J67.9
BillableHypersensitivity pneumonitis due to unspecified organic dust
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is J67.9 an HCC code?
Yes. J67.9 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 J67.9
For J67.9to 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 J67.9 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
J67.9 is the ICD-10-CM diagnosis code for hypersensitivity pneumonitis due to unspecified organic dust. An allergic lung inflammation caused by inhaling organic dust, but the specific type of dust or occupational exposure is not identified or documented. J67.9 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, J67.9 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, J67.9 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.
This is a residual code; use only when the specific organic dust cannot be determined. Because J67.9 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 J67.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a residual code; use only when the specific organic dust cannot be determined
- •Query the provider if possible to identify the specific dust exposure for more precise coding
Clinical Significance
Unspecified hypersensitivity pneumonitis indicates an allergic lung reaction to organic dust where the specific causative agent could not be identified. While it carries the same HCC weight as specific forms, it represents incomplete documentation and should trigger provider queries to identify the exposure for both treatment planning and accurate coding.
Documentation Requirements
- ✓Documentation of hypersensitivity pneumonitis diagnosis (clinical, imaging, or pathological evidence)
- ✓Statement that the specific organic dust exposure could not be determined despite investigation
- ✓Exposure and environmental history that was explored
- ✓Chest imaging and pulmonary function test results
- ✓Biopsy results if obtained showing granulomatous or lymphocytic interstitial inflammation
- ✓Treatment plan and empiric avoidance measures
Commonly Confused Codes
- •J67.0-J67.8 — always attempt to identify the specific dust before using J67.9
- •J84.10 (Pulmonary fibrosis, unspecified) — chronic hypersensitivity pneumonitis with fibrosis may be miscoded as generic pulmonary fibrosis
- •J84.89 (Other specified interstitial pulmonary diseases) — use when interstitial disease is present but not from organic dust
- •J82.89 (Other pulmonary eosinophilia) — different pathology (eosinophilic vs. lymphocytic inflammation)