J43.9 — Emphysema, unspecified
J43.9 is a billable, specific ICD-10-CM code for emphysema, unspecified. It is valid for submission on a claim.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Bullous emphysema (lung)(pulmonary)
- Emphysema (lung)(pulmonary) NOS
- Emphysematous bleb
- Vesicular emphysema (lung)(pulmonary)
Other codes that can never be billed with J43.9
These codes carry an Excludes1 note pointing at J43.9. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading J43.9 alone.
- J98.2Interstitial emphysema
Risk adjustment
J43.9 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 280 Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders0.319 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.
Medicare coverage
J43.9 is named in 24 Medicare coverage policies — 22 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A56566Billing and Coding: Outpatient Physical and Occupational Therapy Servicesnot covered
- A57067Billing and Coding: Outpatient Physical and Occupational Therapy Servicesnot covered
- A52466Nebulizers - Policy Article
- A52466Nebulizers - Policy Article
How J43.9 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to J43.9.
- Emphysema(atrophic) (bullous) (chronic) (interlobular) (lung) (obstructive) (pulmonary) (senile) (vesicular)
- Bleb›emphysematous(lung) (solitary)
- Bleb›lung(ruptured)
- Bleb›subpleural(emphysematous)
- Bulla›lung(emphysematous) (solitary)
- Cyst›lung›giant bullous
- Obstruction, obstructed, obstructive›airway›with›emphysema
- Disease, diseased›lung›obstructive›with›emphysema
Related codes at this level
Codes that share J43. If J43.9 is not quite right, the correct code is usually one of these.
Questions about J43.9
- Is J43.9 a billable ICD-10-CM code?
- Yes. J43.9 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does J43.9 sit in the tabular list?
- Diseases of the respiratory system (J00-J99), in the block Chronic lower respiratory diseases (J40-J4A).