J12.81

Clinical notes

Documentation support

General coding-documentation guidance — not a substitute for payer-specific requirements or professional coding judgment.

• •As a general rule, code to the highest level of specificity supported by the documentation in the medical record.

ICD-9-CM equivalent

Informational only — GEM mappings are approximate, not guaranteed one-to-one equivalents. Verify before use in billing.

• 4803

Associated MS-DRGs

J12.81 can serve as the principal diagnosis for these Medicare Severity Diagnosis-Related Groups.

Informational only — actual DRG assignment also depends on procedures, complications/comorbidities (CC/MCC), discharge status, and payer-specific rules not reflected here.

• DRG 157Dental and Oral Diseases with MCC
• DRG 158Dental and Oral Diseases with CC
• DRG 159Dental and Oral Diseases without CC/MCC
• DRG 193Simple Pneumonia and Pleurisy with MCC
• DRG 194Simple Pneumonia and Pleurisy with CC
• DRG 195Simple Pneumonia and Pleurisy without CC/MCC