J61
BillablePneumoconiosis due to asbestos and other mineral fibers
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is J61 an HCC code?
Yes. J61 maps to Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders 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 J61
For J61to 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 J61 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
J61 is the ICD-10-CM diagnosis code for pneumoconiosis due to asbestos and other mineral fibers. A lung disease caused by inhaling asbestos fibers or other mineral fibers, which can cause scarring and breathing problems. J61 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, J61 maps to Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders (HCC 280) with a community, non-dual, aged base RAF weight of 0.319. Under the older CMS-HCC V24 model, J61 maps to Fibrosis of Lung and Other Chronic Lung Disorders (HCC 112) with a community, non-dual, aged base RAF weight of 0.219. 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.
Document specific exposure history to asbestos or other mineral fibers. Because J61 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 J61 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document specific exposure history to asbestos or other mineral fibers
- •Distinguish from other pneumoconiosis codes; asbestos exposure is a key differentiator
Clinical Significance
Pneumoconiosis due to asbestos (asbestosis) is an irreversible occupational lung disease caused by chronic inhalation of asbestos fibers, leading to progressive pulmonary fibrosis predominantly affecting the lower lobes. Asbestosis carries significant implications for lung cancer risk, mesothelioma screening, and medicolegal documentation requirements.
Documentation Requirements
- ✓Documented history of asbestos exposure with duration, intensity, and occupational context
- ✓Chest imaging (CT preferred) showing characteristic findings: subpleural fibrosis, honeycombing, pleural plaques
- ✓Pulmonary function testing showing restrictive pattern with decreased diffusion capacity
- ✓Provider diagnosis of asbestosis or pneumoconiosis due to asbestos
- ✓Latency period documentation (typically 15-20+ years from exposure to disease)
- ✓Current symptoms and functional limitations
- ✓Screening plan for asbestos-related malignancies (lung cancer, mesothelioma)
Excludes 1 — Do NOT code together
Commonly Confused Codes
- •J60 — Coalworker's pneumoconiosis: different causative dust (coal vs. asbestos)
- •J92.0 — Pleural plaque with presence of asbestos: isolated pleural plaques without parenchymal disease
- •J84.10 — Pulmonary fibrosis, unspecified: does not capture the asbestos etiology
- •C45.0 — Mesothelioma of pleura: a malignancy associated with asbestos, not the pneumoconiosis itself
- •J62.8 — Pneumoconiosis due to other dust containing silica: different exposure type