J68.3 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

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Code lookupJ68.3

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Lung diseases due to external agents (J60-J70)

J68.3

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Other acute and subacute respiratory conditions due to chemicals, gases, fumes and vapors

Other acute or short-term breathing problems resulting from exposure to harmful chemicals, gases, fumes, or vapors that don't fit other specific categories.

Buddy Insight

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 280

Chronic Obstructive Pulmonary...

Coefficient HCC 280: 0.319 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 162

HHS-HCC 162 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 112

Fibrosis of Lung and Other Ch...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

J68Respiratory conditions due to inhalation of chemicals, gases, fumes and vapors J68.3Other acute and subacute respiratory conditions due to chemicals, gases, fumes and vapors

Inclusion Terms

Official

Reactive airways dysfunction syndrome

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

J68.0Bronchitis and pneumonitis due to chemicals, gases, fumes and vapors J68.1Pulmonary edema due to chemicals, gases, fumes and vapors J68.2Upper respiratory inflammation due to chemicals, gases, fumes and vapors, not elsewhere classified J68.4Chronic respiratory conditions due to chemicals, gases, fumes and vapors J68.8Other respiratory conditions due to chemicals, gases, fumes and vapors

Includes

Official

No Includes notes are included in this display for J68.3. Check the code and parent instructions in the Code Book.

Excludes 1

Official

No Excludes 1 notes are included in this display for J68.3. Check the code and parent instructions in the Code Book.

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

Official

No Code Also instructions are included in this display for J68.3. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of the specific acute or subacute respiratory manifestation

Identification of the chemical, gas, fume, or vapor causing the condition

Timing of onset relative to chemical exposure confirming acute/subacute classification

Clinical findings and imaging results

MEAT Support

HCC Buddy guidance

Documentation of the specific acute or subacute respiratory manifestation

Identification of the chemical, gas, fume, or vapor causing the condition

Timing of onset relative to chemical exposure confirming acute/subacute classification

Clinical findings and imaging results

Audit Caution

HCC Buddy guidance

Using this residual code when a more specific J68.0, J68.1, or J68.2 code is appropriate

Not documenting the specific respiratory manifestation to support this catch-all code

Confusing acute/subacute chemical-induced conditions with the chronic form (J68.4)

Failing to document the temporal relationship between exposure and symptom onset

Common Mistakes

HCC Buddy guidance

J68.0 (Bronchitis and pneumonitis due to chemicals) — specific airway inflammation pattern

J68.1 (Pulmonary edema due to chemicals) — specific fluid accumulation pattern

J68.2 (Upper respiratory inflammation due to chemicals) — limited to upper airway

J68.4 (Chronic respiratory conditions due to chemicals) — chronic vs. acute/subacute classification

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 J68.3 an HCC code?

Yes. J68.3 (Other acute and subacute respiratory conditions 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: J68.3 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: J68.3
Description: Other acute and subacute respiratory conditions 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

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 J68.3 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for J68.3

For J68.3, 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

J68.3 is the ICD-10-CM diagnosis code for other acute and subacute respiratory conditions due to chemicals, gases, fumes and vapors. Other acute or short-term breathing problems resulting from exposure to harmful chemicals, gases, fumes, or vapors that don't fit other specific categories. J68.3 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, J68.3 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.

Use this code for acute respiratory symptoms that don't meet criteria for pulmonary edema or upper respiratory inflammation. For J68.3, 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 J68.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use this code for acute respiratory symptoms that don't meet criteria for pulmonary edema or upper respiratory inflammation
•Document onset timing and specific exposure details to support acute classification

Clinical Significance

This code captures acute and subacute respiratory conditions from chemical exposure that do not fit the more specific categories of bronchitis, pneumonitis, pulmonary edema, or upper airway inflammation. It is important for risk adjustment as it documents chemical-induced respiratory disease that may progress to chronic lung disease.

Documentation Requirements

✓Documentation of the specific acute or subacute respiratory manifestation
✓Identification of the chemical, gas, fume, or vapor causing the condition
✓Timing of onset relative to chemical exposure confirming acute/subacute classification
✓Clinical findings and imaging results
✓Explanation of why more specific J68 codes do not apply
✓External cause codes for the exposure circumstances

Commonly Confused Codes

•J68.0 (Bronchitis and pneumonitis due to chemicals): specific airway inflammation pattern
•J68.1 (Pulmonary edema due to chemicals): specific fluid accumulation pattern
•J68.2 (Upper respiratory inflammation due to chemicals): limited to upper airway
•J68.4 (Chronic respiratory conditions due to chemicals): chronic vs. acute/subacute classification