J69.0: Pneumonitis due to inhalation of food and vomit

The ICD-10-CM code for aspiration pneumonia when the documented material is food, regurgitated food, gastric secretions, milk or vomit, in a patient other than a newborn and outside an anesthesia-related event.

Billable

FY2027

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At a glance

Code Family

J69: Pneumonitis due to solids and liquids.

DRG Grouping

MS-DRG 177, 178 or 179, respiratory infections and inflammations, under the FY2027 MS-DRG v44 grouper.

HCC Mapping (v28)

HCC 282: Aspiration and Specified Bacterial Pneumonias.

Condition

Aspiration pneumonia

Billable

Yes

Family Specificity

Three billable child codes split on the material inhaled. J69.0 covers food and vomit. J69.1 covers oils and essences. J69.8 covers other solids and liquids.

Which J69 code do I assign?

The J69 family splits on the material the patient inhaled rather than on how severe the pneumonitis is. The prior question is who the patient is and what caused the aspiration, because a newborn record, an anesthesia-related event or an obstetric event moves the encounter out of category J69 altogether.

When documentation says…

Code

Aspiration pneumonia

J69.0

Aspiration pneumonia NOS is an inclusion term at J69.0. The same code carries aspiration of food, regurgitated food, gastric secretions, milk and vomit. The note needs the aspiration mechanism stated by the provider.

Exogenous lipoid pneumonia after mineral oil aspiration

J69.1

Pneumonitis due to inhalation of oils and essences, carrying exogenous lipoid pneumonia and lipid pneumonia NOS as inclusion terms. The tabular directs a Code First from T51–T65 to identify the substance. Endogenous lipoid pneumonia is an Excludes1 at J69.1 and goes to J84.89.

Pneumonitis due to aspiration of blood

J69.8

Pneumonitis due to inhalation of other solids and liquids, with aspiration of blood and aspiration of detergent as the named inclusion terms. The tabular directs a Code First from T51–T65 to identify the substance.

Pneumonia, organism not identified, no aspiration documented

J18.9

Pneumonia, unspecified organism, which is the nearest wrong choice on this page. Aspiration has to be documented as the mechanism before J69.0 displaces J18.9.

Aspiration pneumonitis on induction of anesthesia

J95.4

Chemical pneumonitis due to anesthesia, carrying Mendelson's syndrome and postprocedural aspiration pneumonia as inclusion terms. J69.0 holds an Excludes1 note for this code. The two are not reported together for the same condition.

Aspiration pneumonia in a newborn

P24.81

Other neonatal aspiration with respiratory symptoms, which is where the Alphabetic Index sends pneumonia, aspiration, newborn. Category J69 holds an Excludes1 note for the neonatal aspiration syndromes in the P24 codes.

Aspiration pneumonitis due to anesthesia during labor and delivery

O74.0

Obstetric aspiration pneumonitis, which J69.0 carries as an Excludes1 note. The equivalents for the other obstetric periods are the O29.01- codes during pregnancy and O89.01 during the puerperium.

Tabular notes

EXCLUDES1

J69.0 carries Excludes1 notes for chemical pneumonitis due to anesthesia (J95.4) and obstetric aspiration pneumonitis (O74.0). Category J69 carries Excludes1 notes for neonatal aspiration syndromes (P24.-) and postprocedural pneumonitis (J95.4). Guideline I.A.12.a of the FY2027 Official Guidelines states that an Excludes1 note means not coded here, and that the excluded code is never used at the same time as the code above the note. The guideline makes an exception when the two conditions are unrelated to each other. A record documenting anesthesia as the cause, or a newborn record, therefore takes the excluded code instead of J69.0 rather than in addition to it.

CODE ALSO

J69.0 carries a Code also note for any associated foreign body in respiratory tract (the T17 codes). The T17 codes require a seventh character: A for initial encounter, D for subsequent encounter, S for sequela. Category J69 carries the separate instruction Code also, if applicable, other types of pneumonias, such as bacterial pneumonia (J13-J15.-) and viral pneumonia (the J12 codes). The FY2027 update revised this note to name those two examples. With the Code also note at category J18 for aspiration pneumonia (J69.-), it permits J69.0 to sit alongside a pneumonia code such as J15.9 or J18.9 when each condition is independently documented.

FY2027: EFFECTIVE 1 OCTOBER 2026

J69.0 is valid in the FY2026 code set and unchanged in the FY2027 update. Its descriptor, its inclusion terms and its own notes are unchanged. No code was added to or deleted from category J69. The FY2027 tabular addenda revise the Code also note at category J69 to name bacterial pneumonia (J13-J15.-) and viral pneumonia (J12.-) as examples.

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+)

J69.0 maps to HCC 282, Aspiration and Specified Bacterial Pneumonias, under CMS-HCC Model Version 28.

J69.1 and J69.8 map to the same category. All three J69 codes are risk adjusting under v28.

J18.9, pneumonia unspecified organism, maps to no CMS-HCC v28 category at all.

Documented aspiration is what separates an HCC-bearing pneumonia code from one that carries no risk adjustment weight.

CMS-HCC v28 is fully operative at 100 percent weight for Medicare Advantage payment year 2026.

MS-DRG v44 (FY2027)

MS-DRG 177: Respiratory infections and inflammations with MCC.

MS-DRG 178: Respiratory infections and inflammations with CC.

MS-DRG 179: Respiratory infections and inflammations without CC/MCC.

J69.0 groups to MS-DRG 177, 178 or 179 under the FY2027 MS-DRG v44 grouper. J18.9 groups instead to MS-DRG 193, 194 or 195, simple pneumonia and pleurisy. The two codes sit in different DRG families, not in different severity tiers of the same one.

MEDICARE AND COMMERCIAL PAYERS

There is no National Coverage Determination specific to J69.0.

The FY2027 ICD-10-CM Official Guidelines contain no guideline specific to aspiration pneumonia. Guideline I.C.10.b.3 names aspiration pneumonia only as an example of an acute condition sequenced with acute respiratory failure. Section I.C.10 for Chapter 10 covers COPD and asthma, acute respiratory failure, influenza due to certain identified influenza viruses, ventilator associated pneumonia and vaping-related disorders.

Guideline I.A.19 states that code assignment is based on the provider's diagnostic statement that the condition exists. It also states that code assignment is not based on the clinical criteria the provider used to establish the diagnosis.

These rules apply to Medicare Fee-for-Service and to Medicare Advantage plans using CMS-HCC v28 for payment year 2026.

WHERE SPECIFICITY IS LOST

Assigning J18.9 when the provider documents aspiration as the mechanism. Category J18 carries a Code also note pointing to aspiration pneumonia in the J69 codes.

Assigning J69.0 on a newborn record. Category J69 excludes the neonatal aspiration syndromes. The Alphabetic Index sends pneumonia, aspiration, newborn to P24.81.

Assigning J69.0 when anesthesia is the documented cause. That is J95.4 outside pregnancy, an O29.01- code during pregnancy, O74.0 during labor and delivery, and O89.01 during the puerperium.

Omitting the dysphagia code. Dysphagia is separately reportable. The R13.1- codes split on the phase of swallowing. That digit is lost when R13.10 is assigned by default.

Omitting the T17 code when a foreign body is documented in the respiratory tract, against the Code also note at J69.0.

Documentation checklist to support J69.0

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

A provider statement naming the mechanism: aspiration pneumonia, aspiration pneumonitis, or pneumonia due to aspiration of food, gastric contents, milk or vomit.

The material aspirated. J69.0 covers food and vomit. J69.1 covers oils and essences. J69.8 covers other solids and liquids.

The aspiration event or the evidence for it: a witnessed choking or emesis episode, a failed bedside swallow screen, a positive instrumental swallow study, or imaging showing a dependent-segment infiltrate.

The predisposing condition where one is documented: dysphagia, a stroke sequela, gastro-esophageal reflux disease, an altered level of consciousness, or enteral tube feeding.

Confirmation that the patient is not a newborn, where the record could read either way. A newborn record goes to the P24 codes.

Whether anesthesia caused the event, because anesthesia-related aspiration pneumonitis is excluded from J69.0 by an Excludes1 note.

Any foreign body documented in the respiratory tract, to support the Code also note and the seventh character on the T17 code.

Treatment and monitoring directed at the pneumonia: antibiotics, oxygen, chest imaging, aspiration precautions, or a modified diet order.

For outpatient encounters, a confirmed diagnosis. Guideline IV.H bars coding an uncertain diagnosis as confirmed in the outpatient setting. Guideline II.H permits an uncertain diagnosis documented at discharge to be coded as confirmed on an inpatient record.

FAQ

Is J69.0 a billable code?

Yes. J69.0 is a valid billable code and takes no further characters. It is valid in the FY2026 code set and unchanged in the FY2027 update.

When do I use J69.0 instead of J18.9?

Use J69.0 when the provider documents aspiration as the mechanism of the pneumonia. Use J18.9 when pneumonia is documented with no organism identified and no aspiration stated. Category J18 carries a Code also note pointing to aspiration pneumonia in the J69 codes. J18 also carries Excludes2 notes for aspiration pneumonia NOS (J69.0) and for aspiration pneumonia due to solids and liquids (the J69 codes). An Excludes2 note means the patient may have both conditions. Both may be reported when each condition is independently documented.

Does J69.0 map to an HCC?

Yes. J69.0 maps to HCC 282, Aspiration and Specified Bacterial Pneumonias, under CMS-HCC Model Version 28. J69.1 and J69.8 map to the same category. J18.9 maps to no v28 category. The documented aspiration mechanism is what carries the risk adjustment.

What must the record show to support J69.0 rather than a plain pneumonia code?

The record must show a provider statement that the pneumonia is due to aspiration, not just a note that the patient is at risk of aspiration. Supporting detail belongs in the record as well: the aspirated material, the event or the swallow study that evidenced it, the predisposing condition such as dysphagia or a stroke sequela, and treatment aimed at the pneumonia. Guideline I.A.19 makes the provider's diagnostic statement the basis for code assignment. Aspiration risk, aspiration precautions and a positive swallow study alone do not establish the diagnosis without that statement.

How do I sequence J69.0?

Sequence J69.0 as the principal diagnosis when aspiration pneumonia is the reason for the admission. When sepsis criteria are met, guideline I.C.1.d.4 sequences the sepsis code first. J69.0 then follows as the localized infection. Dysphagia and a stroke sequela are secondary diagnoses. R13.1- carries a Code first instruction for dysphagia following cerebrovascular disease, which points to the I69 codes with final characters 91.

Do I code dysphagia separately when aspiration pneumonia is documented?

Yes, dysphagia is coded separately when the provider documents it. Guideline I.B.6 states that additional signs and symptoms that may not be associated routinely with a disease process should be coded when present. The R13.1- codes split on the phase of swallowing: R13.11 oral phase, R13.12 oropharyngeal phase, R13.13 pharyngeal phase, R13.14 pharyngoesophageal phase, R13.19 other dysphagia, R13.10 unspecified. Where the dysphagia follows a stroke, the I69 code with final characters 91 is sequenced first.

Does J69.0 work the same way for outpatient and inpatient encounters?

The code is the same. The evidentiary bar is not. Guideline IV.H bars coding an uncertain diagnosis as confirmed in the outpatient setting, and directs coding to the highest degree of certainty for that visit. Guideline II.H permits an uncertain diagnosis documented at discharge to be coded as confirmed on an inpatient record. Inpatient assignment also drives MS-DRG 177, 178 or 179.

Did anything change for aspiration pneumonia in FY2027?

J69.0 is unchanged in the FY2027 update, which revises only the Code also note at category J69. Category J69 received no code additions, no deletions and no note changes in the FY2026 update effective October 1, 2025. The FY2027 update, effective October 1, 2026, adds no code to category J69. It revises the J69 Code also note to name bacterial pneumonia (J13-J15.-) and viral pneumonia (J12.-) as examples of other types of pneumonias.

Related codes

Codes in the same family as J69.0. Only codes with a published page render as links.

Sibling codes in the J69 family

J69.1: Pneumonitis due to inhalation of oils and essences.
J69.8: Pneumonitis due to inhalation of other solids and liquids.

Additional codes to consider

Codes outside the J69 family considered alongside J69.0.

Companion: code alongside when documented

T17-: Foreign body in respiratory tract. Required as a Code also at J69.0 when a foreign body is documented, with a seventh character of A, D or S.
R13.10: Dysphagia, unspecified.
R13.11: Dysphagia, oral phase.
R13.12: Dysphagia, oropharyngeal phase.
R13.13: Dysphagia, pharyngeal phase.
R13.14: Dysphagia, pharyngoesophageal phase.
R13.19: Other dysphagia.
I69.391: Dysphagia following cerebral infarction. Sequenced first under the Code first note at R13.1.
I69.991: Dysphagia following unspecified cerebrovascular disease.
J96.00: Acute respiratory failure, unspecified whether with hypoxia or hypercapnia, sequenced under guideline I.C.10.b.3 when both conditions are documented.
A41.9: Sepsis, unspecified organism, sequenced first when sepsis criteria are met.
J85.1: Abscess of lung with pneumonia.
R63.31: Pediatric feeding disorder, acute, which carries a Code also note for aspiration pneumonia (J69.0).

Consider instead

J18.9: Pneumonia, unspecified organism, where no aspiration is documented.
J95.4: Chemical pneumonitis due to anesthesia, covering Mendelson's syndrome and postprocedural aspiration pneumonia.
P24.81: Other neonatal aspiration with respiratory symptoms, on a newborn record.
O29.01-: Aspiration pneumonitis due to anesthesia during pregnancy, with a sixth character for the trimester.
O74.0: Aspiration pneumonitis due to anesthesia during labor and delivery.
O89.01: Aspiration pneumonitis due to anesthesia during the puerperium.
J84.89: Other specified interstitial pulmonary diseases, which is where endogenous lipoid pneumonia goes.

Mechanical obstruction of the airway by food or a foreign body is a different problem from pneumonitis. Obstruction goes to the T17 codes for the respiratory tract and the T18 codes for the alimentary tract, each with a seventh character. J69.0 is for the inflammatory response to inhaled material.

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