J11.89 ICD-10-CM Code: Influenza due to unidentified influenza virus with other manifestations
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Influenza and pneumonia (J09-J18)
J11.89
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceInfluenza due to unidentified influenza virus with other manifestations
This code describes influenza (flu) caused by an influenza virus that could not be identified or typed, with complications or symptoms beyond the typical respiratory illness. It's used when the specific strain of flu virus is unknown but the patient has additional health effects from the infection.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
Basket needed
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for J11.89 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for J11.89 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for J11.89 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for J11.89 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for J11.89 in this effective period.
Use Additional
Official- codes to identify the manifestations
Code Also
OfficialICD-10-CM does not list Code Also instructions for J11.89 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is J11.89 an HCC code?
No. J11.89 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
J11.89 is the ICD-10-CM diagnosis code for influenza due to unidentified influenza virus with other manifestations. This code describes influenza (flu) caused by an influenza virus that could not be identified or typed, with complications or symptoms beyond the typical respiratory illness. It's used when the specific strain of flu virus is unknown but the patient has additional health effects from the infection. J11.89 sits in the ICD-10-CM chapter for diseases of the respiratory system (j00-j99), within the section covering influenza and pneumonia (j09-j18).
J11.89 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.
Use this code only when the influenza virus type cannot be determined or identified; if the virus type is known (A, B, or C), use the more specific code instead.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for J11.89 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the influenza virus type cannot be determined or identified; if the virus type is known (A, B, or C), use the more specific code instead
- •The 'other manifestations' component means there are complications or secondary conditions present; document what these manifestations are (such as pneumonia, myocarditis, or encephalitis) and code them separately if applicable
Use Additional Code
- codes to identify the manifestations