2027 ICD-10-CM Diagnosis Code J64Unspecified pneumoconiosis
ICD-10-CM Codes›J00–J99›J60-J70›J64
- Billable — Valid for Submission
- Risk Adjusts — HCC 280
- Chronic Condition
J64 is a billable ICD-10-CM diagnosis code for unspecified pneumoconiosis. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 196 through 198. Coders also document this condition as benign pneumoconiosis. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Lung disease due to external agents.
For Medicare Advantage risk adjustment, J64 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
J64 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.
- Benign pneumoconiosis
- Complicated pneumoconiosis
- Mixed dust pneumoconiosis
- Pneumoconiosis
- Simple pneumoconiosis
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to J64: its own notes plus those printed at block J60-J70 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.
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.
- 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 J64, its category, or a range that includes it.
Excludes1 2
These codes carry an Excludes1 note naming J64: they are not reported together with it, unless the two conditions are unrelated.
Excludes2 4
These codes carry an Excludes2 note naming J64: its condition is not part of those codes, and both may be reported when the patient has both.
Code First 1
These codes say to code first a condition named in the note, and J64 is one of the conditions named.
- J84.170 Interstitial lung disease with progressive fibrotic phenotype in diseases classified elsewhere
Use Additional Code 1
These codes say to use an additional code from the note, and J64 is one of the codes named.
- Block T51-T65 Toxic effects of substances chiefly nonmedicinal as to source
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.
Clinical InformationClinical
Pneumoconiosis
a diffuse parenchymal lung disease caused by inhalation of dust and by tissue reaction to their presence. these inorganic, organic, particulate, or vaporized matters usually are inhaled by workers in their occupational environment, leading to the various forms (asbestosis; byssinosis; and others). similar air pollution can also have deleterious effects on the general population.
Patient EducationClinical
Interstitial Lung Diseases
Interstitial lung disease is the name for a large group of diseases that inflame or scar the lungs. The inflammation and scarring make it hard to get enough oxygen. The scarring is called pulmonary fibrosis.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert J64 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About J64Overview
What is the ICD-10 code for unspecified pneumoconiosis?
The ICD-10-CM code for unspecified pneumoconiosis is J64. It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is J64 (Unspecified pneumoconiosis) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report unspecified pneumoconiosis on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does J64 group to?
When unspecified pneumoconiosis is the principal diagnosis on an inpatient stay, it groups to MS-DRG 198, 197, 196, with relative weights from 0.7256 to 1.8335 depending on complications. Higher weights mean higher Medicare reimbursement.
Can J64 be reported with A15?
Not as a rule. The Excludes1 note on J64 lists "pneumonoconiosis with tuberculosis, any type in A15 (J65)". 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 J64?
Under the General Equivalence Mappings, unspecified pneumoconiosis converts to ICD-9-CM 505 (pneumoconiosis NOS). The mapping is approximate, so confirm the match fits the documentation.
What HCC is J64?
J64 (unspecified pneumoconiosis) 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 112 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does J64 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, J64 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.
