J64 ICD-10-CM Code: Unspecified pneumoconiosis
J64 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)
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
Coefficient HCC 280: 0.319 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 162
Code-level coefficient reference
ESRD/PACE
MappedHCC 112
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for J64. Check the code and parent instructions in the Code Book.
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 J64. Check the Code Book for the complete code path.
Includes
OfficialNo Includes notes are included in this display for J64. Check the code and parent instructions in the Code Book.
Excludes 1
Official- pneumonoconiosis with tuberculosis, any type in A15 (J65)
Code First
OfficialNo Code First sequencing instructions are included in this display for J64. 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 J64. 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 J64 an HCC code?
Yes. J64 (Unspecified pneumoconiosis) 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: J64 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
- J64
- Description
- Unspecified pneumoconiosis
- 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 J64 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for J64
For J64, 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
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 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.
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. For J64, 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 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