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ICD-10-CM J12.9: Viral pneumonia, unspecified

J12.9 is the billable ICD-10-CM code for viral pneumonia, unspecified, in category J12 (Viral pneumonia, not elsewhere classified) of the Influenza and pneumonia section. As a principal diagnosis it groups to MS-DRG 193 Simple Pneumonia and Pleurisy with MCC, MS-DRG 194 Simple Pneumonia and Pleurisy with CC, MS-DRG 195 Simple Pneumonia and Pleurisy without CC/MCC (MDC 04 MDC 04: Diseases and Disorders of the Respiratory System); or MS-DRG 974 HIV with Major Related Condition with MCC, MS-DRG 975 HIV with Major Related Condition with CC, MS-DRG 976 HIV with Major Related Condition without CC/MCC (MDC 25 MDC 25: Human Immunodeficiency Virus Infections). As a secondary diagnosis it is an MCC, excluded with 121 principal diagnoses. 12 LCD billing and coding articles list it as covered.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: ICD-10-CM code descriptions: FY2027 (effective October 1, 2026); IPPS Table 5 (MS-DRG weights): v44 FY2027 (final rule + CN3) (effective October 1, 2026); ICD-10-CM to HCC mapping: PY2027 initial ICD-10-CM mappings (dates of service 2026) (payment year 2027); Medicare Coverage Database billing and coding articles: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: FY2028 code files, effective October 1, 2027 for the ICD-10-CM code descriptions; FY2028 final rule (August 2027), effective October 1, 2027; an April 1 interim grouper update when CMS issues one for the IPPS Table 5 (MS-DRG weights); PY2028 advance notice (February 2027) and the PY2027 midyear final mapping (spring 2027) for the ICD-10-CM to HCC mapping; weekly, every Thursday for the Medicare Coverage Database billing and coding articles.

Code
J12.9
billable FY2027 ICD-10-CM code
Category
J12 Viral pneumonia, not elsewhere classified
Chapter
10: Diseases of the respiratory system (J00-J99)
CC/MCC (MS-DRG v44)
MCC
CMS-HCC V28
Not mapped
POA reporting
Required

Tabular list notes for J12.9

The tabular list has no notes on J12.9 itself; the notes below apply from its parent headings.

Inherited from J12 (Viral pneumonia, not elsewhere classified)

Includes
  • bronchopneumonia due to viruses other than influenza viruses
Excludes2 (not part of this condition, may be coded together)
  • aspiration pneumonia due to anesthesia during labor and delivery (O74.0)
  • aspiration pneumonia due to anesthesia during pregnancy (O29)
  • aspiration pneumonia due to anesthesia during puerperium (O89.0)
  • aspiration pneumonia due to solids and liquids (J69.-)
  • aspiration pneumonia NOS (J69.0)
  • congenital pneumonia (P23.0)
  • congenital rubella pneumonitis (P35.0)
  • interstitial pneumonia NOS (J84.9)
  • lipid pneumonia (J69.1)
  • neonatal aspiration pneumonia (P24.-)
Code first
  • associated influenza, if applicable (J09.X1, J10.0-, J11.0-)
Code also
  • associated abscess, if applicable (J85.1)

MS-DRG grouping when J12.9 is the principal diagnosis

MS-DRG v44 groups for J12.9 as principal diagnosis
MDCMS-DRGs
04 MDC 04: Diseases and Disorders of the Respiratory System193194195
25 MDC 25: Human Immunodeficiency Virus Infections974975976

The final group also depends on procedures, secondary diagnoses and discharge status; the MS-DRG lookup for J12.9 shows the full grouping logic.

CC/MCC status and inpatient edits

As a secondary diagnosis, J12.9 is an MCC under MS-DRG v44, unless the principal diagnosis is one of the 121 codes in its exclusion list. Check J12.9 against a principal diagnosis.

  • Present on admission: a POA indicator is required on inpatient claims.

CMS-HCC V28 risk adjustment

J12.9 does not map to a payment HCC in the PY2027 CMS-HCC V28 model, so on its own it does not change a Medicare Advantage risk score.

LCD billing and coding articles that list J12.9

12 current Medicare billing and coding articles list J12.9 among the diagnoses that support medical necessity for the services they cover.

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Frequently asked questions

What does ICD-10-CM J12.9 mean?

J12.9 means viral pneumonia, unspecified. It is one of 8 billable codes under J12, viral pneumonia, not elsewhere classified.

Which MS-DRG does J12.9 group to?

As the principal diagnosis, J12.9 groups to MS-DRG 193 Simple Pneumonia and Pleurisy with MCC, MS-DRG 194 Simple Pneumonia and Pleurisy with CC, MS-DRG 195 Simple Pneumonia and Pleurisy without CC/MCC (MDC 04 MDC 04: Diseases and Disorders of the Respiratory System); or MS-DRG 974 HIV with Major Related Condition with MCC, MS-DRG 975 HIV with Major Related Condition with CC, MS-DRG 976 HIV with Major Related Condition without CC/MCC (MDC 25 MDC 25: Human Immunodeficiency Virus Infections) under MS-DRG v44, before procedures and secondary diagnoses are applied.

Is J12.9 a CC or MCC?

J12.9 is an MCC under MS-DRG v44; 121 principal diagnoses exclude it.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

The descriptor and notes are reproduced from the FY2027 ICD-10-CM files; MS-DRG, CC/MCC and HCC facts come from the CMS FY2027 and PY2027 tables. Code from the medical record and the ICD-10-CM Official Guidelines. Not legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.