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J65 ICD-10-CM Code: Pneumoconiosis associated with tuberculosis

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

J65

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

Pneumoconiosis associated with tuberculosis

A condition where pneumoconiosis (lung scarring from dust inhalation) occurs together with tuberculosis infection. This combination typically results in more severe lung damage than either condition alone.

Buddy the Bee presenting code insight

Buddy Insight

Pneumoconiosis associated with tuberculosis represents a dual-pathology condition where occupational dust disease coexists with tuberculous infection, creating a synergistic and more severe lung disease.

CMS-HCC V28

HCC 280

RAF 0.319

CMS-HCC V24

HCC 112

RAF 0.219

ACA/HHS

HCC 162

Varies by metal level

ESRD/PACE

HCC 112

RAF 0.058

RXHCC

N/A

—

Not mapped

Code Book Path

Official
J6Lung diseases due to external agents (J60-J70)
J65Pneumoconiosis associated with tuberculosis

Inclusion Terms

Official
  • Any condition in J60-J64 with tuberculosis, any type in A15
  • Silicotuberculosis

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for J65 in this effective period.

Related Child Codes

Official

ICD-10-CM does not list child codes under J65 for this display context.

Includes

Official

ICD-10-CM does not list Includes notes for J65 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for J65 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for J65 in this effective period.

Use Additional

Official
  • code, if applicable, for associated cachexia (E88.A)

Code Also

Official

ICD-10-CM does not list Code Also instructions for J65 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Documentation of both pneumoconiosis and tuberculosis (active or history of)
Type of pneumoconiosis if identifiable (silicosis + TB is the most common combination)
Tuberculosis status — active, latent, or resolved with scarring
TB culture or molecular testing results

MEAT Support

HCC Buddy guidance
Documentation of both pneumoconiosis and tuberculosis (active or history of)
Type of pneumoconiosis if identifiable (silicosis + TB is the most common combination)
Tuberculosis status — active, latent, or resolved with scarring
TB culture or molecular testing results

Audit Caution

HCC Buddy guidance
Coding only the pneumoconiosis or only the tuberculosis when both conditions coexist — J65 captures the combination
Not specifying the type of pneumoconiosis in addition to J65 for complete clinical picture
Failing to document whether TB is active, latent, or a sequela
Overlooking this code when a patient with known silicosis develops tuberculosis (silicotuberculosis)

Common Mistakes

HCC Buddy guidance
A15.0 (Tuberculosis of lung) — use when TB exists without concurrent pneumoconiosis
J64 (Unspecified pneumoconiosis) — use when pneumoconiosis exists without TB
J62.8 (Pneumoconiosis due to dust containing silica) — silicosis alone without TB; silicotuberculosis should use J65
B90.9 (Sequelae of respiratory and unspecified tuberculosis) — use for TB sequelae without concurrent active pneumoconiosis

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 J65 an HCC code?

Yes. J65 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

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 J65 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for J65

For J65to 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 J65 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

J65 is the ICD-10-CM diagnosis code for pneumoconiosis associated with tuberculosis. A condition where pneumoconiosis (lung scarring from dust inhalation) occurs together with tuberculosis infection. This combination typically results in more severe lung damage than either condition alone. J65 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, J65 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, J65 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.

Require documentation of both pneumoconiosis and active or history of tuberculosis to assign this code. Because J65 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 J65 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Require documentation of both pneumoconiosis and active or history of tuberculosis to assign this code
  • •Code the specific type of pneumoconiosis (J63.x) in addition to J65 for complete clinical picture

Clinical Significance

Pneumoconiosis associated with tuberculosis represents a dual-pathology condition where occupational dust disease coexists with tuberculous infection, creating a synergistic and more severe lung disease. This combination significantly increases morbidity, treatment complexity, and healthcare resource utilization, making it highly relevant for risk adjustment.

Documentation Requirements

  • ✓Documentation of both pneumoconiosis and tuberculosis (active or history of)
  • ✓Type of pneumoconiosis if identifiable (silicosis + TB is the most common combination)
  • ✓Tuberculosis status — active, latent, or resolved with scarring
  • ✓TB culture or molecular testing results
  • ✓Chest imaging showing both pneumoconiotic and tuberculous changes
  • ✓Current treatment regimen for both conditions
  • ✓Occupational exposure history

Use Additional Code

  • code, if applicable, for associated cachexia (E88.A)

Commonly Confused Codes

  • •A15.0 (Tuberculosis of lung): use when TB exists without concurrent pneumoconiosis
  • •J64 (Unspecified pneumoconiosis): use when pneumoconiosis exists without TB
  • •J62.8 (Pneumoconiosis due to dust containing silica): silicosis alone without TB; silicotuberculosis should use J65
  • •B90.9 (Sequelae of respiratory and unspecified tuberculosis): use for TB sequelae without concurrent active pneumoconiosis

Code Hierarchy

└J65Pneumoconiosis associated with tuberculosis
└J65Pneumoconiosis associated with tuberculosis

Because J65 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.

J65 maps to CMS-HCC V28 category 280, Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works.

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