J40-J4A — Chronic lower respiratory diseases
ICD-10-CM codes J40-J4A cover chronic lower respiratory diseases, within diseases of the respiratory system. The block holds 23 codes across 8 categories, of which 18 are billable and 5 are header codes that cannot be submitted on a claim.
Excludes1 — never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
- bronchitis due to chemicals, gases, fumes and vapors (J68.0)
Excludes2 — not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
- cystic fibrosis (E84.-)
Risk adjustment in J40-J4A
0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.
- HCC 280 Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
- HCC 276 Lung Transplant Status/Complications
What else to watch in J40-J4A
- 17 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.