2025 ICD-10-CM code J96.9
(Valid) Effective Date: N/A Respiratory - Other diseases of the respiratory system Diseases of the respiratory system (J00-J99) Feed
Respiratory failure, unspecified.
Medical necessity is established by the clinical evidence of impaired gas exchange.This is usually demonstrated by abnormal arterial blood gases, along with signs and symptoms of respiratory distress.The documentation must support the severity of the respiratory failure and the need for interventions like oxygen therapy or mechanical ventilation.
Physicians evaluating and treating patients with respiratory failure use this code when the underlying cause is not yet determined or when it's necessary to document the respiratory failure itself as a significant condition, separate from any underlying diagnosis.
In simple words: This code signifies a general dysfunction in breathing, where the lungs are not effectively transferring oxygen into the blood and removing carbon dioxide, without specifying the underlying cause.It can lead to low oxygen levels and a buildup of carbon dioxide in the body.
A disorder characterized by impaired gas exchange by the respiratory system resulting in hypoxemia (low blood oxygen) and decreased oxygenation of the tissues. This may be associated with hypercapnia (increased arterial levels of carbon dioxide).
Example 1: A patient presents to the emergency room with shortness of breath, cyanosis, and altered mental status. Blood gas analysis reveals low oxygen and high carbon dioxide levels, indicating respiratory failure. The underlying cause is not immediately apparent, so J96.9 is used until further investigation (e.g., imaging, additional lab tests) can pinpoint the etiology., A patient with a history of chronic obstructive pulmonary disease (COPD) experiences an acute exacerbation, leading to worsening shortness of breath and decreased oxygen saturation. While the COPD is the underlying cause, the acute respiratory failure is a significant clinical concern and is coded as J96.9 in addition to the COPD code., A patient post-operatively develops difficulty breathing and requires supplemental oxygen.Initial assessments suggest respiratory failure, but the exact cause is unclear.J96.9 is used until the medical team can determine if the issue is related to anesthesia, surgical complications, or another underlying factor.
Documentation should include signs and symptoms of respiratory distress (e.g., shortness of breath, rapid breathing, cyanosis), arterial blood gas values demonstrating hypoxemia and possibly hypercapnia, and any diagnostic tests performed to identify the underlying cause. Clinical findings, such as auscultation of the lungs and chest x-ray results, are also important.
** Excludes1: acute respiratory distress syndrome (J80), cardiorespiratory failure (R09.2), newborn respiratory distress syndrome (P22.0), postprocedural respiratory failure (J95.82-), respiratory arrest (R09.2), respiratory arrest of newborn (P28.81), respiratory failure of newborn (P28.5). Excludes2: certain conditions originating in the perinatal period (P04-P96), certain infectious and parasitic diseases (A00-B99), complications of pregnancy, childbirth and the puerperium (O00-O9A), congenital malformations, deformations and chromosomal abnormalities (Q00-Q99), endocrine, nutritional and metabolic diseases (E00-E88), injury, poisoning and certain other consequences of external causes (S00-T88), neoplasms (C00-D49), smoke inhalation (T59.81-), symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94).
- Payment Status: Active
- Specialties:Pulmonology, Critical Care, Internal Medicine, Emergency Medicine, Hospitalists
- Place of Service:Inpatient Hospital, Emergency Room - Hospital, Office, Skilled Nursing Facility, Nursing Facility