J44.81 ICD-10-CM Code: Bronchiolitis obliterans and bronchiolitis obliterans syndrome
J44.81 maps to CMS-HCC V28 280 (RAF 0.319). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools
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FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Chronic lower respiratory diseases (J40-J4A)
J44.81
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceBronchiolitis obliterans and bronchiolitis obliterans syndrome
A rare lung condition where the smallest airways (bronchioles) become scarred and narrowed, often resulting from inhalation injury or lung transplant complications.
Buddy Insight
Bronchiolitis obliterans and bronchiolitis obliterans syndrome represent severe, progressive small airway disease causing irreversible airflow obstruction.
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- Obliterative bronchiolitis
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for J44.81 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for J44.81 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for J44.81 in this effective period.
Code First
Official- , if applicable:
- complication of bone marrow transplant (T86.09)
- complication of stem cell transplant (T86.5)
- heart-lung transplant rejection (T86.31)
- lung transplant rejection (T86.810)
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for J44.81 in this effective period.
Code Also
Official- , if applicable, associated conditions, such as:
- chronic graft-versus-host disease (D89.811)
- chronic lung allograft dysfunction (J4A.-)
- chronic respiratory conditions due to chemicals, gases, fumes and vapors (J68.4)
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 J44.81 an HCC code?
Yes. J44.81 (Bronchiolitis obliterans and bronchiolitis obliterans syndrome) 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: J44.81 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
- J44.81
- Description
- Bronchiolitis obliterans and bronchiolitis obliterans syndrome
- 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 J44.81 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for J44.81
For J44.81 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 J44.81 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
J44.81 is the ICD-10-CM diagnosis code for bronchiolitis obliterans and bronchiolitis obliterans syndrome. A rare lung condition where the smallest airways (bronchioles) become scarred and narrowed, often resulting from inhalation injury or lung transplant complications. J44.81 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, J44.81 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, J44.81 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.
This is a specific COPD variant; ensure documentation clearly indicates bronchiolitis obliterans or bronchiolitis obliterans syndrome. Because J44.81 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 J44.81 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a specific COPD variant; ensure documentation clearly indicates bronchiolitis obliterans or bronchiolitis obliterans syndrome
- •Research the underlying cause (chemical exposure, transplant rejection, etc.) as it may require additional coding
Clinical Significance
Bronchiolitis obliterans and bronchiolitis obliterans syndrome represent severe, progressive small airway disease causing irreversible airflow obstruction. This condition is most commonly seen after lung transplantation (as chronic rejection) or following toxic inhalation exposure, and carries a poor prognosis with significant implications for ongoing medical management.
Documentation Requirements
- ✓Confirmed diagnosis of bronchiolitis obliterans or bronchiolitis obliterans syndrome
- ✓Pulmonary function testing showing progressive decline in FEV1 from baseline
- ✓CT imaging findings if available (mosaic attenuation, air trapping)
- ✓Etiology documented: post-transplant, post-inhalation injury, connective tissue disease, or other cause
- ✓Treatment plan including immunosuppression adjustments (if transplant-related), bronchodilators, or other interventions
- ✓For transplant patients: documentation of relationship to graft rejection
Code First
Code Also
Commonly Confused Codes
- •J44.9: COPD, unspecified: bronchiolitis obliterans is a distinct condition from typical COPD, though it is classified within COPD codes
- •J4A.0: Restrictive allograft syndrome: a different form of chronic lung allograft dysfunction with restrictive (not obstructive) physiology
- •J21.x: Acute bronchiolitis: an acute viral infection in infants, completely different from bronchiolitis obliterans
- •T68.x: Toxic effects of gases/fumes: code additionally if bronchiolitis obliterans resulted from toxic inhalation