J84.116
BillableCryptogenic organizing pneumonia
HCC Category Mapping
V28HCC 280 — Chronic Obstructive Pulmonary Disease
0.334V24HCC 112 — Fibrosis of Lung and Other Chronic Lung Disorders
0.268ESRDHCC 112 — Fibrosis of Lung and Other Chronic Lung Disorders
0.000RxHCCHCC 227 — Sarcoidosis, Pulmonary Alveolar Disorders
0.000What This Code Means
A rare lung disease characterized by abnormal scar tissue formation in the lungs without a known cause, leading to progressive breathing problems.
Coding Tips
- •Document that the cause is cryptogenic (unknown) to justify this specific code
- •Verify organizing pneumonia pattern on imaging or biopsy before coding
Clinical Significance
Cryptogenic organizing pneumonia is a distinct inflammatory lung condition where granulation tissue fills the small airways and alveoli without an identifiable cause. It typically responds well to corticosteroids but has a high relapse rate requiring prolonged treatment. Accurate coding captures the chronic treatment burden and relapse monitoring needs that drive resource utilization.
Documentation Requirements
- ✓Imaging (CT chest) showing patchy bilateral consolidations, ground-glass opacities, often migratory or peribronchovascular
- ✓Lung biopsy showing organizing pneumonia pattern with intraluminal granulation tissue if performed
- ✓Documentation that the organizing pneumonia is cryptogenic (no identifiable cause such as infection, drug reaction, or connective tissue disease)
- ✓Treatment response documentation including steroid therapy and tapering schedule
- ✓Follow-up plan addressing the high relapse rate (25-50%)
Excludes 1 — Do NOT code together
- organizing pneumonia NOS, or due to known underlying cause (J84.89)
Commonly Confused Codes
J84.89 — Other specified interstitial pulmonary diseases should not be used when COP is specifically documentedJ18.9 — Pneumonia unspecified represents infectious pneumonia, not organizing pneumonia which is inflammatoryJ84.111 — Idiopathic interstitial pneumonia NOS is less specific and should not be used when COP pattern is confirmedB44.81 — Allergic bronchopulmonary aspergillosis can mimic COP on imaging but has a distinct fungal etiology