What is ICD-10 code J68.4?

J68.4 is the ICD-10-CM diagnosis code for Chronic respiratory conditions due to chemicals, gases, fumes and vapors. Long-term lung disease caused by repeated or prolonged exposure to chemicals, gases, fumes, or vapors, typically from occupational settings. J68.4 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. J68.4 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. J68.4 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. J68.4 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does J68.4 map to under V28?

J68.4 maps to CMS-HCC V28 280 (Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does J68.4 pay in RAF?

J68.4 carries a community, non-dual, aged (CNA) RAF weight of 0.319 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for J68.4?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For J68.4, V28 maps to Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders at RAF 0.319 while V24 mapped to Fibrosis of Lung and Other Chronic Lung Disorders at RAF 0.219. Both models can still appear in legacy data and in payer-specific lookback periods.

What documentation supports J68.4?

This code indicates chronic/long-standing condition, so document duration of exposure and symptoms Consider occupational history and whether this is work-related for proper coding and potential workers' compensation claims Because J68.4 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM J68.4: Chronic respiratory

J68.4 maps to CMS-HCC V28 280 (RAF 0.319). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC Buddy coding tools

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Code lookupJ68.4Effective 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)

J68.4

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

Chronic respiratory conditions due to chemicals, gases, fumes and vapors

Long-term lung disease caused by repeated or prolonged exposure to chemicals, gases, fumes, or vapors, typically from occupational settings.

Buddy Insight

CMS-HCC V28

Mapped

HCC 280

Chronic Obstructive Pulmonary...

RAF 0.319

CMS-HCC V24

Mapped

HCC 112

Fibrosis of Lung and Other Ch...

RAF 0.219

ACA/HHS

Mapped

HCC 162

HHS-HCC 162

Varies by metal level

ESRD/PACE

Mapped

HCC 112

Fibrosis of Lung and Other Ch...

RAF 0.058

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

J68.4Chronic respiratory conditions due to chemicals, gases, fumes and vapors

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for J68.4 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for J68.4 in this effective period.

Related Child 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

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

J68.8Other respiratory conditions due to chemicals, gases, fumes and vapors

Includes

Official

ICD-10-CM does not list Includes notes for J68.4 in this effective period.

Excludes 1

Official

chronic pulmonary edema due to chemicals, gases, fumes and vapors (J68.1)

Code First

Official

(T51-T65) to identify cause

Use Additional

Official

code to identify associated respiratory conditions, such as:
acute respiratory failure (J96.0-)

Code Also

Official

, if applicable, chronic conditions, such as:
emphysema (J43.-)
obliterative bronchiolitis (J44.81)
pulmonary fibrosis (J84.10)

Buddy Documentation Tip

HCC Buddy guidance

Documentation of chronic respiratory disease with established chemical causation

Identification of the specific chemical, gas, fume, or vapor responsible

Duration of exposure and symptom timeline establishing chronicity

Pulmonary function test results showing chronic impairment

MEAT Support

HCC Buddy guidance

Documentation of chronic respiratory disease with established chemical causation

Identification of the specific chemical, gas, fume, or vapor responsible

Duration of exposure and symptom timeline establishing chronicity

Pulmonary function test results showing chronic impairment

Audit Caution

HCC Buddy guidance

Using generic COPD codes (J44.x) when the chemical etiology is documented — J68.4 provides the causal link

Not distinguishing chronic from acute chemical-induced conditions — this affects both coding and clinical management

Failing to link occupational exposure for potential workers' compensation claims

Coding as unspecified pulmonary fibrosis when the chemical cause is established

Common Mistakes

HCC Buddy guidance

J68.0-J68.3 (Acute chemical respiratory conditions) — these are acute, while J68.4 is chronic

J44.1 (Chronic obstructive pulmonary disease with acute exacerbation) — idiopathic COPD vs. chemical-induced chronic disease

J84.10 (Pulmonary fibrosis, unspecified) — when chemical exposure causes fibrosis, use J68.4 to capture the etiology

J68.8 (Other respiratory conditions due to chemicals) — J68.4 specifically captures the chronic nature

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 J68.4 an HCC code?

Yes. J68.4 (Chronic respiratory conditions due to chemicals, gases, fumes and vapors) 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), with a community non-dual aged RAF of 0.319. It is billable for payment year 2026.

Coder answer: J68.4 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: J68.4
Description: Chronic 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: 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

V24HCC 112, Fibrosis of Lung and Other Chronic Lung Disorders

0.219

ESRDHCC 112, Fibrosis of Lung and Other Chronic Lung Disorders

0.058

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work J68.4 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for J68.4

For J68.4 to 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 J68.4 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

J68.4 is the ICD-10-CM diagnosis code for chronic respiratory conditions due to chemicals, gases, fumes and vapors. Long-term lung disease caused by repeated or prolonged exposure to chemicals, gases, fumes, or vapors, typically from occupational settings. J68.4 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, J68.4 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, J68.4 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.

This code indicates chronic/long-standing condition, so document duration of exposure and symptoms. Because J68.4 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 J68.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This code indicates chronic/long-standing condition, so document duration of exposure and symptoms
•Consider occupational history and whether this is work-related for proper coding and potential workers' compensation claims

Clinical Significance

Chronic respiratory conditions from chemical exposure represent the long-term sequelae of toxic inhalation, including obliterative bronchiolitis, chronic chemical bronchitis, and chemical-induced pulmonary fibrosis. This code is highly relevant for risk adjustment because it captures ongoing, irreversible lung disease requiring continuous medical management.

Documentation Requirements

✓Documentation of chronic respiratory disease with established chemical causation
✓Identification of the specific chemical, gas, fume, or vapor responsible
✓Duration of exposure and symptom timeline establishing chronicity
✓Pulmonary function test results showing chronic impairment
✓Chest imaging documenting chronic changes
✓Occupational history linking the condition to workplace exposure
✓Current treatment plan and functional limitations

Excludes 1, Do NOT code together

chronic pulmonary edema due to chemicals, gases, fumes and vapors (J68.1)

Code Also

, if applicable, chronic conditions, such as:
emphysema (J43.-)
obliterative bronchiolitis (J44.81)
pulmonary fibrosis (J84.10)

Commonly Confused Codes

•J68.0-J68.3 (Acute chemical respiratory conditions): these are acute, while J68.4 is chronic
•J44.1 (Chronic obstructive pulmonary disease with acute exacerbation): idiopathic COPD vs. chemical-induced chronic disease
•J84.10 (Pulmonary fibrosis, unspecified): when chemical exposure causes fibrosis, use J68.4 to capture the etiology
•J68.8 (Other respiratory conditions due to chemicals): J68.4 specifically captures the chronic nature