2025 ICD-10-CM code J96
Respiratory failure not otherwise specified.
Medical necessity for the diagnosis of respiratory failure is established when the patient demonstrates clinical signs and symptoms of inadequate oxygenation or carbon dioxide removal, requiring intervention to maintain respiratory function. This often involves oxygen therapy, mechanical ventilation, and treatment of the underlying condition causing the respiratory failure.
Physicians, including pulmonologists, intensivists, hospitalists, and emergency medicine physicians, are responsible for diagnosing and managing respiratory failure. They use various tools such as blood gas analysis, pulmonary function tests, and imaging studies to assess the severity and cause of respiratory failure. Treatment includes ensuring adequate oxygenation, supporting ventilation if needed, and addressing the underlying cause.
In simple words: This code signifies a failure of the lungs to adequately oxygenate the blood or remove carbon dioxide, but it doesn't specify the underlying cause or type of respiratory failure.It's a general term encompassing various conditions where the lungs aren't functioning effectively for gas exchange.This code excludes conditions like acute respiratory distress syndrome or respiratory arrest, which are coded separately due to their distinct clinical presentations.
Respiratory failure, not elsewhere classified. 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)
Example 1: A patient with chronic obstructive pulmonary disease (COPD) experiences worsening shortness of breath and low oxygen levels, requiring hospitalization for acute respiratory failure., A patient develops pneumonia, leading to impaired lung function and respiratory failure., Following major surgery, a patient experiences respiratory failure due to complications like atelectasis (lung collapse).
Documentation should include details of the patient's symptoms, physical exam findings (such as respiratory rate, oxygen saturation, and lung sounds), arterial blood gas results, chest x-ray or CT scan findings, and the underlying cause of respiratory failure.
** For subtypes of respiratory failure (acute, chronic, or unspecified, and further specifications related to hypoxia and/or hypercapnia), utilize the more specific codes under J96 (e.g., J96.00, J96.01, J96.10, J96.11, J96.20, J96.21, J96.90, and J96.91). Ensure appropriate documentation to support the most specific code selection.
- Payment Status: Active
- Specialties:Pulmonary Disease, Critical Care Medicine, Internal Medicine, Emergency Medicine
- Place of Service:Inpatient Hospital, Emergency Room - Hospital, Skilled Nursing Facility