J62.8
BillablePneumoconiosis due to other dust containing silica
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is J62.8 an HCC code?
Yes. J62.8 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 J62.8
For J62.8to 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 J62.8 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
J62.8 is the ICD-10-CM diagnosis code for pneumoconiosis due to other dust containing silica. A lung disease caused by inhaling dust that contains silica particles from sources other than coal or asbestos, leading to lung scarring. J62.8 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, J62.8 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, J62.8 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.
Use when silica-containing dust exposure is documented but the source is not coal or asbestos. Because J62.8 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 J62.8 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use when silica-containing dust exposure is documented but the source is not coal or asbestos
- •Document the specific type of silica-containing dust exposure when possible
Clinical Significance
Pneumoconiosis due to other dust containing silica encompasses silicosis and related conditions caused by inhalation of crystalline silica dust (quartz, cristobalite, tridymite). Silicosis is one of the oldest and most prevalent occupational lung diseases worldwide, occurring in mining, sandblasting, quarrying, and construction, with potential progression to progressive massive fibrosis.
Documentation Requirements
- ✓Documented occupational history of silica dust exposure with type of work and duration
- ✓Chest imaging (X-ray or CT) showing characteristic findings: upper-lobe predominant nodules, eggshell calcification of hilar lymph nodes, progressive massive fibrosis
- ✓ILO classification of chest radiograph if available
- ✓Pulmonary function testing showing restrictive and/or mixed pattern
- ✓Provider diagnosis of silicosis or pneumoconiosis due to silica-containing dust
- ✓Assessment for associated conditions: tuberculosis (increased risk with silicosis), connective tissue disease
- ✓Type of silicosis documented if applicable: acute, accelerated, or chronic
Commonly Confused Codes
- •J62.0 — Pneumoconiosis due to talc dust: different mineral dust (talc vs. crystalline silica)
- •J60 — Coalworker's pneumoconiosis: coal dust, not silica; though coal may contain silica
- •J63.0 — Aluminosis: aluminum dust, different exposure
- •J64 — Unspecified pneumoconiosis: less specific; use J62.8 when silica exposure is documented