ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 J63.3

Billable / Specific HCC v28: 112

Graphite fibrosis (of lung)

J63
Block
0
Synonyms
172
LCDs
11
Payer Policies
0
Linked CPTs

About ICD-10-CM J63.3

ICD-10-CM code J63.3 represents Graphite fibrosis (of lung). This is a billable/specific code in the Respiratory System chapter (block J63). The 2026 edition of ICD-10-CM J63.3 became effective on October 1, 2025.

Coding Tips for J63.3

Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.

HCC capture: document with MEAT each year

J63.3 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.

Medicare Advantage HCC Impact

CMS-HCC v28 (current)
Category 112
ESRD-HCC
Category 112
RxHCC (Part D)
Category 112

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 J63.3

Local Coverage Determinations (LCDs) from CMS MACs that list J63.3 as a covered diagnosis.

172 LCDs

Showing top 10 of 172 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94660 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94726 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94664 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94618 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94772 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94642 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT G0238 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94004 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94668 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94680 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing J63.3.

11 policies

5 Medicare

Nebulizers - Policy Article
Policy ID: ART-52466
Billing and Coding: Computerized Axial Tomography (CT), Thorax
Policy ID: ART-56580
Billing and Coding: Respiratory Therapy (Respiratory Care)
Policy ID: ART-56717
Billing and Coding: Respiratory Therapy and Oximetry Services
Policy ID: ART-56730
Billing and Coding: Pulmonary Stress Testing
Policy ID: ART-56784

CPT Codes Commonly Billed with J63.3

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

No procedure linkages on file for J63.3

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 J63.3 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
J63.3 503 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 J63.3, Billing FAQ

Is ICD-10 code J63.3 billable? +

Yes, J63.3 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

Does J63.3 affect Medicare Advantage HCC risk adjustment? +

Yes. J63.3 maps to CMS-HCC v28 category 112. Capture this diagnosis annually for accurate Medicare Advantage risk score.

What ICD-9 codes does J63.3 map to? +

Per CMS GEMs, J63.3 maps to ICD-9 codes: 503. 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 May 31, 2026.

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