J43.8 ICD-10-CM Code: Other emphysema
J43.8 maps to CMS-HCC V28 280. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Chronic lower respiratory diseases (J40-J4A)
J43.8
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther emphysema
Emphysema that does not fit into the standard categories of unilateral, panlobular, or centrilobular types, or a combination of different emphysema patterns.
Buddy Insight
Other emphysema captures emphysema types not classified as unilateral, panlobular, or centrilobular, including paraseptal (distal acinar) emphysema and bullous emphysema.
CMS-HCC V28
MappedHCC 280
Coefficient HCC 280: 0.319 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
Context neededHCC 160
Coefficient needs member context
ESRD/PACE
Context neededHCC 111, HCC 112
Coefficient needs member context
RXHCC
MappedHCC 229
Code-level coefficient reference
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for J43.8. Check the code and parent instructions in the Code Book.
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from J00-J99, J40-J4A, J43
- certain infectious and parasitic diseases (A00-B99)Inherited from J00-J99, J40-J4A, J43
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from J00-J99, J40-J4A, J43
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from J00-J99, J40-J4A, J43
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from J00-J99, J40-J4A, J43
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from J00-J99, J40-J4A, J43
- neoplasms (C00-D49)Inherited from J00-J99, J40-J4A, J43
- smoke inhalation (T59.81-)Inherited from J00-J99, J40-J4A, J43
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from J00-J99, J40-J4A, J43
- cystic fibrosis (E84.-)Inherited from J00-J99, J40-J4A, J43
- emphysema due to inhalation of chemicals, gases, fumes or vapors (J68.4)Inherited from J00-J99, J40-J4A, J43
- emphysema with chronic (obstructive) bronchitis (J44.-)Inherited from J00-J99, J40-J4A, J43
- emphysematous (obstructive) bronchitis (J44.-)Inherited from J00-J99, J40-J4A, J43
- traumatic subcutaneous emphysema (T79.7)Inherited from J00-J99, J40-J4A, J43
Related Codes
Includes
OfficialNo Includes notes are included in this display for J43.8. Check the code and parent instructions in the Code Book.
Excludes 1
Official- bronchitis due to chemicals, gases, fumes and vapors (J68.0)Inherited from J40-J4A, J43
- compensatory emphysema (J98.3)Inherited from J40-J4A, J43
- interstitial emphysema (J98.2)Inherited from J40-J4A, J43
- mediastinal emphysema (J98.2)Inherited from J40-J4A, J43
- neonatal interstitial emphysema (P25.0)Inherited from J40-J4A, J43
- surgical (subcutaneous) emphysema (T81.82)Inherited from J40-J4A, J43
Code First
OfficialNo Code First sequencing instructions are included in this display for J43.8. Check the code and parent instructions in the Code Book.
Use Additional
Official- code, where applicable, to identify:Inherited from J00-J99
- exposure to environmental tobacco smoke (Z77.22)Inherited from J00-J99
- exposure to tobacco smoke in the perinatal period (P96.81)Inherited from J00-J99
- history of tobacco dependence (Z87.891)Inherited from J00-J99
- occupational exposure to environmental tobacco smoke (Z57.31)Inherited from J00-J99
- tobacco dependence (F17.-)Inherited from J00-J99
- tobacco use (Z72.0)Inherited from J00-J99
Code Also
OfficialNo Code Also instructions are included in this display for J43.8. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is J43.8 an HCC code?
Yes. J43.8 (Other emphysema) maps to HCC 280, Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.319. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: J43.8 is billable and maps to V28 HCC 280, Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- J43.8
- Description
- Other emphysema
- HCC (V28)
- HCC 280 — Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
- RAF reference coefficient
- 0.319
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work J43.8 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for J43.8
For J43.8, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Coder workflow notes
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What This Code Means
J43.8 is the ICD-10-CM diagnosis code for other emphysema. Emphysema that does not fit into the standard categories of unilateral, panlobular, or centrilobular types, or a combination of different emphysema patterns. J43.8 sits in the ICD-10-CM chapter for diseases of the respiratory system (j00-j99), within the section covering chronic lower respiratory diseases (j40-j4a).
Under the CMS-HCC V28 risk adjustment model, J43.8 maps to Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders (HCC 280) with a source-labeled community, non-dual, aged reference coefficient of 0.319. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Use this code for emphysema with mixed patterns or other specified types not captured by J43.0-J43.2. For J43.8, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for J43.8 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Other emphysema captures emphysema types not classified as unilateral, panlobular, or centrilobular, including paraseptal (distal acinar) emphysema and bullous emphysema. Paraseptal emphysema involves the distal alveoli adjacent to the pleura and septa, and is associated with spontaneous pneumothorax in young adults.
Documentation Requirements
- ✓CT imaging describing the specific type of emphysema (paraseptal, bullous, etc.)
- ✓Documentation confirming the emphysema does not fit centrilobular (J43.2) or panlobular (J43.1) classification
- ✓Pulmonary function testing if available
- ✓Clinical impact assessment: symptoms, functional limitations, complications (e.g., pneumothorax history)
- ✓Treatment plan and monitoring strategy
Commonly Confused Codes
- •J43.2: Centrilobular emphysema: most common type, upper-lobe, smoking-related
- •J43.1: Panlobular emphysema: lower-lobe, alpha-1 antitrypsin deficiency related
- •J43.9: Emphysema, unspecified: use when no specific type is documented
- •J43.0: Unilateral pulmonary emphysema: MacLeod's/Swyer-James syndrome specifically
- •J93.x: Pneumothorax: a complication that may result from paraseptal emphysema, coded separately