2025 ICD-10-CM code J96.1
(Active) Effective Date: N/A Revision Date: N/A Respiratory System Diseases - Other diseases of the respiratory system Chapter 10: Diseases of the respiratory system Feed
Chronic respiratory failure.
Medical necessity for the diagnosis and management of chronic respiratory failure is established based on the severity of the patient's symptoms (e.g., shortness of breath, fatigue, cyanosis), the presence of hypoxemia and/or hypercapnia, the impact on the patient's functional status, and the need for interventions to improve oxygenation and ventilation (e.g., oxygen therapy, non-invasive ventilation, respiratory medications).
The clinical responsibility for managing chronic respiratory failure involves assessment of the patient's respiratory status, identification of underlying causes, management of symptoms, and implementation of therapeutic interventions to improve oxygenation and ventilation.This may involve pulmonologists, intensivists, or other healthcare professionals depending on the severity and complexity of the case.
In simple words: Chronic respiratory failure means the lungs aren't working well enough to get enough oxygen into the blood and remove enough carbon dioxide. This is a long-term problem that needs ongoing medical care.
Chronic respiratory failure is a condition characterized by the inability of the respiratory system to adequately exchange oxygen and carbon dioxide, resulting in persistently low blood oxygen levels (hypoxemia) and/or elevated carbon dioxide levels (hypercapnia). This can be caused by various underlying conditions affecting the lungs, airways, or respiratory muscles.It is a long-term condition, often requiring ongoing medical management.
Example 1: A 70-year-old patient with a history of COPD presents with worsening shortness of breath, increased sputum production, and reduced exercise tolerance.Pulmonary function tests reveal severely reduced lung capacity, and arterial blood gas analysis shows hypoxemia and hypercapnia, consistent with chronic respiratory failure., A 65-year-old patient with neuromuscular disease experiences progressive weakness of the respiratory muscles, leading to decreased tidal volume and increased work of breathing. This results in chronic respiratory failure requiring non-invasive ventilation at home., A 55-year-old patient with cystic fibrosis develops chronic respiratory failure secondary to recurrent lung infections and progressive airway obstruction. This necessitates long-term oxygen therapy and aggressive pulmonary rehabilitation.
Comprehensive documentation should include a detailed history of the patient's respiratory symptoms, relevant past medical history, physical examination findings (including respiratory rate, effort, and auscultation), results of pulmonary function tests, arterial blood gas analysis, and imaging studies (chest X-ray, CT scan).Documentation should also include the patient's response to treatment and any complications encountered.
** This code is for chronic respiratory failure.Acute respiratory failure is coded differently.The underlying cause of the chronic respiratory failure should also be coded when known.
- Payment Status: Active
- Specialties:Pulmonology, Critical Care Medicine, Internal Medicine
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office, Skilled Nursing Facility