J68.9: Unspecified respiratory condition due to chemicals, gases, fumes and vapors

Risk adjustment

J68.9 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

J68.9 is named in 5 Medicare coverage policies: 5 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A52466Nebulizers - Policy Article
• A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
• A56730Billing and Coding: Respiratory Therapy and Oximetry Services
• A57205Billing and Coding: Oximetry Services