J00
BillableAcute nasopharyngitis [common cold]
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is J00 an HCC code?
No. J00 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
J00 is the ICD-10-CM diagnosis code for acute nasopharyngitis [common cold]. The common cold, which is a viral infection of the nose and throat causing congestion, runny nose, and sore throat. J00 sits in the ICD-10-CM chapter for diseases of the respiratory system (j00-j99), within the section covering acute upper respiratory infections (j00-j06).
J00 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
This code does not require specification of the causative virus; it represents the clinical syndrome.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for J00 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code does not require specification of the causative virus; it represents the clinical syndrome
- •Do not use this code if the patient has lower respiratory involvement; use J20 codes for acute bronchitis instead