ICD-10 J64
Billable / Specific HCC v28: 112Unspecified pneumoconiosis
About ICD-10-CM J64
ICD-10-CM code J64 represents Unspecified pneumoconiosis. This is a billable/specific code in the Respiratory System chapter (block J64). The 2026 edition of ICD-10-CM J64 became effective on October 1, 2025.
Coding Tips for J64
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
J64 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.
Type 1 Excludes
Pure excludes, these codes can never be coded together with J64. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- pneumonoconiosis 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 J64
Local Coverage Determinations (LCDs) from CMS MACs that list J64 as a covered diagnosis.
Showing top 10 of 98 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing J64.
5 Medicare
CPT Codes Commonly Billed with J64
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 J64 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 |
|---|---|---|
| J64 | 505 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To J64
Other codes in section J60-J70 (Lung diseases due to external agents).
ICD-10 J64, Billing FAQ
Is ICD-10 code J64 billable? +
Yes, J64 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 1 Excludes for J64? +
Type 1 Excludes (never code together with J64): pneumonoconiosis with tuberculosis, any type in A15 (J65)
Does J64 affect Medicare Advantage HCC risk adjustment? +
Yes. J64 maps to CMS-HCC v28 category 112. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What ICD-9 codes does J64 map to? +
Per CMS GEMs, J64 maps to ICD-9 codes: 505. 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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