ICD-10 J43.9
Billable / Specific HCC v28: 111Emphysema, unspecified
About ICD-10-CM J43.9
ICD-10-CM code J43.9 represents Emphysema, unspecified. This is a billable/specific code in the Respiratory System chapter (block J43). The 2026 edition of ICD-10-CM J43.9 became effective on October 1, 2025.
Coding Tips for J43.9
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
J43.9 is a CMS-HCC v28 risk-adjustment code (category 111). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under J43.9. Per CMS ICD-10-CM Tabular 2026.
- Bullous emphysema (lung)(pulmonary)
- Emphysema (lung)(pulmonary) NOS
- Emphysematous bleb
- Vesicular emphysema (lung)(pulmonary)
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for J43.9
Local Coverage Determinations (LCDs) from CMS MACs that list J43.9 as a covered diagnosis.
Showing top 10 of 327 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing J43.9.
5 Medicare
3 Aetna
CPT Codes Commonly Billed with J43.9
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 94729 DLCO — COPD, pulmonary fibrosis, emphysema, dyspnea, chronic respiratory failure, acute respiratory failure Pulmonology
Convert J43.9 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| J43.9 | 4920 | 10000 |
| J43.9 | 4928 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To J43.9
Other codes in section J40-J4A (Chronic lower respiratory diseases).
ICD-10 J43.9, Billing FAQ
Is ICD-10 code J43.9 billable? +
Yes, J43.9 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to J43.9? +
ICD-10 J43.9 includes: Bullous emphysema (lung)(pulmonary); Emphysema (lung)(pulmonary) NOS; Emphysematous bleb, and 1 more clinical synonyms.
Does J43.9 affect Medicare Advantage HCC risk adjustment? +
Yes. J43.9 maps to CMS-HCC v28 category 111. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with J43.9? +
Procedures frequently paired with J43.9 include: 94729.
What ICD-9 codes does J43.9 map to? +
Per CMS GEMs, J43.9 maps to ICD-9 codes: 4920, 4928. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on July 17, 2026.
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