Emphysema
Diseases of the Respiratory System·Chronic lower respiratory diseases (J40-J4B)·category·FY 2027
5 billable codes under J43: none are a CC or MCC; all map to HCC 280 (Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders).An HCC counts toward a Medicare Advantage patient's risk score.
Emphysema: Emphysema is a type of COPD (chronic obstructive pulmonary disease). COPD is a group of lung diseases that make it hard to breathe and get worse over time. The other main type of COPD is chronic bronchitis. Most people with COPD have both emphysema and chronic bronchitis, but how severe each type is can be different from person to person.
Read more about emphysema on MedlinePlus · Source: MedlinePlus, National Library of Medicine
Instructional notes
Excludes1: not coded here, use a different code
Also applies, from Chronic lower respiratory diseases (J40-J4B)
These notes sit on J40-J4B and apply to every code under it, including J43.
All codes under J43
J43 can't be used on a claim. Pick a billable code below; grey headings group them.
MS-DRGs
As the principal diagnosis, all 5 billable codes under J43 group to these MS-DRGs (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.
Codes whose notes mention J43
If you are coding one of these, its note tells you to add J43 too (Code Also, Use Additional Code), code it first (Code First), or not use it together (Excludes1).