ICD-10 J43
Non-Billable HeaderEmphysema
About ICD-10-CM J43
ICD-10-CM code J43 represents Emphysema. This is a non-billable header code in the Respiratory System chapter (block J43). The 2026 edition of ICD-10-CM J43 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Type 1 Excludes
Pure excludes, these codes can never be coded together with J43. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- compensatory emphysema (J98.3)
- interstitial emphysema (J98.2)
- mediastinal emphysema (J98.2)
- neonatal interstitial emphysema (P25.0)
- surgical (subcutaneous) emphysema (T81.82)
Type 2 Excludes
Not included here, the excluded code is not part of J43, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- 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)
Medicare LCD Coverage for J43
Local Coverage Determinations (LCDs) from CMS MACs that list J43 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing J43.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but J43 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with J43
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 94620 Pulmonary function testing for respiratory symptoms Internal Medicine
Codes Adjacent To J43
Other codes in section J40-J4A (Chronic lower respiratory diseases).
ICD-10 J43, Billing FAQ
Is ICD-10 code J43 billable? +
No, J43 is a non-billable header code. Use a more specific child code from block J43 when submitting claims.
What codes are Type 1 Excludes for J43? +
Type 1 Excludes (never code together with J43): compensatory emphysema (J98.3); interstitial emphysema (J98.2); mediastinal emphysema (J98.2)
What codes are Type 2 Excludes for J43? +
Type 2 Excludes (may be coded together when both conditions exist): emphysema due to inhalation of chemicals, gases, fumes or vapors (J68.4); emphysema with chronic (obstructive) bronchitis (J44.-); emphysematous (obstructive) bronchitis (J44.-)
What CPT codes are commonly billed with J43? +
Procedures frequently paired with J43 include: 94620.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 2, 2026.
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