October 1 update. Our PDGM and ICD-10 tools now use the FY2027 code set: 190 codes added, 30 deleted, and no existing code changed clinical group.

See what changed

ICD-10 · PDGM grouping

J12 Viral pneumonia, not elsewhere classified

All 8 codes in the J12 family, with the PDGM clinical group, comorbidity subgroup and primary-position rule CMS assigns, read from the CMS grouper crosswalk v07.2.26 and the CDC FY2027 code file.

ICD-10-CM FY2027 · CMS grouper v07.2.26

Codes in family

8

Can lead a claim

7

Cannot lead a claim

1

What CMS assigns to J12

7 of the 8 codes group to MMTA - Respiratory; 1 is assigned no clinical group. Comorbidity subgroups: 7 toward Whooping Cough and Pneumonia; 1 toward Influenza. 7 of the 8 can lead a claim. CMS attaches a code-first note to all 8.

  • Whooping Cough and Pneumonia: counts toward the high comorbidity tier only in an interaction pair.
  • Influenza

Code first

CMS grouper convention 82, on J12.0, J12.1, J12.2, J12.3, J12.81, J12.89, J12.9. Code first:

  • associated influenza, if applicable (J09.X1, J10.0-, J11.0-)

CMS grouper convention 83, on J12.82. Code first:

  • COVID-19 (U07.1)
  • associated influenza, if applicable (J09.X1, J10.0-, J11.0-)

Every code in J12

Descriptions are CDC’s FY2027 wording; where CMS’s grouper abbreviates one, its form is shown beneath.

CodeDescriptionPrimary positionClinical groupComorbidity subgroup
J12.0Adenoviral pneumoniaCan lead a claim, code first appliesLWhooping Cough and Pneumonia
J12.1Respiratory syncytial virus pneumoniaCan lead a claim, code first appliesLWhooping Cough and Pneumonia
J12.2Parainfluenza virus pneumoniaCan lead a claim, code first appliesLWhooping Cough and Pneumonia
J12.3Human metapneumovirus pneumoniaCan lead a claim, code first appliesLWhooping Cough and Pneumonia
J12.8 Other viral pneumonia
J12.81Pneumonia due to SARS-associated coronavirusCan lead a claim, code first appliesLWhooping Cough and Pneumonia
J12.82Pneumonia due to coronavirus disease 2019Cannot lead a claimUnacceptable principal diagnosis, code is not reportable as principal diagnosisNoneWhooping Cough and Pneumonia
J12.89Other viral pneumoniaCan lead a claim, code first appliesLWhooping Cough and Pneumonia
J12.9Viral pneumonia, unspecifiedCan lead a claim, code first appliesLInfluenza

Sources: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01, for the clinical group, comorbidity subgroup, code-first conventions and primary-position flags; CDC NCHS ICD-10-CM FY2027 code descriptions for the family title and code wording. This is the crosswalk Medicare runs a claim through. Grouping also depends on admission source, timing, the OASIS functional items and the rest of the diagnosis list.

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