2027 ICD-10-CM Diagnosis Code J43.9Emphysema, unspecified
ICD-10-CM Codes›J00–J99›J40-J4B›J43
- Billable — Valid for Submission
- Risk Adjusts — HCC 280
- Chronic Condition
J43.9 is a billable ICD-10-CM diagnosis code for emphysema, unspecified. 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. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Chronic obstructive pulmonary disease and bronchiectasis.
For Medicare Advantage risk adjustment, J43.9 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
Code Classification
Medicare Risk Adjustment (HCC)Billing
J43.9 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.
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.
- Atrophic emphysema
- Bulla of lung
- Bullous emphysema with collapse
- Chronic atelectasis
- Chronic bullous emphysema
- Chronic hemolytic anemia
- Emphysema of left lung
- Emphysema of right lung
- Emphysematous bleb of lung
- Giant bullous emphysema
- Hemolytic anemia with emphysema AND cutis laxa
- Obstructive emphysema
- Paraseptal emphysema
- Pulmonary emphysema
- Pulmonary emphysema co-occurrent with fibrosis of lung
- Pulmonary emphysema in alpha-1 PI deficiency
- Ruptured emphysematous bleb of lung
- Segmental bullous emphysema
- Vanishing lung
- Zonal bullous emphysema
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to J43.9: 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.
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Bullous emphysema (lung)(pulmonary)
- Emphysema (lung)(pulmonary) NOS
- Emphysematous bleb
- Vesicular emphysema (lung)(pulmonary)
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- 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.
- cystic fibrosis (E84.-)
- 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)
Notes
General instructions on how these codes are used.
- 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 J43.9, its category, or a range that includes it.
Applicable To 1
These notes mention J43.9.
- Z82.5 Family history of asthma and other chronic lower respiratory diseases
Excludes1 1
These codes carry an Excludes1 note naming J43.9: they are not reported together with it, unless the two conditions are unrelated.
- J98.2 Interstitial emphysemaemphysema NOS (J43.9)
Excludes2 2
These codes carry an Excludes2 note naming J43.9: its condition is not part of those codes, and both may be reported when the patient has both.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
lung (ruptured) J43.9
Disease, diseased See Also: Syndrome;
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
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 J43.9 to ICD-9-CMHistory
Code HistoryHistory
Questions About J43.9Overview
What is the ICD-10 code for emphysema, unspecified?
The ICD-10-CM code for emphysema, unspecified is J43.9 (sometimes written as J439). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is J43.9 (Emphysema) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report emphysema, unspecified on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does J43.9 group to?
When emphysema, unspecified 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 J43.9 be reported with J98.3?
Not as a rule. The Excludes1 note at J43, which applies to J43.9, 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 J43.9?
Under the General Equivalence Mappings, emphysema, unspecified converts to ICD-9-CM 492.0 (emphysematous bleb) and 492.8 (emphysema NEC). The mapping is approximate, so confirm the match fits the documentation.
What HCC is J43.9?
J43.9 (emphysema, unspecified) 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 J43.9 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, J43.9 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.
