J44.1
BillableChronic obstructive pulmonary disease with (acute) exacerbation
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is J44.1 an HCC code?
Yes. J44.1 maps to Chronic Obstructive Pulmonary Disease under the CMS-HCC V28 risk adjustment model (and Chronic Obstructive Pulmonary Disease under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for J44.1
For J44.1 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed J44.1 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
J44.1 is the ICD-10-CM diagnosis code for chronic obstructive pulmonary disease with (acute) exacerbation. A chronic lung disease (COPD) that is currently experiencing a sudden worsening of symptoms such as increased shortness of breath or coughing. J44.1 sits in the ICD-10-CM chapter for diseases of the respiratory system (j00-j99), within the section covering chronic lower respiratory diseases (j40-j4a).
Under the CMS-HCC V28 risk adjustment model, J44.1 maps to Chronic Obstructive Pulmonary Disease (HCC 280) with a community, non-dual, aged base RAF weight of 0.334. The V24 model used during the PY2024–PY2025 transition mapped J44.1 the same way and at the same RAF weight. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Exacerbation must be documented as acute worsening; look for terms like 'acute exacerbation,' 'flare-up,' or 'decompensation'. Because J44.1 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for J44.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Exacerbation must be documented as acute worsening; look for terms like 'acute exacerbation,' 'flare-up,' or 'decompensation'
- •Distinguish between exacerbation (J44.1) and infection (J44.0); exacerbation does not require an identified infection
Clinical Significance
Chronic obstructive pulmonary disease with acute exacerbation represents a worsening of baseline COPD symptoms beyond normal day-to-day variation, requiring a change in treatment. Acute exacerbations are the leading cause of COPD-related hospitalizations and are associated with accelerated decline in lung function and increased mortality risk.
Documentation Requirements
- ✓Established diagnosis of COPD (chronic obstructive pulmonary disease)
- ✓Clear documentation of acute exacerbation: worsening dyspnea, increased sputum volume or purulence, increased cough
- ✓Provider must use terms indicating acute worsening: 'exacerbation,' 'flare,' 'acute worsening,' or equivalent clinical language
- ✓Change in treatment from baseline: increased bronchodilators, systemic steroids, antibiotics, hospitalization
- ✓Severity assessment: respiratory distress level, oxygen requirements, need for ventilatory support
- ✓Baseline COPD severity for comparison
Excludes 2 — Not included here, may code separately
Commonly Confused Codes
- •J44.0 — COPD with acute lower respiratory infection: use when a specific infection (pneumonia, acute bronchitis) is identified as the cause
- •J44.9 — COPD, unspecified: use for stable COPD without acute exacerbation or infection
- •J44.89 — Other specified COPD: use for specified COPD presentations not captured by J44.0 or J44.1
- •J96.x — Respiratory failure: code additionally when exacerbation leads to respiratory failure