J69.0 ICD-10-CM Code: Pneumonitis due to inhalation of food and vomit
J69.0 maps to CMS-HCC V28 282 (RAF 0.440). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC Buddy coding tools
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FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Lung diseases due to external agents (J60-J70)
J69.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePneumonitis due to inhalation of food and vomit
Lung inflammation caused by accidentally inhaling food particles or vomit, which can occur during choking, aspiration, or while unconscious.
Buddy Insight
Aspiration pneumonitis due to food and vomit is a common and serious condition that carries substantially higher risk adjustment weight than other codes in this chunk.
CMS-HCC V28
MappedHCC 282
RAF 0.440
CMS-HCC V24
MappedHCC 114
RAF 0.517
ACA/HHS
MappedHCC 163
Varies by metal level
ESRD/PACE
MappedHCC 114
RAF 0.090
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Aspiration pneumonia NOS
- Aspiration pneumonia (due to) food (regurgitated)
- Aspiration pneumonia (due to) gastric secretions
- Aspiration pneumonia (due to) milk
- Aspiration pneumonia (due to) vomit
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for J69.0 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for J69.0 in this effective period.
Excludes 1
Official- chemical pneumonitis due to anesthesia (J95.4)
- obstetric aspiration pneumonitis (O74.0)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for J69.0 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for J69.0 in this effective period.
Code Also
Official- any associated foreign body in respiratory tract (T17.-)
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 →
Is J69.0 an HCC code?
Yes. J69.0 (Pneumonitis due to inhalation of food and vomit) maps to Aspiration and Specified Bacterial Pneumonias under the CMS-HCC V28 risk adjustment model (and Aspiration and Specified Bacterial Pneumonias under V24), with a community non-dual aged RAF of 0.440. It is billable for payment year 2026.
Coder answer: J69.0 is billable and maps to V28 HCC 282, Aspiration and Specified Bacterial Pneumonias. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- J69.0
- Description
- Pneumonitis due to inhalation of food and vomit
- HCC (V28)
- HCC 282 — Aspiration and Specified Bacterial Pneumonias
- RAF
- 0.440
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
Work J69.0 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for J69.0
For J69.0 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed J69.0 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
J69.0 is the ICD-10-CM diagnosis code for pneumonitis due to inhalation of food and vomit. Lung inflammation caused by accidentally inhaling food particles or vomit, which can occur during choking, aspiration, or while unconscious. J69.0 sits in the ICD-10-CM chapter for diseases of the respiratory system (j00-j99), within the section covering lung diseases due to external agents (j60-j70).
Under the CMS-HCC V28 risk adjustment model, J69.0 maps to Aspiration and Specified Bacterial Pneumonias (HCC 282) with a community, non-dual, aged base RAF weight of 0.440. Under the older V24 model, J69.0 mapped to the same category but with a base RAF weight of 0.517, V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Document the specific substance aspirated (food type, gastric contents) when available. Because J69.0 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for J69.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific substance aspirated (food type, gastric contents) when available
- •Consider if this is related to a procedure, altered consciousness, or swallowing disorder for complete clinical picture
Clinical Significance
Aspiration pneumonitis due to food and vomit is a common and serious condition that carries substantially higher risk adjustment weight than other codes in this chunk. It is frequently seen in patients with dysphagia, altered mental status, or post-procedural complications, and it significantly increases morbidity, mortality, and healthcare resource utilization.
Documentation Requirements
- ✓Documentation of aspiration event or clinical evidence of aspiration
- ✓Identification of the aspirated substance (food, gastric contents, vomitus)
- ✓Underlying condition predisposing to aspiration (dysphagia, altered consciousness, stroke, GERD, anesthesia)
- ✓Chest imaging findings consistent with aspiration pneumonitis
- ✓Clinical markers of infection vs. chemical pneumonitis if applicable
- ✓Treatment plan including antibiotics, respiratory support, and swallowing evaluation
Excludes 1, Do NOT code together
Code Also
- any associated foreign body in respiratory tract (T17.-)
Commonly Confused Codes
- •J15.x (Bacterial pneumonia codes): aspiration pneumonia with identified organism uses specific bacterial codes; J69.0 is for the aspiration pneumonitis itself
- •J69.1 (Pneumonitis due to inhalation of oils and essences): oil or lipoid aspiration, not food/vomit
- •J69.8 (Pneumonitis due to inhalation of other solids and liquids): other substances, not food/vomit
- •J95.4 (Chemical pneumonitis due to anesthesia): Mendelson syndrome during anesthesia is a specific form