J64 ICD-10-CM Code: Unspecified pneumoconiosis
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Lung diseases due to external agents (J60-J70)
J64
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceUnspecified pneumoconiosis
This code describes lung disease caused by inhaling dust or particles over time, when the specific type of dust or particle cannot be identified. It's commonly seen in workers exposed to occupational dust without a clear diagnosis of a specific pneumoconiosis type.
Buddy Insight
Unspecified pneumoconiosis represents dust-induced lung disease where the specific causative agent cannot be determined.
CMS-HCC V28
MappedHCC 280
RAF 0.319
CMS-HCC V24
MappedHCC 112
RAF 0.219
ACA/HHS
MappedHCC 162
Varies by metal level
ESRD/PACE
MappedHCC 112
RAF 0.058
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for J64 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for J64 in this effective period.
Related Child Codes
ICD-10-CM does not list child codes under J64 for this display context.
Includes
OfficialICD-10-CM does not list Includes notes for J64 in this effective period.
Excludes 1
Official- pneumonoconiosis with tuberculosis, any type in A15 (J65)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for J64 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for J64 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for J64 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is J64 an HCC code?
Yes. J64 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
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 J64 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for J64
For J64to 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 J64 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
Get the V28 RAF + MEAT cheat sheet
One printable page: confirm a code's V28 HCC status, its RAF weight, and the MEAT your note needs to make it stick. Free, no card.
Free PDF. No card. Unsubscribe anytime.
What This Code Means
J64 is the ICD-10-CM diagnosis code for unspecified pneumoconiosis. This code describes lung disease caused by inhaling dust or particles over time, when the specific type of dust or particle cannot be identified. It's commonly seen in workers exposed to occupational dust without a clear diagnosis of a specific pneumoconiosis type. J64 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, J64 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, J64 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.
Always attempt to identify the specific type of pneumoconiosis (such as silicosis, asbestosis, or coal worker's pneumoconiosis) before using this unspecified code, as more specific codes provide better clinical detail. Because J64 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 J64 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Always attempt to identify the specific type of pneumoconiosis (such as silicosis, asbestosis, or coal worker's pneumoconiosis) before using this unspecified code, as more specific codes provide better clinical detail
- •Document the patient's occupational history and exposure to dust or particles to support the diagnosis and help determine if a more specific pneumoconiosis code should be used
Clinical Significance
Unspecified pneumoconiosis represents dust-induced lung disease where the specific causative agent cannot be determined. While it carries the same HCC weight as specified pneumoconioses, it signals incomplete documentation and should prompt provider queries to identify the specific dust type for both clinical management and accurate risk adjustment.
Documentation Requirements
- ✓Documentation that pneumoconiosis has been diagnosed (clinical, radiographic, or pathological evidence)
- ✓Occupational and environmental exposure history, even if the specific dust cannot be identified
- ✓Chest imaging findings showing pneumoconiotic changes
- ✓Pulmonary function test results
- ✓Provider attestation that the specific dust type could not be determined
- ✓Current respiratory symptoms and management plan
Commonly Confused Codes
- •J60 (Coal workers' pneumoconiosis): use when coal mine exposure is documented
- •J61 (Pneumoconiosis due to asbestos and other mineral fibers): use when asbestos exposure is confirmed
- •J62.8 (Pneumoconiosis due to other dust containing silica): use when silica-containing dust is identified
- •J63.0-J63.6: use when any specific inorganic dust is identified
- •J84.10 (Pulmonary fibrosis, unspecified): use when fibrosis exists but no dust exposure is documented