J60
BillableCoalworker's pneumoconiosis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is J60 an HCC code?
Yes. J60 maps to Chronic Obstructive Pulmonary Disease under the CMS-HCC V28 risk adjustment model (and Fibrosis of Lung and Other Chronic Lung Disorders under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for J60
For J60to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- 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
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed J60 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
J60 is the ICD-10-CM diagnosis code for coalworker's pneumoconiosis. A lung disease caused by inhaling coal dust over many years, leading to scarring and reduced lung function. J60 sits in the ICD-10-CM chapter for diseases of the respiratory system (j00-j99), within the section covering lung diseases due to external agents (j60-j70).
Under the CMS-HCC V28 risk adjustment model, J60 maps to Chronic Obstructive Pulmonary Disease (HCC 280) with a community, non-dual, aged base RAF weight of 0.334. Under the older CMS-HCC V24 model, J60 maps to Fibrosis of Lung and Other Chronic Lung Disorders (HCC 112) with a community, non-dual, aged base RAF weight of 0.268. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Requires occupational history documentation indicating coal mining exposure. Because J60 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, and MEAT documentation criteria for J60 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Requires occupational history documentation indicating coal mining exposure
- •Differentiate from other pneumoconiosis codes based on specific dust exposure type
Clinical Significance
Coalworker's pneumoconiosis (black lung disease) is an occupational lung disease caused by chronic inhalation of coal dust, leading to coal macule formation and progressive pulmonary fibrosis. It is an irreversible condition with significant implications for disability determination, workers' compensation, and long-term respiratory care planning.
Documentation Requirements
- ✓Documented history of coal dust exposure with duration and intensity
- ✓Chest imaging showing characteristic findings: small rounded opacities, progressive massive fibrosis
- ✓Pulmonary function testing demonstrating restrictive and/or obstructive pattern
- ✓Provider diagnosis of coalworker's pneumoconiosis or black lung disease
- ✓Current symptom assessment: dyspnea, cough, exercise limitation
- ✓Occupational history detailing coal mining exposure
- ✓Any associated complications: progressive massive fibrosis, tuberculosis, cor pulmonale
Commonly Confused Codes
- •J61 — Pneumoconiosis due to asbestos: different causative agent (asbestos vs. coal dust)
- •J62.8 — Pneumoconiosis due to other dust containing silica: silicosis from silica dust, not coal dust specifically
- •J64 — Unspecified pneumoconiosis: less specific; use J60 when coal dust exposure is documented
- •J84.10 — Pulmonary fibrosis, unspecified: does not capture the occupational etiology