J84.01 ICD-10-CM Code: Alveolar proteinosis
J84.01 maps to CMS-HCC V28 280. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Other respiratory diseases principally affecting the interstitium (J80-J84)
J84.01
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAlveolar proteinosis
A rare lung disease where a protein substance accumulates in the air sacs, interfering with oxygen absorption.
Buddy Insight
Alveolar proteinosis is a rare lung disease where lipoproteinaceous material accumulates in the alveoli, impairing gas exchange.
CMS-HCC V28
MappedHCC 280
Coefficient HCC 280: 0.319 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 162
Code-level coefficient reference
ESRD/PACE
MappedHCC 112
Code-level coefficient reference
RXHCC
MappedHCC 227
Code-level coefficient reference
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for J84.01. Check the code and parent instructions in the Code Book.
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from J00-J99, J84
- certain infectious and parasitic diseases (A00-B99)Inherited from J00-J99, J84
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from J00-J99, J84
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from J00-J99, J84
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from J00-J99, J84
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from J00-J99, J84
- neoplasms (C00-D49)Inherited from J00-J99, J84
- smoke inhalation (T59.81-)Inherited from J00-J99, J84
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from J00-J99, J84
- lung diseases due to external agents (J60-J70)Inherited from J00-J99, J84
Related Codes
Includes
OfficialNo Includes notes are included in this display for J84.01. Check the code and parent instructions in the Code Book.
Excludes 1
Official- drug-induced interstitial lung disorders (J70.2-J70.4)Inherited from J84
- interstitial emphysema (J98.2)Inherited from J84
Code First
OfficialNo Code First sequencing instructions are included in this display for J84.01. Check the code and parent instructions in the Code Book.
Use Additional
Official- code, where applicable, to identify:Inherited from J00-J99
- exposure to environmental tobacco smoke (Z77.22)Inherited from J00-J99
- exposure to tobacco smoke in the perinatal period (P96.81)Inherited from J00-J99
- history of tobacco dependence (Z87.891)Inherited from J00-J99
- occupational exposure to environmental tobacco smoke (Z57.31)Inherited from J00-J99
- tobacco dependence (F17.-)Inherited from J00-J99
- tobacco use (Z72.0)Inherited from J00-J99
Code Also
Official- , if applicable, associated conditionInherited from J84
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 J84.01 an HCC code?
Yes. J84.01 (Alveolar proteinosis) maps to HCC 280, Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.319. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: J84.01 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
- J84.01
- Description
- Alveolar proteinosis
- 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 J84.01 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for J84.01
For J84.01, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
J84.01 is the ICD-10-CM diagnosis code for alveolar proteinosis. A rare lung disease where a protein substance accumulates in the air sacs, interfering with oxygen absorption. J84.01 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, J84.01 maps to Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders (HCC 280) with a source-labeled community, non-dual, aged reference coefficient of 0.319. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
This is a rare condition; ensure documentation clearly supports the diagnosis. For J84.01, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for J84.01 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a rare condition; ensure documentation clearly supports the diagnosis
- •Consider whether the patient has secondary alveolar proteinosis related to another condition
Clinical Significance
Alveolar proteinosis is a rare lung disease where lipoproteinaceous material accumulates in the alveoli, impairing gas exchange. It is significant for risk adjustment because it requires specialized treatment including whole-lung lavage, GM-CSF therapy, and close pulmonary monitoring, reflecting high healthcare resource utilization for a chronic condition.
Documentation Requirements
- ✓Chest imaging showing bilateral ground-glass opacities with 'crazy paving' pattern
- ✓Bronchoalveolar lavage findings showing milky/opaque fluid with PAS-positive material
- ✓Classification as autoimmune (primary), secondary (hematologic malignancy, dust exposure), or congenital
- ✓GM-CSF antibody levels if autoimmune type is suspected
- ✓Pulmonary function test results
- ✓Treatment history including whole-lung lavage procedures
- ✓Assessment of disease severity and functional impairment
Commonly Confused Codes
- •J84.09 (Other alveolar and parieto-alveolar conditions): use J84.01 specifically for alveolar proteinosis
- •J84.10 (Pulmonary fibrosis, unspecified): different disease process; proteinosis is filling, not scarring
- •J80 (ARDS): bilateral ground-glass on imaging can mimic ARDS; clinical context and BAL differentiate
- •J84.02 (Pulmonary alveolar microlithiasis): mineral deposits vs. proteinaceous material in alveoli