J44.0 ICD-10-CM Code: Chronic obstructive pulmonary disease with (acute) lower respiratory infection

Code

J44.0

Description

Chronic obstructive pulmonary disease with (acute) lower respiratory infection

HCC (V28)

HCC 280 — Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders

RAF reference coefficient

0.319

Billable

Yes

Payment year

2026

HCC Category Mapping

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work J44.0 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for J44.0

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for J44.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Documentation must support COPD with a current acute lower respiratory infection, pneumonia, acute bronchitis, or documented LRI at the encounter. Pair with the specific infection code (J12-J18 for pneumonia, J20.* for acute bronchitis) per 'use additional code' convention.
• •Do not report J44.0 for a COPD patient with a URI (cold, sinusitis). The 'lower' respiratory infection is specific, upper-tract infections don't qualify.

Clinical Significance

Chronic obstructive pulmonary disease with acute lower respiratory infection represents a COPD patient experiencing a concurrent acute infection such as pneumonia or acute bronchitis. This combination significantly increases morbidity, hospitalization risk, and mortality, making accurate capture critical for reflecting true patient acuity in risk adjustment.

Documentation Requirements

• ✓Established diagnosis of COPD (chronic obstructive pulmonary disease)
• ✓Documentation of an acute lower respiratory infection (pneumonia, acute bronchitis) occurring concurrently
• ✓The specific acute infection should be identified and coded separately (e.g., J13-J18 for pneumonia, J20.x for acute bronchitis)
• ✓Clinical presentation: increased dyspnea, fever, purulent sputum, new infiltrate on imaging
• ✓Treatment plan for both the underlying COPD and the acute infection
• ✓Severity indicators: oxygen requirements, hospitalization, respiratory failure

Commonly Confused Codes

• •J44.1: COPD with acute exacerbation: use when COPD worsens without a documented infection; J44.0 requires documented infection
• •J44.9: COPD, unspecified: does not capture the acute component; never use when an acute infection is documented
• •J18.9: Pneumonia, unspecified: code additionally to identify the infection; J44.0 alone does not specify the type
• •J20.9: Acute bronchitis, unspecified: code additionally if this is the acute lower respiratory infection

Child Codes