Skip to content
HCC Buddy home

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

J65 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 · free HCC coding tools

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupJ65

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.

OverviewRisk ModelsCode BookDocumentationAuditNotesEdition comparison

CMS-HCC V28

HCC 280

Code-level coefficient reference

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

HCC 162

Code-level coefficient reference

ESRD/PACE

HCC 112

Code-level coefficient reference

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
  • 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

Official

No related codes are included in this display for J65. Check the Code Book for the complete code path.

Includes

Official

No Includes notes are included in this display for J65. Check the code and parent instructions in the Code Book.

Excludes 1

Official

No Excludes 1 notes are included in this display for J65. Check the code and parent instructions in the Code Book.

Code First

Official

No Code First sequencing instructions are included in this display for J65. Check the code and parent instructions in the Code Book.

Use Additional

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

Official

No Code Also instructions are included in this display for J65. Check the code and parent instructions in the Code Book.

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

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 J65 an HCC code?

Yes. J65 (Pneumoconiosis associated with tuberculosis) 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: J65 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
J65
Description
Pneumoconiosis associated with tuberculosis
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

V28HCC 280, Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
0.319
ESRDHCC 112, Fibrosis of Lung and Other Chronic Lung Disorders
Not separately weighted

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

MEAT review for J65

For J65, 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

Get the V28 mapping + MEAT cheat sheet

One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.

Free PDF. No card. Unsubscribe anytime.

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 source-labeled community, non-dual, aged reference coefficient of 0.319. No V24 mapping is shown for J65; use the applicable model and payment year when reviewing the V28 mapping. 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.

Require documentation of both pneumoconiosis and active or history of tuberculosis to assign this code. For J65, 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 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

For J65, 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.

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. The mapping identifies a payment HCC category for J65. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

Work J65 in HCC Buddy

Open J65 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

Open in Code BookOpen in EncoderStart Pro