2027 ICD-10-CM Diagnosis Code J95.851Ventilator associated pneumonia
ICD-10-CM Codes›J00–J99›J95›J95
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 211
- Not Chronic
J95.851 is a billable ICD-10-CM diagnosis code for ventilator associated pneumonia. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 205 through 206, 791, 793. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 55 closely related codes. Coders also document this condition as complication of respiratory therapy procedure. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Pneumonia (except that caused by tuberculosis) and Postprocedural or postoperative respiratory system complication.
For Medicare Advantage risk adjustment, J95.851 maps to CMS-HCC Category 211 (Respirator Dependence/Tracheostomy Status/Complications) under the V28 model, adding a risk factor of about 0.879 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
J95.851 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.
- Complication of respiratory therapy procedure
- Ventilator associated pneumonia
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to J95.851: 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.
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.
- Ventilator associated pneumonitis
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- ventilator lung in newborn (P27.8)
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 J95.851, its category, or a range that includes it.
Excludes2 3
These codes carry an Excludes2 note naming J95.851: its condition is not part of those codes, and both may be reported when the patient has both.
- Block J09-J18 Influenza and pneumoniaventilator associated pneumonia (J95.851)
- Block T80-T88 Complications of surgical and medical care, not elsewhere classifiedventilator associated pneumonia (J95.851)
- 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.
Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) J18.9
ventilator associated J95.851
Pneumonitis (acute) (primary) See Also: Pneumonia; J98.4
ventilator J95.851
ventilator associated J95.851
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Pneumonia, Ventilator-Associated
serious inflammation of the lung in patients who required the use of pulmonary ventilator. it is usually caused by bacterial cross infection in hospitals.
Patient EducationClinical
Pneumonia
Pneumonia is an infection in one or both of your lungs. It causes the air sacs of your lungs to fill up with fluid or pus. Pneumonia can range from mild to severe, depending on what caused it, your age, and your overall health.
The full article covers:
- What is pneumonia?
- What causes pneumonia?
- Who is more likely to develop pneumonia?
- What are the symptoms of pneumonia?
- What other problems can pneumonia cause?
- How is pneumonia diagnosed?
- What are the treatments for pneumonia?
- Can pneumonia be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert J95.851 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About J95.851Overview
What is the ICD-10 code for ventilator associated pneumonia?
The ICD-10-CM code for ventilator associated pneumonia is J95.851 (sometimes written as J95851). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is J95.851 (Complication of respirator [ventilator]) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report ventilator associated pneumonia on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does J95.851 group to?
When ventilator associated pneumonia is the principal diagnosis on an inpatient stay, it groups to MS-DRG 793, 791, 206, 205, with relative weights from 0.9255 to 4.2192 depending on complications. Higher weights mean higher Medicare reimbursement.
Is J95.851 a CC or MCC?
CMS lists J95.851 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 55 closely related codes in its exclusion list.
Can J95.851 be reported with P27.8?
Not as a rule. The Excludes1 note on J95.851 lists "ventilator lung in newborn (P27.8)". 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 J95.851?
J95.851 (ventilator associated pneumonia) maps to CMS-HCC Category 211 (Respirator Dependence/Tracheostomy Status/Complications), commonly written as HCC 211, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 114 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 J95.851 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, J95.851 adds a risk adjustment factor of about 0.879 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.590 to 1.981 depending on the payment segment). HCC 211 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 211 category page.
