J06.9: Acute upper respiratory infection, unspecified

The ICD-10-CM code for an acute upper respiratory infection when the record documents multiple sites, or does not name the anatomic site at all.

Billable

FY2027

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At a glance

Code Family

J06: Acute upper respiratory infections of multiple and unspecified sites.

DRG Grouping

MS-DRG 152 or 153 in MDC 3 under the FY2027 MS-DRG v44 grouper, split on the presence of an MCC.

HCC Mapping (v28)

None. J06.9 carries no CMS-HCC v28 payment condition category.

Condition

Upper respiratory infection

Family Specificity

Two billable child codes. J06.0 names the larynx and the pharynx together, and J06.9 is the residual code for an infection at multiple or unstated sites.

Billable

Yes. J06.9 is valid for submission under FY2027, effective 1 October 2026.

Which J06 code do I assign?

The J06 codes cover an acute upper respiratory infection at multiple sites, or at a site the record does not name. Work down the anatomic sites in block J00–J06 before reaching for J06.9, because a named site always takes the site-specific code.

When documentation says…

Code

Head cold with runny nose, sneezing and congestion

J00

Acute nasopharyngitis, the common cold. The note describes rhinorrhea, sneezing and nasal congestion, and names no separate site such as the sinuses or the tonsils.

Sore throat, pharyngeal erythema, no other site named

J02.9

Acute pharyngitis, unspecified. The pharynx is the documented site and no organism is named. J02.0 applies instead when the record documents streptococcal pharyngitis.

Tonsillar exudate and enlarged tonsils

J03.90

Acute tonsillitis, unspecified. The note places the infection at the tonsils. J03.00 applies when the record documents streptococcal tonsillitis.

Hoarseness, barking cough, laryngitis or tracheitis

J04.-

Acute laryngitis and tracheitis. J04.0 is acute laryngitis, J04.10 is acute tracheitis without obstruction, and J04.2 is acute laryngotracheitis.

Facial pain and purulent nasal discharge, sinusitis on exam

J01.90

Acute sinusitis, unspecified. The record must document sinus involvement. A named sinus directs the code to J01.0–J01.4.

Acute inflammation of both the larynx and the pharynx

J06.0

Acute laryngopharyngitis. Both sites are documented as inflamed at the same encounter. Category J02 carries an Excludes1 note for J06.0. The two are not reported together for the same condition.

URI, no site documented

J06.9

Acute upper respiratory infection, unspecified. The infection involves more than one upper airway site, or the note records only upper respiratory infection with no site. Check the J06 Excludes1 before assigning.

Tabular notes

EXCLUDES1

Category J06 carries an Excludes1 note for acute respiratory infection NOS (J22), for influenza virus with other respiratory manifestations (J09.X2, J10.1, J11.1), and for streptococcal pharyngitis (J02.0). Excludes1 means those conditions are not coded with J06.9 for the same condition. Block J00–J06 carries a further Excludes1 note for chronic obstructive pulmonary disease with acute lower respiratory infection (J44.0).

USE ADDITIONAL

Use an additional code from B95–B97 to identify the infectious agent when it is known, such as B97.4 for respiratory syncytial virus. The organism code is secondary to J06.9. Assign it only where the provider documents the organism.

FY2027: EFFECTIVE 1 OCTOBER 2026

J06.9 is valid in the FY2026 code set and unchanged in the FY2027 update. No codes were added to, revised in or deleted from category J06 for FY2026. The FY2027 codes and tabular addenda make no addition, deletion or revision in category J06.

Operational & financial impact

Why specificity matters beyond the chart: risk adjustment, DRG assignment and denial exposure all follow from which code is selected.

CMS-HCC v28 (PY2024+)

J06.9 carries no CMS-HCC v28 payment condition category.

An acute upper respiratory infection is self-limited. The CMS-HCC models carry conditions used to predict the following year's costs, and an acute infection is outside that set.

Recording J06.9 at a Medicare Advantage encounter adds nothing to the risk score. Capture the chronic conditions addressed at the same visit under their own codes.

Severity designation under the MS-DRG grouper and mapping under CMS-HCC v28 are separate questions, decided by different CMS files.

MS-DRG v44 (FY2027)

MS-DRG 152: Otitis media and URI with MCC.

MS-DRG 153: Otitis media and URI without MCC.

An inpatient admission with J06.9 as the principal diagnosis groups to MS-DRG 152 or 153 in MDC 3, Diseases and Disorders of the Ear, Nose, Mouth and Throat. The pair splits on the presence of an MCC rather than on a CC.

Medicare and commercial payers

There is no National Coverage Determination specific to acute upper respiratory infection diagnosis coding.

J06.9 is one of three codes in the URI value set for the NCQA HEDIS measure Appropriate Treatment for Upper Respiratory Infection, alongside J00 and J06.0.

That measure counts episodes for members 3 months of age and older that did not result in an antibiotic dispensing event on or within 3 days of the episode date. A higher rate is better performance.

An encounter coded J06.9 falls inside that antibiotic stewardship denominator. Health plans report the measure to NCQA.

WHERE SPECIFICITY IS LOST

J06.9 is a residual code. Every encounter that names an anatomic site belongs to J00, J01.-, J02.-, J03.-, J04.- or J05.-, and the site-specific code applies.

Coding J06.9 when the note says acute bronchitis moves the encounter to the wrong tract. Acute bronchitis is a lower respiratory tract infection and belongs to the J20.- codes.

Reporting J06.9 alongside J22 for the same infection breaks an Excludes1 in both directions. J22 carries an Excludes1 note for upper respiratory infection (acute) (J06.9), and category J06 carries one for acute respiratory infection NOS (J22).

Where the provider documents COVID-19 or influenza, the infection is no longer unspecified. U07.1 or a code from J09–J11 replaces J06.9.

SEVERITY DESIGNATION (MS-DRG V44.0)

J06.9 carries no severity designation. It appears in neither Appendix G, the CC list, nor Appendix H, the MCC list, of the ICD-10 MS-DRG Definitions Manual Version 44.0. A case reaches the higher tier of its DRG pair on a designation carried by another diagnosis.

Documentation checklist to support J06.9

Chart elements that support code selection and reduce specificity-driven denials.

A provider diagnostic statement naming an acute upper respiratory infection.

The anatomic site, or an explicit statement that the infection involves more than one upper airway site.

Whether the record names a specific condition such as the common cold, pharyngitis, tonsillitis, sinusitis or laryngitis, each of which carries its own code.

The absence of a documented lower respiratory tract diagnosis. Acute bronchitis directs the encounter to the J20.- codes instead.

The causative organism where it is identified, to support a secondary code from B95–B97 such as B97.4 for respiratory syncytial virus.

A provider statement rather than a laboratory result alone for COVID-19 or influenza, because a confirmed diagnosis rests on the provider's documentation.

The antibiotic decision and the reasoning behind it, because J06.9 sits in the denominator of the NCQA HEDIS upper respiratory infection measure.

For outpatient encounters, a confirmed diagnosis only. A probable or suspected upper respiratory infection is coded to the presenting signs and symptoms.

FAQ

Is J06.9 a billable code?

Yes. J06.9 is a valid ICD-10-CM code and may be submitted on a claim for FY2027, effective 1 October 2026. It is the residual code in category J06. Use it only when no site-specific acute upper respiratory infection code fits the documentation.

When do I use J06.9 instead of J20.9?

J06.9 covers the upper respiratory tract: the nose, sinuses, pharynx and larynx. J20.9 is acute bronchitis, a lower respiratory tract infection. Chapter 10 of the tabular directs that a respiratory condition documented at more than one site, and not specifically indexed, is classified to the lower anatomic site. J06.9 and J22 carry reciprocal Excludes1 notes. The two are not reported together for the same condition.

Does J06.9 map to an HCC under CMS-HCC v28?

No. J06.9 carries no CMS-HCC v28 payment condition category. An acute upper respiratory infection is self-limited, and the CMS-HCC models are built from conditions that predict the following year's costs. Severity designation under the MS-DRG grouper is a separate question from HCC mapping.

A patient has an unspecified URI and a positive SARS-CoV-2 test. Do I still code J06.9?

J06.9 is not coded where the provider documents COVID-19. Assign U07.1 instead. J06.9 describes an infection whose cause the record does not specify, and a documented COVID-19 diagnosis specifies it. The FY2027 Official Guidelines state that confirmation does not require a positive test result, and that the provider's documentation that the individual has COVID-19 is sufficient. Where the provider records suspected, possible, probable or inconclusive COVID-19, do not assign U07.1, and code the presenting signs and symptoms.

How is U07.1 sequenced when COVID-19 is the reason for the encounter?

The FY2027 ICD-10-CM Official Guidelines, section I.C.1.g.1)(b), state that when COVID-19 meets the definition of principal diagnosis, U07.1 is sequenced first, followed by the appropriate codes for associated manifestations. Exceptions apply where another guideline requires a different code first, such as obstetrics, sepsis or transplant complications.

What has to be in the note to support J06.9?

The note needs a provider statement of an acute upper respiratory infection. It also needs either an explicit finding that several upper airway sites are involved, or no named site at all. Record the organism where it is identified, which supports a secondary code from B95–B97. Where a single site is documented, the site-specific code from J00–J05 applies instead.

Does J06.9 behave differently for inpatient and outpatient coding?

Yes. In the outpatient setting, code only a confirmed diagnosis, and code the presenting signs and symptoms where the diagnosis is documented as probable or suspected. On the inpatient side, UHDDS rules allow a diagnosis documented as uncertain at discharge to be coded as if it were confirmed. As a principal diagnosis on an inpatient claim, J06.9 groups to MS-DRG 152 or 153.

Did anything change for J06.9 in FY2027?

J06.9 is unchanged in the FY2027 update. Category J06 gained no new codes in the FY2026 update effective 1 October 2025. No J06 code was revised or deleted in that update. The FY2027 codes and tabular addenda, effective 1 October 2026, make no addition, deletion or revision in category J06 either.

Related codes

Codes in the same family as J06.9. Only codes with a published page render as links.

Sibling codes in the J06 family

J06.0: Acute laryngopharyngitis.

Additional codes to consider

Codes outside the J06 family considered alongside J06.9.

Companion: code alongside when documented

B95–B97: Bacterial and viral agents as the cause of diseases classified elsewhere, the Use Additional range named at J06.9.
B97.4: Respiratory syncytial virus as the cause of diseases classified elsewhere.
B97.89: Other viral agents as the cause of diseases classified elsewhere.

Consider instead

J00: Acute nasopharyngitis [common cold], where the record documents a head cold.
J01.90: Acute sinusitis, unspecified, where sinus involvement is documented.
J02.9: Acute pharyngitis, unspecified, where the pharynx is the documented site.
J02.0: Streptococcal pharyngitis, which category J06 excludes under Excludes1.
J03.90: Acute tonsillitis, unspecified, where the tonsils are the documented site.
J04.0: Acute laryngitis, where the larynx is the documented site.
J05.0: Acute obstructive laryngitis [croup], where croup is documented.
J20.9: Acute bronchitis, unspecified, a lower respiratory tract infection.
J22: Unspecified acute lower respiratory infection, which carries a reciprocal Excludes1 with J06.9.
J40: Bronchitis, not specified as acute or chronic.
J11.1: Influenza due to unidentified influenza virus with other respiratory manifestations.
R05.9: Cough, unspecified, where no diagnosis is established at the encounter.
U07.1: COVID-19 replaces J06.9 where the provider documents a confirmed COVID-19 diagnosis.

Sources

All claims on this page derive from government and professional-standards sources.

National Center for Health Statistics. (2026). International classification of diseases, tenth revision, clinical modification (ICD-10-CM) FY2027 files. https://www.cdc.gov/nchs/icd/icd-10-cm/files.html
Centers for Medicare & Medicaid Services and National Center for Health Statistics. (2026). ICD-10-CM official guidelines for coding and reporting FY2027. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2027/ICD-10-CM-October-1-2026-FY27-Guidelines.pdf
Centers for Medicare & Medicaid Services. (2025). 2026 model software/ICD-10 mappings. https://www.cms.gov/medicare/payment/medicare-advantage-rates-statistics/risk-adjustment/2026-model-software-icd-10-mappings
Centers for Medicare & Medicaid Services. (2026). MS-DRG classifications and software, version 44. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/ms-drg-classifications-and-software