J12 ICD-10-CM Code: Viral pneumonia, not elsewhere classified
J12 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Influenza and pneumonia (J09-J18)
J12
Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidanceViral pneumonia, not elsewhere classified
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for J12. Check the code and parent instructions in the Code Book.
Excludes 2
Official- 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)Inherited from J00-J99, J09-J18
- congenital pneumonia (P23.0)
- congenital rubella pneumonitis (P35.0)
- interstitial pneumonia NOS (J84.9)
- lipid pneumonia (J69.1)Inherited from J00-J99, J09-J18
- neonatal aspiration pneumonia (P24.-)Inherited from J00-J99, J09-J18
- certain conditions originating in the perinatal period (P04-P96)Inherited from J00-J99, J09-J18
- certain infectious and parasitic diseases (A00-B99)Inherited from J00-J99, J09-J18
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from J00-J99, J09-J18
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from J00-J99, J09-J18
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from J00-J99, J09-J18
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from J00-J99, J09-J18
- neoplasms (C00-D49)Inherited from J00-J99, J09-J18
- smoke inhalation (T59.81-)Inherited from J00-J99, J09-J18
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from J00-J99, J09-J18
- allergic or eosinophilic pneumonia (J82)Inherited from J00-J99, J09-J18
- meconium pneumonia (P24.01)Inherited from J00-J99, J09-J18
- pneumonia due to solids and liquids (J69.-)Inherited from J00-J99, J09-J18
- congenital pneumonia (P23.9)Inherited from J00-J99, J09-J18
- rheumatic pneumonia (I00)Inherited from J00-J99, J09-J18
- ventilator associated pneumonia (J95.851)Inherited from J00-J99, J09-J18
Related Codes
Includes
Official- bronchopneumonia due to viruses other than influenza viruses
Excludes 1
OfficialNo Excludes 1 notes are included in this display for J12. Check the code and parent instructions in the Code Book.
Code First
Official- associated influenza, if applicable (J09.X1, J10.0-, J11.0-)
Use Additional
Official- code, where applicable, to identify:Inherited from J00-J99, J09-J18
- exposure to environmental tobacco smoke (Z77.22)Inherited from J00-J99, J09-J18
- exposure to tobacco smoke in the perinatal period (P96.81)Inherited from J00-J99, J09-J18
- history of tobacco dependence (Z87.891)Inherited from J00-J99, J09-J18
- occupational exposure to environmental tobacco smoke (Z57.31)Inherited from J00-J99, J09-J18
- tobacco dependence (F17.-)Inherited from J00-J99, J09-J18
- tobacco use (Z72.0)Inherited from J00-J99, J09-J18
- code, if applicable, to identify resistance to antimicrobial drugs (Z16.-)Inherited from J00-J99, J09-J18
Code Also
Official- associated abscess, if applicable (J85.1)
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
- Code
- J12
- Description
- Viral pneumonia, not elsewhere classified
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- No
- Payment year
- 2026
Coder workflow notes
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What This Code Means
J12 is the ICD-10-CM diagnosis code for viral pneumonia, not elsewhere classified. J12 sits in the ICD-10-CM chapter for diseases of the respiratory system (j00-j99), within the section covering influenza and pneumonia (j09-j18).
Header codes like J12 cannot be reported on claims directly; they organize child codes that share clinical context. Coders should select the billable child code that matches the documented presentation and then verify its current source-backed HCC mapping. Do not infer a child code or risk adjustment value from the header alone.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for J12 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Includes
- bronchopneumonia due to viruses other than influenza viruses
Excludes 2, Not included here, may code separately
- 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 Also
- associated abscess, if applicable (J85.1)