2026 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 2026 (October 1, 2025 through September 30, 2026) 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 2026.
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 2026.
Source: CMS Payment Year 2026 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
Tabular List NotesGuidance
Coding notes and annotation back-references applicable to this code.
Type 1 Excludes
A type 1 excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
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
Anthracosis
a diffuse parenchymal lung disease caused by accumulation of inhaled carbon or coal dust. the disease can progress from asymptomatic anthracosis to massive lung fibrosis. this lung lesion usually occurs in coal miners, but can be seen in urban dwellers and tobacco smokers.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, 2025 through September 30, 2026.
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, 2025 through September 30, 2026.
What MS-DRG does J64 group to?
When unspecified pneumoconiosis is the principal diagnosis on an inpatient stay, it groups to MS-DRG 196, 197, 198, with relative weights from 0.7162 to 1.8872 depending on complications. Higher weights mean higher Medicare reimbursement.
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 2026. 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.
