ICD-10 J44.1
Billable / Specific HCC v28: 111 CCChronic obstructive pulmonary disease with (acute) exacerbation
About ICD-10-CM J44.1
ICD-10-CM code J44.1 represents Chronic obstructive pulmonary disease with (acute) exacerbation. This is a billable/specific code in the Respiratory System chapter (block J44). The 2026 edition of ICD-10-CM J44.1 became effective on October 1, 2025.
Coding Tips for J44.1
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
J44.1 is a CMS-HCC v28 risk-adjustment code (category 111). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
J44.1 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under J44.1. Per CMS ICD-10-CM Tabular 2026.
- Decompensated COPD
- Decompensated COPD with (acute) exacerbation
Type 2 Excludes
Not included here, the excluded code is not part of J44.1, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- chronic obstructive pulmonary disease [COPD] with acute bronchitis (J44.0)
- lung diseases due to external agents (J60-J70)
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, CC
codes Chronic obstructive pulmonary disease with (acute) exacerbation. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for J44.1
Local Coverage Determinations (LCDs) from CMS MACs that list J44.1 as a covered diagnosis.
Showing top 10 of 926 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing J44.1.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with J44.1
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 99215 Complex chronic disease management Internal Medicine
- 99490 Chronic Care Management — 2+ chronic conditions required Internal Medicine
- 99204 New patient office visit — multiple chronic conditions: HTN, T2DM, hyperlipidemia, asthma, anxiety, depression, obesity, IBS, COPD, thyroid, anemia, CAD, sleep apnea, psoriasis, RA Primary Care
- 99205 New patient office visit — complex/high-risk: uncontrolled diabetes, heart failure, COPD exacerbation, cancer, MS, RA, CKD, CAD, recurrent depression, epilepsy, lupus, syncope, cognitive decline Primary Care
- 99214 Established patient — moderate complexity: uncontrolled HTN, diabetes with complications, multiple chronic conditions, COPD, AFib, CKD, sleep apnea, chronic pain, depression Primary Care
- 99215 Established patient — high complexity: HF exacerbation, COPD exacerbation, cancer management, MS, advanced CKD, uncontrolled diabetes, recurrent syncope, respiratory failure, liver cirrhosis Primary Care
- 71046 Chest X-ray 2 views — cough, dyspnea, wheezing, chest pain, pneumonia, COPD exacerbation, asthma exacerbation, respiratory failure, lung nodule, pneumothorax, heart failure, hx pneumonia, TB, hypoxemia Radiology
- 94010 Spirometry — asthma all severity, COPD, COPD with exacerbation, dyspnea, wheezing, chronic cough, pulmonary disease, pulmonary fibrosis Pulmonology
- 94729 DLCO — COPD, pulmonary fibrosis, emphysema, dyspnea, chronic respiratory failure, acute respiratory failure Pulmonology
- 94660 CPAP initiation — acute/chronic respiratory failure, sleep apnea, COPD exacerbation, severe asthma, dyspnea, apnea, obesity hypoventilation Pulmonology
Convert J44.1 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| J44.1 | 49121 | 10000 |
| J44.1 | 49322 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To J44.1
Other codes in section J40-J4A (Chronic lower respiratory diseases).
ICD-10 J44.1, Billing FAQ
Is ICD-10 code J44.1 billable? +
Yes, J44.1 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to J44.1? +
ICD-10 J44.1 includes: Decompensated COPD; Decompensated COPD with (acute) exacerbation.
What codes are Type 2 Excludes for J44.1? +
Type 2 Excludes (may be coded together when both conditions exist): chronic obstructive pulmonary disease [COPD] with acute bronchitis (J44.0); lung diseases due to external agents (J60-J70)
Does J44.1 affect Medicare Advantage HCC risk adjustment? +
Yes. J44.1 maps to CMS-HCC v28 category 111. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is J44.1 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with J44.1? +
Procedures frequently paired with J44.1 include: 99215, 99490, 99204, 99205, 99214.
What ICD-9 codes does J44.1 map to? +
Per CMS GEMs, J44.1 maps to ICD-9 codes: 49121, 49322. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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