J68.1 ICD-10-CM Code: Pulmonary edema due to chemicals, gases, fumes and vapors
J68.1 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 · HCC Buddy coding tools
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FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Lung diseases due to external agents (J60-J70)
J68.1
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePulmonary edema due to chemicals, gases, fumes and vapors
Fluid buildup in the lungs caused by exposure to harmful chemicals, gases, fumes, or vapors, often from workplace or accidental exposure.
Buddy Insight
Chemical-induced pulmonary edema represents severe acute lung injury with fluid flooding the alveoli, often a medical emergency requiring intensive care.
CMS-HCC V28
MappedHCC 280
Coefficient HCC 280: 0.319 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 162
Code-level coefficient reference
ESRD/PACE
MappedHCC 112
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Chemical pulmonary edema (acute) (chronic)
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
Includes
OfficialNo Includes notes are included in this display for J68.1. Check the code and parent instructions in the Code Book.
Excludes 1
Official- pulmonary edema (acute) (chronic) NOS (J81.-)
Code First
Official- (T51-T65) to identify causeInherited from J68
Use Additional
Official- code, where applicable, to identify:Inherited from J00-J99, J68
- exposure to environmental tobacco smoke (Z77.22)Inherited from J00-J99, J68
- exposure to tobacco smoke in the perinatal period (P96.81)Inherited from J00-J99, J68
- history of tobacco dependence (Z87.891)Inherited from J00-J99, J68
- occupational exposure to environmental tobacco smoke (Z57.31)Inherited from J00-J99, J68
- tobacco dependence (F17.-)Inherited from J00-J99, J68
- tobacco use (Z72.0)Inherited from J00-J99, J68
- code to identify associated respiratory conditions, such as:Inherited from J00-J99, J68
- acute respiratory failure (J96.0-)Inherited from J00-J99, J68
Code Also
OfficialNo Code Also instructions are included in this display for J68.1. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 J68.1 an HCC code?
Yes. J68.1 (Pulmonary edema due to chemicals, gases, fumes and vapors) 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: J68.1 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
- J68.1
- Description
- Pulmonary edema due to chemicals, gases, fumes and vapors
- 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
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 J68.1 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for J68.1
For J68.1, 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
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What This Code Means
J68.1 is the ICD-10-CM diagnosis code for pulmonary edema due to chemicals, gases, fumes and vapors. Fluid buildup in the lungs caused by exposure to harmful chemicals, gases, fumes, or vapors, often from workplace or accidental exposure. J68.1 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, J68.1 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. 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.
Always document the specific chemical, gas, fume, or vapor exposure when available to support medical necessity. For J68.1, 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 J68.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Always document the specific chemical, gas, fume, or vapor exposure when available to support medical necessity
- •Consider using an external cause code (Chapter 20) to identify how the exposure occurred (occupational, accidental, etc.)
Clinical Significance
Chemical-induced pulmonary edema represents severe acute lung injury with fluid flooding the alveoli, often a medical emergency requiring intensive care. This code carries significant risk adjustment weight because it reflects a life-threatening condition with high resource utilization, including potential mechanical ventilation and ICU stay.
Documentation Requirements
- ✓Identification of the specific chemical, gas, fume, or vapor causing pulmonary edema
- ✓Chest imaging confirming pulmonary edema pattern
- ✓Arterial blood gas results showing respiratory compromise
- ✓Oxygen requirements and ventilatory support details
- ✓Temporal relationship between chemical exposure and symptom onset
- ✓External cause codes documenting the circumstances of exposure
- ✓Clinical differentiation from cardiogenic pulmonary edema
Excludes 1, Do NOT code together
- pulmonary edema (acute) (chronic) NOS (J81.-)
Commonly Confused Codes
- •J81.0 (Acute pulmonary edema): non-chemical cause; use J68.1 when chemicals are the documented cause
- •J68.0 (Bronchitis and pneumonitis due to chemicals): airway inflammation vs. alveolar flooding
- •J80 (Acute respiratory distress syndrome): ARDS is a specific syndrome; chemical pulmonary edema may progress to ARDS
- •I50.1 (Left ventricular failure): cardiogenic pulmonary edema has a cardiac cause, not chemical