2025 ICD-10-CM code J96.20
(Active) Effective Date: N/A Respiratory Failure - Other diseases of the respiratory system (J96-J99) Diseases of the respiratory system (J00-J99) Feed
Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia.
Medical necessity for services related to respiratory failure is established by the severity of the condition and the need for interventions such as oxygen therapy, mechanical ventilation, or treatment of underlying causes. Documentation should support the need for these interventions.
The physician is responsible for determining the underlying cause of the respiratory failure, managing the patient's condition (which may include oxygen therapy, mechanical ventilation, and treatment of underlying conditions), and documenting the type and acuity of the respiratory failure.
In simple words: This code indicates a patient is experiencing both acute (sudden onset) and chronic (long-term) respiratory failure.It signifies the lungs are not providing enough oxygen to the body or removing enough carbon dioxide, but it doesn't specify whether low oxygen (hypoxia) or high carbon dioxide (hypercapnia) is the primary issue.
Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia.
Example 1: A patient with a long history of COPD experiences a sudden worsening of symptoms, including shortness of breath and low oxygen saturation, requiring hospitalization and mechanical ventilation. This represents an acute exacerbation of chronic respiratory failure., A patient with cystic fibrosis has progressively worsening lung function and requires continuous supplemental oxygen. They are admitted to the hospital for a respiratory infection. The chronic respiratory failure should be coded, along with the infection., A patient with both emphysema and congestive heart failure develops difficulty breathing and is found to have both low oxygen and high carbon dioxide levels in their blood. This represents acute and chronic respiratory failure.
Documentation should clearly specify the acuity (acute, chronic, or both) and type of respiratory failure (with or without hypoxia or hypercapnia). The underlying cause of respiratory failure should also be documented and coded. Supporting documentation may include arterial blood gas results, pulmonary function tests, and imaging studies.
** It is important to differentiate between acute, chronic and acute and chronic respiratory failure for accurate coding and reimbursement.
- Payment Status: Active
- Specialties:Pulmonology, Critical Care Medicine, Internal Medicine, Hospital Medicine
- Place of Service:Inpatient Hospital, Emergency Room - Hospital