What is ICD-10 code J63.1?

J63.1 is the ICD-10-CM diagnosis code for Bauxite fibrosis (of lung). A lung disease caused by inhaling bauxite dust, leading to scarring and inflammation of lung tissue. This occupational condition typically affects workers in aluminum mining and processing. J63.1 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. J63.1 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. J63.1 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. J63.1 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for J63.1?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For J63.1, V28 maps to Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders at RAF 0.319 while V24 mapped to Fibrosis of Lung and Other Chronic Lung Disorders at RAF 0.219. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting J63.1?

Verify occupational exposure history to bauxite dust in patient documentation Ensure this is not being confused with other pneumoconiosis types; bauxite fibrosis is specifically related to aluminum ore processing Because J63.1 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM J63.1: Bauxite fibrosis (of lung)

ICD-10-CM Code View

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Code lookupJ63.1Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Lung diseases due to external agents (J60-J70)

J63.1

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Bauxite fibrosis (of lung)

A lung disease caused by inhaling bauxite dust, leading to scarring and inflammation of lung tissue. This occupational condition typically affects workers in aluminum mining and processing.

Buddy Insight

CMS-HCC V28

Mapped

HCC 280

Chronic Obstructive Pulmonary...

RAF 0.319

CMS-HCC V24

Mapped

HCC 112

Fibrosis of Lung and Other Ch...

RAF 0.219

ACA/HHS

Mapped

HCC 162

HHS-HCC 162

Varies by metal level

ESRD/PACE

Mapped

HCC 112

Fibrosis of Lung and Other Ch...

RAF 0.058

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

J63Pneumoconiosis due to other inorganic dusts

J63.1Bauxite fibrosis (of lung)

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for J63.1 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for J63.1 in this effective period.

Related Child Codes

Official

J63.0Aluminosis (of lung)

J63.2Berylliosis

J63.3Graphite fibrosis (of lung)

J63.4Siderosis

J63.5Stannosis

Includes

Official

ICD-10-CM does not list Includes notes for J63.1 in this effective period.

Excludes 1

Official

pneumoconiosis with tuberculosis, any type in A15 (J65)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for J63.1 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for J63.1 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for J63.1 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documented occupational history with specific exposure to bauxite (aluminum ore) dust

Imaging findings (chest X-ray or CT) showing fibrotic changes consistent with pneumoconiosis

Pulmonary function test results demonstrating restrictive pattern

Duration and intensity of exposure

MEAT Support

HCC Buddy guidance

Documented occupational history with specific exposure to bauxite (aluminum ore) dust

Imaging findings (chest X-ray or CT) showing fibrotic changes consistent with pneumoconiosis

Pulmonary function test results demonstrating restrictive pattern

Duration and intensity of exposure

Audit Caution

HCC Buddy guidance

Failing to document the specific occupational exposure to bauxite, which could result in a less specific code being assigned

Confusing bauxite fibrosis with general aluminosis (J63.0) — bauxite is specifically aluminum ore

Not linking to external cause codes (Chapter 20) for occupational exposure when applicable

Coding this as unspecified pneumoconiosis (J64) when the bauxite exposure is clearly documented

Common Mistakes

HCC Buddy guidance

J63.0 (Aluminosis of lung) — aluminosis is from aluminum dust generally, while J63.1 is specifically from bauxite ore dust

J63.6 (Pneumoconiosis due to other specified inorganic dusts) — use J63.1 when bauxite is specifically identified

J84.10 (Pulmonary fibrosis, unspecified) — use J63.1 when fibrosis has a documented occupational bauxite cause

J64 (Unspecified pneumoconiosis) — always code to the specific dust type when known

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 J63.1 an HCC code?

Yes. J63.1 (Bauxite fibrosis (of lung)) 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), with a community non-dual aged RAF of 0.319. It is billable for payment year 2026.

Coder answer: J63.1 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: J63.1
Description: Bauxite fibrosis (of lung)
HCC (V28): HCC 280 — Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
RAF: 0.319
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 280, Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders

0.319

V24HCC 112, Fibrosis of Lung and Other Chronic Lung Disorders

0.219

ESRDHCC 112, Fibrosis of Lung and Other Chronic Lung Disorders

0.058

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work J63.1 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for J63.1

For J63.1 to 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 J63.1 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

J63.1 is the ICD-10-CM diagnosis code for bauxite fibrosis (of lung). A lung disease caused by inhaling bauxite dust, leading to scarring and inflammation of lung tissue. This occupational condition typically affects workers in aluminum mining and processing. J63.1 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, J63.1 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, J63.1 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.

Verify occupational exposure history to bauxite dust in patient documentation. Because J63.1 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 J63.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify occupational exposure history to bauxite dust in patient documentation
•Ensure this is not being confused with other pneumoconiosis types; bauxite fibrosis is specifically related to aluminum ore processing

Clinical Significance

Bauxite fibrosis is an occupational pneumoconiosis that carries significant risk adjustment weight because it represents irreversible lung parenchymal damage requiring ongoing monitoring and treatment. This condition indicates chronic respiratory impairment from aluminum dust exposure, increasing the patient's expected healthcare utilization for pulmonary function testing, imaging, and potentially oxygen therapy.

Documentation Requirements

✓Documented occupational history with specific exposure to bauxite (aluminum ore) dust
✓Imaging findings (chest X-ray or CT) showing fibrotic changes consistent with pneumoconiosis
✓Pulmonary function test results demonstrating restrictive pattern
✓Duration and intensity of exposure
✓Current symptom burden (dyspnea, cough, exercise intolerance)
✓Treatment plan including any oxygen requirements or medications

Commonly Confused Codes

•J63.0 (Aluminosis of lung): aluminosis is from aluminum dust generally, while J63.1 is specifically from bauxite ore dust
•J63.6 (Pneumoconiosis due to other specified inorganic dusts): use J63.1 when bauxite is specifically identified
•J84.10 (Pulmonary fibrosis, unspecified): use J63.1 when fibrosis has a documented occupational bauxite cause
•J64 (Unspecified pneumoconiosis): always code to the specific dust type when known