2025 ICD-10-CM code J96.00
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Respiratory System Diseases - Other diseases of the respiratory system (J96-J99) Chapter 10: Diseases of the respiratory system (J00-J99) Feed
Acute respiratory failure, unspecified whether with hypoxia or hypercapnia.
Modifiers may be applicable depending on the specific circumstances of the case. Consult current modifier guidelines.
Medical necessity for coding J96.00 is established by documentation of clinical findings consistent with acute respiratory failure, including objective evidence of impaired gas exchange and the need for intervention.
The clinical responsibility involves diagnosing and managing acute respiratory failure, which may include administering oxygen therapy, mechanical ventilation, or medications to address underlying causes.Continuous monitoring of vital signs and respiratory function is crucial.
- Chapter 10: Diseases of the respiratory system (J00-J99)
- J96-J99: Other diseases of the respiratory system
In simple words: This code indicates a sudden and serious problem with breathing, where the body isn't getting enough oxygen or removing enough carbon dioxide. This can be caused by several lung conditions and needs immediate medical attention.
J96.00 signifies acute respiratory failure where the presence or absence of hypoxia (low blood oxygen) and hypercapnia (high blood carbon dioxide) is not specified.This code encompasses various conditions leading to insufficient gas exchange, such as pneumonia, pulmonary edema, or chronic obstructive pulmonary disease (COPD) exacerbations.The diagnosis requires clinical assessment, including arterial blood gas analysis to confirm impaired respiratory function.
Example 1: A 70-year-old male with a history of COPD presents to the emergency department with worsening shortness of breath, tachypnea, and decreased oxygen saturation.Arterial blood gases reveal hypoxemia and hypercapnia.J96.00 is assigned., A 55-year-old female with pneumonia develops acute respiratory distress. Despite oxygen therapy, her respiratory status deteriorates requiring intubation and mechanical ventilation.J96.00 is appropriate., A 25-year-old male is involved in a motor vehicle accident and sustains multiple rib fractures resulting in pneumothorax and acute respiratory failure.J96.00 is used along with codes for the rib fractures and pneumothorax.
* Complete history and physical examination.* Respiratory assessment including respiratory rate, oxygen saturation, and work of breathing.* Arterial blood gas results.* Chest x-ray or other imaging studies as clinically indicated.* Documentation of treatment provided (e.g., oxygen therapy, mechanical ventilation, medications).
** This code should only be used when the clinical picture meets the criteria for acute respiratory failure. The specificity of hypoxia and hypercapnia should be addressed when possible.
- Revenue Code: Appropriate revenue codes will vary depending on the healthcare setting and the services provided. Consult your local fee schedule for specifics.
- RVU: RVUs vary based on location, facility type, and other factors.Consult the relevant fee schedule for reimbursement details.
- Global Days: Not applicable.This is a diagnosis code, not a procedural code.
- Payment Status: Active
- Modifier TC rule: Not applicable to this diagnosis code.
- Fee Schedule: Historical fee schedules are not applicable to diagnosis codes.Consult payer-specific reimbursement guidelines.
- Specialties:Pulmonology, Critical Care Medicine, Emergency Medicine, Internal Medicine
- Place of Service:Inpatient Hospital, Emergency Room - Hospital, Outpatient Hospital, Skilled Nursing Facility