J60 ICD-10-CM Code: Coalworker's pneumoconiosis

Code

J60

Description

Coalworker's pneumoconiosis

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 J60 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for J60

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, 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

• •Use J60 when the provider wording supports coalworker's pneumoconiosis. Check the FY2026 tabular notes and the full code path before the final code choice.
• •For this DOS, capture the provider's current assessment and the care action documented for coalworker's pneumoconiosis. Keep the checklist tied to the note.
• •The FY2026 Alphabetic Index routes Fibrosis, fibrotic under lung (atrophic) (chronic) (confluent) (massive) (perialveolar) (peribronchial) with anthracosilicosis to J60. Confirm that the indexed wording matches the provider documentation before using this route.
• •Ask Buddy to show the official notes and code path for J60.

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