmonary insufficiency following thoracic surgery (J95.1)
- T81 Complications of procedures, not elsewhere classifiedintraoperative and postprocedural complications of specific body system (D78.-, E36.-, E89.-, G97.3-, G97.4, H59.3-, H59.-, H95.2-, H95.3, I97.4-, I97.5, J95, K91.-, L76.-, M96.-, N99.-) names J95, 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.
Convert J95.1 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About J95.1Overview
What is the ICD-10 code for acute pulmonary insufficiency following thoracic surgery?
The ICD-10-CM code for acute pulmonary insufficiency following thoracic surgery is J95.1 (sometimes written as J951). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is J95.1 a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report acute pulmonary insufficiency following thoracic surgery on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does J95.1 group to?
When acute pulmonary insufficiency following thoracic surgery is the principal diagnosis on an inpatient stay, it groups to MS-DRG 793, 791, 189, 929, 934, 928, with relative weights from 1.2107 to 7.6444 depending on complications. Higher weights mean higher Medicare reimbursement.
Is J95.1 a CC or MCC?
CMS lists J95.1 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 13 closely related codes in its exclusion list.
What is the ICD-9 equivalent of J95.1?
Under the General Equivalence Mappings, acute pulmonary insufficiency following thoracic surgery converts to ICD-9-CM 518.52 (ot pul insuf fol trm/srg). The mapping is approximate, so confirm the match fits the documentation.
Does J95.1 risk-adjust for Medicare Advantage payment?
Not for Medicare Advantage. J95.1 mapped to HCC 84 in the retired CMS-HCC V24 model, which last determined payment in 2025, but it maps to no category in the live V28 model; see all codes that no longer risk-adjust. It still risk-adjusts in the PACE (CMS-HCC V22) category 84 (Cardio-Respiratory Failure and Shock), ESRD (V21) category 84 (Cardio-Respiratory Failure and Shock), and ESRD (V24) category 84 (Cardio-Respiratory Failure and Shock).
