J65
BillablePneumoconiosis associated with tuberculosis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is J65 an HCC code?
Yes. J65 maps to Chronic Obstructive Pulmonary Disease 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 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.
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 (HCC 280) with a community, non-dual, aged base RAF weight of 0.334. 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 0.268. 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