J67.1
BillableBagassosis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is J67.1 an HCC code?
Yes. J67.1 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
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 J67.1
For J67.1to 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 J67.1 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
J67.1 is the ICD-10-CM diagnosis code for bagassosis. An allergic lung inflammation caused by inhaling dust from moldy sugarcane bagasse, typically occurring in workers in the sugar cane industry. J67.1 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, J67.1 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, J67.1 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.
Bagassosis is a form of hypersensitivity pneumonitis; document occupational exposure to bagasse dust. Because J67.1 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 J67.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Bagassosis is a form of hypersensitivity pneumonitis; document occupational exposure to bagasse dust
- •Specify acute, subacute, or chronic form if documented in the clinical record
Clinical Significance
Bagassosis is a form of hypersensitivity pneumonitis specific to sugarcane processing workers, caused by inhalation of moldy bagasse (sugarcane fiber residue). It is relevant for risk adjustment as a chronic occupational lung condition that can progress to pulmonary fibrosis and respiratory failure if exposure continues.
Documentation Requirements
- ✓Documented occupational exposure to bagasse (sugarcane fiber) dust, particularly moldy bagasse
- ✓Employment history in sugar cane industry or related processing
- ✓Classification as acute, subacute, or chronic disease
- ✓Chest imaging and pulmonary function test results
- ✓Serum precipitins or specific antibody testing if performed
- ✓Treatment plan and exposure avoidance recommendations
Commonly Confused Codes
- •J67.0 (Farmer's lung) — moldy hay exposure vs. moldy sugarcane bagasse
- •J67.8 (Hypersensitivity pneumonitis due to other organic dusts) — use J67.1 when bagasse is the specific agent
- •J67.9 (Hypersensitivity pneumonitis due to unspecified organic dust) — use J67.1 when sugarcane exposure is documented
- •J66.8 (Airway disease due to other specific organic dusts) — different mechanism; J67.1 is allergic/immunologic