What is ICD-10 code J80?

J80 is the ICD-10-CM diagnosis code for Acute respiratory distress syndrome. A severe, life-threatening condition where the lungs fill with fluid, making it difficult or impossible to breathe and requiring immediate medical intervention. It belongs to the ICD-10-CM chapter for diseases of the respiratory system (j00-j99). J80 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. J80 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. J80 is a payment HCC under the CMS risk adjustment model. Under the CMS-HCC V28 risk adjustment model it maps to Cardio-Respiratory Failure and Shock with a community, non-dual, aged base RAF weight of 0.370. Under the older CMS-HCC V24 model it maps to Cardio-Respiratory Failure and Shock at RAF 0.282. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. HCC Buddy maintains the V28 and V24 mapping, RAF weight, and MEAT documentation criteria for J80 sourced directly from the CMS-HCC model files.

Yes. J80 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. J80 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for J80?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For J80, V28 maps to Cardio-Respiratory Failure and Shock at RAF 0.370 while V24 mapped to Cardio-Respiratory Failure and Shock at RAF 0.282. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting J80?

This is a critical diagnosis often requiring ICU-level care; ensure it is clearly documented in the medical record Document the underlying cause (sepsis, trauma, aspiration, etc.) with additional codes to support severity and treatment decisions Because J80 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

J80: Acute respiratory distress syndrome — ICD-10 | Cardio-Respiratory Failure and Shock

ICD-10-CM Code View

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Code lookupJ80Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Other respiratory diseases principally affecting the interstitium (J80-J84)

J80

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Acute respiratory distress syndrome

A severe, life-threatening condition where the lungs fill with fluid, making it difficult or impossible to breathe and requiring immediate medical intervention.

Buddy Insight

CMS-HCC V28

Mapped

HCC 213

Cardio-Respiratory Failure an...

RAF 0.370

CMS-HCC V24

Mapped

HCC 84

Cardio-Respiratory Failure an...

RAF 0.282

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 84

Cardio-Respiratory Failure an...

RAF 0.0

RXHCC

Not risk-adjusted for this model/period.

RAF 0

Code Trumping

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Code Book Path

Official

J8Other respiratory diseases principally affecting the interstitium (J80-J84)

J80Acute respiratory distress syndrome

Inclusion Terms

Official

Acute respiratory distress syndrome in adult or child
Adult hyaline membrane disease

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for J80 in this effective period.

Related Child Codes

Official

ICD-10-CM does not list child codes under J80 for this display context.

Includes

Official

ICD-10-CM does not list Includes notes for J80 in this effective period.

Excludes 1

Official

respiratory distress syndrome in newborn (perinatal) (P22.0)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for J80 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for J80 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for J80 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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.)

MEAT Support

HCC Buddy guidance

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.)

Audit Caution

HCC Buddy guidance

Confusing ARDS (a syndrome with specific diagnostic criteria) with acute respiratory distress (a symptom coded with R06.03)

Not coding the underlying cause of ARDS in addition to J80 — the etiology is critical

Using J80 for cardiogenic pulmonary edema — ARDS is specifically non-cardiogenic by definition

Applying ARDS coding without Berlin criteria documentation (bilateral infiltrates, PaO2/FiO2 ratio, timing, exclusion of cardiac cause)

Common Mistakes

HCC Buddy guidance

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

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is J80 an HCC code?

Yes. J80 maps to Cardio-Respiratory Failure and Shock under the CMS-HCC V28 risk adjustment model (and Cardio-Respiratory Failure and Shock under V24).

HCC Category Mapping

V28HCC 213, Cardio-Respiratory Failure and Shock

0.370

V24HCC 84, Cardio-Respiratory Failure and Shock

0.282

ESRDHCC 84, Cardio-Respiratory Failure and Shock

0.000

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.

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

MEAT Criteria for J80

For J80to 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 J80 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

J80 is the ICD-10-CM diagnosis code for acute respiratory distress syndrome. A severe, life-threatening condition where the lungs fill with fluid, making it difficult or impossible to breathe and requiring immediate medical intervention. J80 sits in the ICD-10-CM chapter for diseases of the respiratory system (j00-j99), within the section covering other respiratory diseases principally affecting the interstitium (j80-j84).

Under the CMS-HCC V28 risk adjustment model, J80 maps to Cardio-Respiratory Failure and Shock (HCC 213) with a community, non-dual, aged base RAF weight of 0.370. Under the older V24 model, J80 mapped to the same category but with a base RAF weight of 0.282, V28 recalibrated weights across the entire model. 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 critical diagnosis often requiring ICU-level care; ensure it is clearly documented in the medical record. Because J80 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 J80 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This is a critical diagnosis often requiring ICU-level care; ensure it is clearly documented in the medical record
•Document the underlying cause (sepsis, trauma, aspiration, etc.) with additional codes to support severity and treatment decisions

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

Excludes 1, Do NOT code together

respiratory distress syndrome in newborn (perinatal) (P22.0)

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

Code Hierarchy

└J80Acute respiratory distress syndrome

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

HCC Buddy Code Card

J80

Is J80 an HCC code?

HCC Category Mapping

MEAT Criteria for J80

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What This Code Means

Coding Tips

Clinical Significance

Documentation Requirements

Excludes 1, Do NOT code together

Commonly Confused Codes

Code Hierarchy

Work J80 in HCC Buddy