2025 ICD-10-CM code J96.10
(Active) Effective Date: N/A Respiratory Failure - Other diseases of the respiratory system (J96-J99) Diseases of the respiratory system (J00-J99) Feed
Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia.
Medical necessity for this diagnosis would be supported by documentation of the signs, symptoms, and diagnostic test results consistent with chronic respiratory failure. This could include, but is not limited to, physical exam findings, arterial blood gas results, pulmonary function tests, and imaging studies.
Physicians use this code to reflect the patient's respiratory condition on their medical record and insurance claims to facilitate proper treatment and reimbursement. It is essential to accurately document the type of respiratory failure to ensure the most appropriate care.
In simple words: This code indicates long-term breathing problems where the lungs aren't effectively supplying oxygen to the body or removing carbon dioxide, but it's unclear if it is due to low oxygen, high carbon dioxide, or both.
This code signifies chronic respiratory failure where it is not specified whether hypoxia (low oxygen levels in the blood) or hypercapnia (high carbon dioxide levels in the blood) are present.It is used when the documentation does not clearly indicate which of these conditions, or both, are contributing to the patient's chronic respiratory failure.
Example 1: A patient with a long history of COPD presents with shortness of breath and fatigue. Lab tests reveal low oxygen saturation, but no specific mention of carbon dioxide levels is made in the physician's notes. In this case, J96.10 is appropriate as the type of chronic respiratory failure is not specified. Further investigation is needed to determine if hypercapnia is also present., A patient with cystic fibrosis experiences increasing difficulty breathing over several months. Their medical record indicates ongoing respiratory issues, but the current documentation does not specify whether the failure is primarily due to hypoxia or hypercapnia.J96.10 would be applied until further details are available., A patient with pulmonary fibrosis is admitted to the hospital with exacerbated respiratory symptoms. The physician documents chronic respiratory failure, but doesn't specify whether it's with hypoxia, hypercapnia, or both. Code J96.10 would be used for this encounter.
The documentation should clearly state "chronic respiratory failure". If the physician has determined whether hypoxia or hypercapnia is present, those details should be documented for more specific coding; if neither hypoxia nor hypercapnia are specifically documented, then code J96.10 is appropriate.Documentation of underlying conditions such as COPD or cystic fibrosis is important as well.
- Specialties:Pulmonology, Critical Care Medicine, Internal Medicine, Family Medicine
- Place of Service:Inpatient Hospital, Office, Home