2027 ICD-10-CM Diagnosis Code J43.8Other emphysema

ICD-10-CM Codes›J00–J99›J40-J4B›J43

ICD-10-CM J43.8
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

J43.8 is a billable ICD-10-CM diagnosis code for other emphysema. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 190 through 192. Coders also document this condition as scar emphysema. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Chronic obstructive pulmonary disease and bronchiectasis.

For Medicare Advantage risk adjustment, J43.8 maps to CMS-HCC Category 280 (Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders) under the V28 model, adding a risk factor of about 0.319 for a community, non-dual, aged beneficiary in payment year 2027.

Code Identity

ICD-10-CM Code
J43.8
Billable Status
Yes — Valid for Submission
Code Describes
Other emphysema
Short Description
Other emphysema
Same as the full description in the CMS dataset.
Parent Code
J43
Emphysema

Code Classification

ChapterJ00–J99Diseases of the respiratory system
SectionJ40-J4BChronic lower respiratory diseases
CategoryJ43Emphysema
This CodeJ43.8Other emphysema

Medicare Risk Adjustment (HCC)Billing

J43.8 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.

CMS-HCC V28 Category (Payment Model)
HCC 280— Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
Payment HCC · PY 2027 one of 79 ICD-10-CM codes in this category
Risk Adjustment Factor (RAF) Weight
+0.319
community, non-dual, aged · ranges 0.209–0.390 across segments
Hierarchy
Superseded by HCC 276, HCC 277, HCC 278, and HCC 279
a more severe related category takes the payment when both are reported
Prior Model (CMS-HCC V24)
HCC 111
V24 retired V28 pays 100% of MA risk scores since PY 2026
Other CMS Models
PACE (CMS-HCC V22): HCC 111 · ESRD (V21): HCC 111 · ESRD (V24): HCC 111
ESRD V21 weights: 0.072 dialysis, 0.299–0.313 functioning graft · ESRD V24 weights: 0.058 dialysis, 0.187–0.344 functioning graft
Part D (RxHCC)
RxHCC 229 — Chronic Obstructive Pulmonary Disease, Bronchiectasis, and Other Asthma
also risk-adjusts in the Part D prescription drug model (V08)

Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Scar emphysema

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to J43.8: its own notes plus those printed at J43, block J40-J4B, and Chapter 10. A note printed at a category, block or chapter applies to every code under it.

Excludes1

Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.

From J43 Emphysema applies to 5 codes
  • compensatory emphysema (J98.3)
  • interstitial emphysema (J98.2)
  • mediastinal emphysema (J98.2)
  • neonatal interstitial emphysema (P25.0)
  • surgical (subcutaneous) emphysema (T81.82)
From Block J40-J4B Chronic lower respiratory diseases applies to 40 codes
  • bronchitis due to chemicals, gases, fumes and vapors (J68.0)

Excludes2

Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.

From J43 Emphysema applies to 5 codes
  • emphysema due to inhalation of chemicals, gases, fumes or vapors (J68.4)
  • emphysema with chronic (obstructive) bronchitis (J44.-)
  • emphysematous (obstructive) bronchitis (J44.-)
  • traumatic subcutaneous emphysema (T79.7)
From Block J40-J4B Chronic lower respiratory diseases applies to 40 codes
From Chapter 10 (J00-J99) Diseases of the respiratory system applies to 366 codes
  • certain conditions originating in the perinatal period (P04-P96)
  • certain infectious and parasitic diseases (A00-B99)
  • complications of pregnancy, childbirth and the puerperium (O00-O9A)
  • congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
  • endocrine, nutritional and metabolic diseases (E00-E88)
  • injury, poisoning and certain other consequences of external causes (S00-T88)
  • neoplasms (C00-D49)
  • smoke inhalation (T59.81-)
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

Use Additional Code

Add a second code, after this one, to fully describe the condition.

From Chapter 10 (J00-J99) Diseases of the respiratory system applies to 366 codes
  • code, where applicable, to identify:
  • exposure to environmental tobacco smoke (Z77.22)
  • exposure to tobacco smoke in the perinatal period (P96.81)
  • history of tobacco dependence (Z87.891)
  • occupational exposure to environmental tobacco smoke (Z57.31)
  • tobacco dependence (F17.-)
  • tobacco use (Z72.0)

Notes

General instructions on how these codes are used.

From Chapter 10 (J00-J99) Diseases of the respiratory system applies to 366 codes
  • When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name J43.8, its category, or a range that includes it.

Applicable To 1

These notes mention J43.8.

  • Z82.5 Family history of asthma and other chronic lower respiratory diseases
    Conditions classifiable to J40-J47 names J40-J47, which includes this code

Excludes2 2

These codes carry an Excludes2 note naming J43.8: its condition is not part of those codes, and both may be reported when the patient has both.

  • J44 Other chronic obstructive pulmonary disease
    emphysema without chronic bronchitis (J43.-) names J43.-, which includes this code
  • T79.7 Traumatic subcutaneous emphysema
    emphysema NOS (J43) names J43, which includes this code

Code Also 1

These codes say J43.8 may also be needed to fully describe the condition. The note gives no sequencing direction.

  • J68.4 Chronic respiratory conditions due to chemicals, gases, fumes and vapors
    emphysema (J43.-) names J43.-, which includes this code

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR RSP008
Chronic obstructive pulmonary disease and bronchiectasis
Default principal diagnosis: inpatient Yes · outpatient Yes

Clinical InformationClinical

  • Emphysema

    a pathological accumulation of air in tissues or organs.

Patient EducationClinical

Emphysema

Emphysema is a type of COPD (chronic obstructive pulmonary disease). COPD is a group of lung diseases that make it hard to breathe and get worse over time. The other main type of COPD is chronic bronchitis. Most people with COPD have both emphysema and chronic bronchitis, but how severe each type is can be different from person to person.

The full article covers:

  • What is emphysema?
  • What causes emphysema?
  • Who is at risk for emphysema?
  • What are the symptoms of emphysema?
  • How is emphysema diagnosed?
  • What are the treatments for emphysema?
  • Can emphysema be prevented?

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert J43.8 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
492.8 Emphysema NEC
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About J43.8Overview

What is the ICD-10 code for other emphysema?

The ICD-10-CM code for other emphysema is J43.8 (sometimes written as J438). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is J43.8 (Emphysema) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report other emphysema on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does J43.8 group to?

When other emphysema is the principal diagnosis on an inpatient stay, it groups to MS-DRG 192, 190, 191, with relative weights from 0.6285 to 1.0749 depending on complications. Higher weights mean higher Medicare reimbursement.

Can J43.8 be reported with J98.3?

Not as a rule. The Excludes1 note at J43, which applies to J43.8, lists "compensatory emphysema (J98.3)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).

What is the ICD-9 equivalent of J43.8?

Under the General Equivalence Mappings, other emphysema converts to ICD-9-CM 492.8 (emphysema NEC). The mapping is approximate, so confirm the match fits the documentation.

What HCC is J43.8?

J43.8 (other emphysema) maps to CMS-HCC Category 280 (Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders), commonly written as HCC 280, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 111 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 229.

Does J43.8 risk-adjust for Medicare Advantage payment?

Yes. When documented and reported on a Medicare Advantage encounter, J43.8 adds a risk adjustment factor of about 0.319 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.209 to 0.390 depending on the payment segment). A more severe related category (HCC 276, HCC 277, HCC 278, and HCC 279) supersedes it when both are reported. See the full factor table on the HCC 280 category page.