J61 ICD-10-CM Code: Pneumoconiosis due to asbestos and other mineral fibers
J61 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 coding software
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FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Lung diseases due to external agents (J60-J70)
J61
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePneumoconiosis 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.
Buddy Insight
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.
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 162
Coefficient needs member context
ESRD/PACE
Context neededHCC 112
Coefficient needs member context
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Asbestosis
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from J00-J99, J60-J70
- certain infectious and parasitic diseases (A00-B99)Inherited from J00-J99, J60-J70
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from J00-J99, J60-J70
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from J00-J99, J60-J70
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from J00-J99, J60-J70
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from J00-J99, J60-J70
- neoplasms (C00-D49)Inherited from J00-J99, J60-J70
- smoke inhalation (T59.81-)Inherited from J00-J99, J60-J70
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from J00-J99, J60-J70
- asthma (J45.-)Inherited from J00-J99, J60-J70
- malignant neoplasm of bronchus and lung (C34.-)Inherited from J00-J99, J60-J70
Related Codes
No related codes are included in this display for J61. Check the Code Book for the complete code path.
Includes
OfficialNo Includes notes are included in this display for J61. Check the code and parent instructions in the Code Book.
Excludes 1
Official- pleural plaque with asbestosis (J92.0)
- pneumoconiosis with tuberculosis, any type in A15 (J65)
Code First
OfficialNo Code First sequencing instructions are included in this display for J61. 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 J61. 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 J61 an HCC code?
Yes. J61 (Pneumoconiosis due to asbestos and other mineral fibers) 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: J61 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
- J61
- Description
- Pneumoconiosis due to asbestos and other mineral fibers
- 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 J61 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for J61
For J61, 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
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 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 J61 when the provider wording supports pneumoconiosis due to asbestos and other mineral fibers. Check the FY2026 tabular notes and the full code path before the final code choice. For J61, 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 J61 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use J61 when the provider wording supports pneumoconiosis due to asbestos and other mineral fibers. 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 pneumoconiosis due to asbestos and other mineral fibers. Keep the checklist tied to the note.
- •The FY2026 Alphabetic Index routes Fibrosis, fibrotic under lung (atrophic) (chronic) (confluent) (massive) (perialveolar) (peribronchial) with asbestosis to J61. Confirm that the indexed wording matches the provider documentation before using this route.
- •Ask Buddy to show the official notes and code path for J61.
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