ICD-10 J80
Billable / Specific HCC v28: 84 MCCAcute respiratory distress syndrome
About ICD-10-CM J80
ICD-10-CM code J80 represents Acute respiratory distress syndrome. This is a billable/specific code in the Respiratory System chapter (block J80). The 2026 edition of ICD-10-CM J80 became effective on October 1, 2025.
Coding Tips for J80
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
J80 is a CMS-HCC v28 risk-adjustment code (category 84). 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.
J80 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC 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 J80. Per CMS ICD-10-CM Tabular 2026.
- Acute respiratory distress syndrome in adult or child
- Adult hyaline membrane disease
Type 1 Excludes
Pure excludes, these codes can never be coded together with J80. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- respiratory distress syndrome in newborn (perinatal) (P22.0)
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, MCC
codes Acute respiratory distress syndrome. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for J80
Local Coverage Determinations (LCDs) from CMS MACs that list J80 as a covered diagnosis.
Showing top 10 of 313 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing J80.
1 Aetna
2 Cigna
5 Medicare
CPT Codes Commonly Billed with J80
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 99285 ED visit level 5 — STEMI, massive PE, respiratory failure, cardiogenic shock, cardiac arrest, ICH, encephalopathy, coma, anaphylaxis, SAH, ARDS, compartment syndrome Emergency Medicine
Convert J80 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 |
|---|---|---|
| J80 | 51882 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To J80
Other codes in section J80-J84 (Other respiratory diseases principally affecting the interstitium).
ICD-10 J80, Billing FAQ
Is ICD-10 code J80 billable? +
Yes, J80 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 J80? +
ICD-10 J80 includes: Acute respiratory distress syndrome in adult or child; Adult hyaline membrane disease.
What codes are Type 1 Excludes for J80? +
Type 1 Excludes (never code together with J80): respiratory distress syndrome in newborn (perinatal) (P22.0)
Does J80 affect Medicare Advantage HCC risk adjustment? +
Yes. J80 maps to CMS-HCC v28 category 84. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is J80 a CC or MCC for inpatient DRG? +
Yes, this code is designated as MCC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with J80? +
Procedures frequently paired with J80 include: 99285.
What ICD-9 codes does J80 map to? +
Per CMS GEMs, J80 maps to ICD-9 codes: 51882. 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 June 1, 2026.
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