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ICD-10-CM J95.811: Postprocedural pneumothorax

J95.811 is the billable ICD-10-CM code for postprocedural pneumothorax, in category J95 (Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified) of the Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified section. As a principal diagnosis it groups to MS-DRG 199 Pneumothorax with MCC, MS-DRG 200 Pneumothorax with CC, MS-DRG 201 Pneumothorax without CC/MCC (MDC 04 MDC 04: Diseases and Disorders of the Respiratory System). As a secondary diagnosis it is a CC, excluded with 18 principal diagnoses. 5 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
J95.811
billable FY2027 ICD-10-CM code
Category
J95 Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified
Chapter
10: Diseases of the respiratory system (J00-J99)
CC/MCC (MS-DRG v44)
CC
CMS-HCC V28
Not mapped
POA reporting
Required

Tabular list notes for J95.811

The tabular list has no notes on J95.811 itself; the notes below apply from its parent headings.

Inherited from J95 (Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified)

Excludes2 (not part of this condition, may be coded together)
  • aspiration pneumonia (J69.-)
  • emphysema (subcutaneous) resulting from a procedure (T81.82)
  • hypostatic pneumonia (J18.2)
  • pulmonary manifestations due to radiation (J70.0-J70.1)

MS-DRG grouping when J95.811 is the principal diagnosis

MS-DRG v44 groups for J95.811 as principal diagnosis
MDCMS-DRGs
04 MDC 04: Diseases and Disorders of the Respiratory System199200201

The final group also depends on procedures, secondary diagnoses and discharge status; the MS-DRG lookup for J95.811 shows the full grouping logic.

CC/MCC status and inpatient edits

As a secondary diagnosis, J95.811 is a CC under MS-DRG v44, unless the principal diagnosis is one of the 18 codes in its exclusion list. Check J95.811 against a principal diagnosis.

  • Present on admission: a POA indicator is required on inpatient claims.
  • Hospital-acquired condition: HAC 14 Iatrogenic Pneumothorax with Venous Catheterization.

CMS-HCC V28 risk adjustment

J95.811 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 J95.811

5 current Medicare billing and coding articles list J95.811 among the diagnoses that support medical necessity for the services they cover.

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Frequently asked questions

What does ICD-10-CM J95.811 mean?

J95.811 means postprocedural pneumothorax. It is one of 25 billable codes under J95, intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified.

Which MS-DRG does J95.811 group to?

As the principal diagnosis, J95.811 groups to MS-DRG 199 Pneumothorax with MCC, MS-DRG 200 Pneumothorax with CC, MS-DRG 201 Pneumothorax without CC/MCC (MDC 04 MDC 04: Diseases and Disorders of the Respiratory System) under MS-DRG v44, before procedures and secondary diagnoses are applied.

Is J95.811 a CC or MCC?

J95.811 is a CC under MS-DRG v44; 18 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.