Question 1

What is ICD-10 code J22?

Accepted Answer

J22 is the ICD-10-CM diagnosis code for unspecified acute lower respiratory infection. An acute infection of the lower respiratory tract (lungs and airways) that cannot be classified as a more specific condition like pneumonia or bronchitis. J22 sits in the ICD-10-CM chapter for diseases of the respiratory system (j00-j99), within the section covering other acute lower respiratory infections (j20-j22).

J22 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 is a catch-all code for acute lower respiratory infections; use only when a more specific diagnosis cannot be determined.

Question 2

Is J22 an HCC code?

Accepted Answer

No. J22 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is J22 billable?

Accepted Answer

Yes. J22 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. J22 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for J22?

Accepted Answer

J22 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards J22 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting J22?

Accepted Answer

This is a catch-all code for acute lower respiratory infections; use only when a more specific diagnosis cannot be determined Review documentation to see if the condition can be more specifically classified as bronchitis, bronchiolitis, or pneumonia

J22

Is J22 an HCC code?

What This Code Means

Coding Tips

Excludes 1 — Do NOT code together

Code Hierarchy

Open J22 in the Interactive Encoder