ICD-10 J61
Billable / Specific HCC v28: 112Pneumoconiosis due to asbestos and other mineral fibers
About ICD-10-CM J61
ICD-10-CM code J61 represents Pneumoconiosis due to asbestos and other mineral fibers. This is a billable/specific code in the Respiratory System chapter (block J61). The 2026 edition of ICD-10-CM J61 became effective on October 1, 2025.
Coding Tips for J61
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
J61 is a CMS-HCC v28 risk-adjustment code (category 112). 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 J61. Per CMS ICD-10-CM Tabular 2026.
- Asbestosis
Type 1 Excludes
Pure excludes, these codes can never be coded together with J61. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- pleural plaque with asbestosis (J92.0)
- pneumoconiosis with tuberculosis, any type in A15 (J65)
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 J61
Local Coverage Determinations (LCDs) from CMS MACs that list J61 as a covered diagnosis.
Showing top 10 of 172 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing J61.
5 Medicare
CPT Codes Commonly Billed with J61
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert J61 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 |
|---|---|---|
| J61 | 501 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To J61
Other codes in section J60-J70 (Lung diseases due to external agents).
ICD-10 J61, Billing FAQ
Is ICD-10 code J61 billable? +
Yes, J61 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 J61? +
ICD-10 J61 includes: Asbestosis.
What codes are Type 1 Excludes for J61? +
Type 1 Excludes (never code together with J61): pleural plaque with asbestosis (J92.0); pneumoconiosis with tuberculosis, any type in A15 (J65)
Does J61 affect Medicare Advantage HCC risk adjustment? +
Yes. J61 maps to CMS-HCC v28 category 112. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What ICD-9 codes does J61 map to? +
Per CMS GEMs, J61 maps to ICD-9 codes: 501. 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 June 1, 2026.
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