2025 ICD-10-CM code J96.01
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Diseases of the respiratory system - Other diseases of the respiratory system (J96-J99) Chapter 10: Diseases of the respiratory system (J00-J99) Feed
Acute respiratory failure with hypoxia.
Modifiers may be applicable depending on the circumstances of the encounter and the specific services rendered. Consult the official coding guidelines for appropriate modifier usage.
Medical necessity is established by the presence of acute respiratory failure, documented by clinical symptoms and objective findings (such as arterial blood gas analysis and imaging), demonstrating a significant impairment of gas exchange (oxygenation and/or carbon dioxide removal) that poses an immediate threat to life or requires urgent intervention to prevent serious complications or death.
The clinical responsibility involves the diagnosis and management of acute respiratory failure, including oxygen therapy, mechanical ventilation (if needed), treatment of underlying causes, and monitoring of vital signs and respiratory status. This requires a comprehensive assessment of the patient's clinical presentation, arterial blood gases, and chest imaging.Ongoing monitoring and adjustments to treatment plans are essential to ensure adequate oxygenation and prevent complications.
- Chapter 10: Diseases of the respiratory system (J00-J99)
- Other diseases of the respiratory system (J96-J99)
In simple words: This code indicates a serious and sudden problem with breathing where the body isn't getting enough oxygen.It's a life-threatening condition requiring immediate medical attention.Symptoms can include difficulty breathing, rapid breathing, and feeling confused or anxious.
J96.01, Acute respiratory failure with hypoxia, signifies a rapidly developing, severe, and life-threatening impairment of the body's ability to adequately absorb oxygen or expel sufficient carbon dioxide. This condition is characterized by symptomatic presentation and necessitates substantial medical intervention.Symptoms may include shortness of breath, rapid breathing (tachypnea), intercostal retractions, anxiety, lethargy, or confusion.The diagnosis requires a clinical assessment, often including arterial blood gas analysis and chest x-ray, to confirm the presence of both acute respiratory failure and hypoxia (low blood oxygen levels).
Example 1: A 70-year-old male with a history of COPD presents to the emergency department with severe shortness of breath, increased work of breathing, and altered mental status.Arterial blood gas analysis reveals hypoxemia and hypercapnia.The patient requires intubation and mechanical ventilation., A 55-year-old female with pneumonia develops acute respiratory distress and hypoxemia requiring high-flow oxygen therapy. Her condition improves with antibiotic treatment and supportive care., A 30-year-old male involved in a motor vehicle accident experiences severe chest trauma leading to acute respiratory failure and hypoxia, necessitating immediate intubation and mechanical ventilation in the ICU.
Detailed history and physical examination, including respiratory assessment (rate, rhythm, depth, effort, presence of crackles, wheezes); arterial blood gas results showing hypoxemia (low PaO2) and potentially hypercapnia (high PaCO2); chest x-ray findings; results of any other relevant investigations (e.g., pulmonary function tests); documentation of interventions and response to treatment, anddetailed progress notes.
** The severity of acute respiratory failure with hypoxia can range from mild to severe, requiring varying levels of intervention from supplemental oxygen to mechanical ventilation. Accurate coding requires detailed documentation of the patient's clinical presentation, diagnostic findings, and treatment provided.
- Payment Status: Active
- Specialties:Pulmonology, Critical Care Medicine, Emergency Medicine, Internal Medicine
- Place of Service:Inpatient Hospital, Emergency Room - Hospital, Intensive Care Unit (ICU), Ambulatory Surgical Center,Other Place of Service (depending on the clinical setting)