J44.1 ICD-10-CM Code: Chronic obstructive pulmonary disease with (acute) exacerbation

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 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 J44.1 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for J44.1

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, 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.

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

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

Child Codes