Question 1

What is ICD-10 code J11.83?

Accepted Answer

J11.83 is the ICD-10-CM diagnosis code for influenza due to unidentified influenza virus with otitis media. Flu caused by an unidentified influenza virus that causes ear infection or inflammation of the middle ear. J11.83 sits in the ICD-10-CM chapter for diseases of the respiratory system (j00-j99), within the section covering influenza and pneumonia (j09-j18).

J11.83 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

Document whether the otitis media is acute or chronic.

Question 2

Is J11.83 an HCC code?

Accepted Answer

No. J11.83 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is J11.83 billable?

Accepted Answer

Yes. J11.83 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. J11.83 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for J11.83?

Accepted Answer

J11.83 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards J11.83 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting J11.83?

Accepted Answer

Document whether the otitis media is acute or chronic Specify if it is unilateral or bilateral when documented

HCC Buddy Code Card

J11.83

Is J11.83 an HCC code?

What This Code Means

Coding Tips

Use Additional Code

Child Codes

Code Hierarchy

Open J11.83 in the Interactive Encoder

J11.83 ICD-10-CM Code: Influenza due to unidentified influenza virus with otitis media

HCC Buddy Code Card

J11.83

Is J11.83 an HCC code?

What This Code Means

Coding Tips

Use Additional Code

Child Codes

Code Hierarchy

Open J11.83 in the Interactive Encoder