J80 ICD-10-CM Code: Acute respiratory distress syndrome

Code

J80

Description

Acute respiratory distress syndrome

HCC (V28)

HCC 213 — Cardio-Respiratory Failure and Shock

RAF reference coefficient

0.370

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 J80 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for J80

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for J80 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Use J80 when the provider wording supports acute respiratory distress syndrome. Check the FY2026 tabular notes and the full code path before the final code choice.
• •For this DOS, capture the provider's current assessment and the care action documented for acute respiratory distress syndrome. Keep the checklist tied to the note.
• •J80 maps to V28 HCC 213, Cardio-Respiratory Failure and Shock. The mapping does not replace the documentation review. The code still has to match the note.
• •Ask Buddy to show the official notes and code path for J80.

Clinical Significance

Acute Respiratory Distress Syndrome is a life-threatening condition characterized by rapid onset of widespread alveolar inflammation, capillary leak, and bilateral pulmonary infiltrates leading to refractory hypoxemia. It is one of the most resource-intensive diagnoses in medicine, typically requiring ICU admission, mechanical ventilation, and multidisciplinary care, making it highly significant for risk adjustment.

Documentation Requirements

• ✓Bilateral pulmonary infiltrates on chest imaging not fully explained by cardiac failure or fluid overload
• ✓PaO2/FiO2 ratio documenting severity (Berlin criteria: mild 200-300, moderate 100-200, severe <100)
• ✓Acute onset within 1 week of known clinical insult or new/worsening respiratory symptoms
• ✓Underlying cause documented (sepsis, pneumonia, aspiration, trauma, pancreatitis, etc.)
• ✓Mechanical ventilation parameters if intubated (PEEP settings, FiO2, tidal volumes)
• ✓ICU admission documentation and severity scoring

Commonly Confused Codes

• •J81.0 (Acute pulmonary edema): cardiogenic vs. non-cardiogenic; ARDS is non-cardiogenic by definition
• •J96.0x (Acute respiratory failure): respiratory failure is a broader category; ARDS is a specific syndrome
• •J18.9 (Pneumonia, unspecified): pneumonia may cause ARDS, but they are separate diagnoses requiring separate codes
• •R06.03 (Acute respiratory distress): symptom code only, not the syndrome; J80 requires clinical criteria