J44.1 ICD-10-CM Code: Chronic obstructive pulmonary disease with (acute) exacerbation
HCC Buddy Code Card
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FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Chronic lower respiratory diseases (J40-J4A)
J44.1
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceChronic 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.
Buddy Insight
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.
CMS-HCC V28
MappedHCC 280
RAF 0.319
CMS-HCC V24
MappedHCC 111
RAF 0.335
ACA/HHS
N/A—
Not mapped
ESRD/PACE
MappedHCC 111
RAF 0.058
RXHCC
MappedHCC 229
RAF 0.237
Code Book Path
Inclusion Terms
Official- Decompensated COPD
- Decompensated COPD with (acute) exacerbation
Excludes 2
Official- chronic obstructive pulmonary disease [COPD] with acute bronchitis (J44.0)
- lung diseases due to external agents (J60-J70)
Related Child Codes
Includes
Official- asthma with chronic obstructive pulmonary disease
- chronic asthmatic (obstructive) bronchitis
- chronic bronchitis with airway obstruction
- chronic bronchitis with emphysema
- chronic emphysematous bronchitis
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for J44.1 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for J44.1 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for J44.1 in this effective period.
Code Also
Official- type of asthma, if applicable (J45.-)
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is J44.1 an HCC code?
Yes. J44.1 (Chronic obstructive pulmonary disease with (acute) exacerbation) maps to Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders under the CMS-HCC V28 risk adjustment model (and Chronic Obstructive Pulmonary Disease under V24), with a community non-dual aged RAF of 0.319. It is billable for payment year 2026.
Coder answer: J44.1 is billable and maps to V28 HCC 280, Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- J44.1
- Description
- Chronic obstructive pulmonary disease with (acute) exacerbation
- HCC (V28)
- HCC 280 — Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
- RAF
- 0.319
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so 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 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.
Work J44.1 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
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.
Coder workflow notes
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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, Interstitial Lung Disorders, and Other Chronic Lung Disorders (HCC 280) with a community, non-dual, aged base RAF weight of 0.319. Under the older CMS-HCC V24 model, J44.1 maps to Chronic Obstructive Pulmonary Disease (HCC 111) with a community, non-dual, aged base RAF weight of 0.335. 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.
Documentation must support COPD with acute exacerbation, increased dyspnea, sputum change, or course of oral steroids/antibiotics tied to COPD decompensation. A routine COPD visit without acute change is J44.9, not J44.1. 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
- •Documentation must support COPD with acute exacerbation, increased dyspnea, sputum change, or course of oral steroids/antibiotics tied to COPD decompensation. A routine COPD visit without acute change is J44.9, not J44.1.
- •Do not default to J44.1 whenever a COPD patient has any respiratory symptom. The exacerbation must be documented clinically distinct from baseline.
- •V28 HCC 280 at RAF 0.319. The acute-exacerbation detail matters for inpatient DRG and severity scoring but does not change the outpatient RAF calculation.
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