Respiratory Failure ICD-10-CM codes

The fourth character of J96 gives acuity: J96.0- acute, J96.1- chronic, J96.2- acute and chronic (acute on chronic), and J96.9- unspecified. The fifth character specifies the gas exchange problem: 0 unspecified, 1 with hypoxia, 2 with hypercapnia. Acute hypoxic respiratory failure is J96.01 and acute hypercapnic failure is J96.02; when both hypoxia and hypercapnia are documented, assign both codes because there is no combination code.

Respiratory failure may be principal diagnosis when it is the condition that occasioned the admission and no chapter-specific sequencing rule (obstetrics, poisoning, HIV, newborn) applies. When it is present on admission together with another acute condition such as MI, stroke, or aspiration pneumonia, either may be sequenced first depending on the circumstances of admission, and if it develops after admission it is always secondary.

Hypoxemia without a diagnosis of respiratory failure is R09.02. Acute respiratory distress syndrome is J80 and is excluded from J96. Respiratory failure following surgery is J95.821 (acute) or J95.822 (acute and chronic) rather than J96, and it should only be coded when the provider documents it as a complication of the procedure.

For chronic respiratory failure, add Z99.81 when the patient depends on home oxygen and Z99.11 for ventilator dependence. Chronic respiratory failure is frequently a secondary diagnosis in COPD, neuromuscular disease, and obesity hypoventilation, so check that the acuity in the code matches the documentation.