2025 ICD-10-CM code J96.90
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Respiratory System Diseases - Other diseases of the respiratory system Chapter 10: Diseases of the respiratory system Feed
Respiratory failure, unspecified, with or without hypoxia or hypercapnia.
Medical necessity for coding J96.90 is established when the patient demonstrates clinical signs and symptoms of respiratory failure, irrespective of the specified presence or absence of hypoxia or hypercapnia. The medical record should clearly show the clinical indication for the diagnosis, potentially including respiratory distress, shortness of breath, hypoxemia, and/or hypercapnia (if available). Supporting documentation, like arterial blood gas results, is crucial for demonstrating medical necessity.
The clinical responsibility for coding J96.90 rests with the physician or qualified healthcare professional who manages the patient's respiratory condition. This involves correctly assessing the acuity (acute, chronic, or both), type (hypoxemia, hypercapnia, or unspecified), and any underlying conditions contributing to the respiratory failure. The clinician also needs to ensure proper documentation in the medical record to support the chosen code.
In simple words: This code means the patient has trouble breathing, and it's unclear if their blood oxygen is low or their blood carbon dioxide is high.Doctors use this when they don't have enough information to use a more precise code.
This ICD-10-CM code signifies respiratory failure where the presence of hypoxia (low blood oxygen) or hypercapnia (high blood carbon dioxide) is not specified.It encompasses cases of unspecified respiratory failure,acute, chronic, or both acute and chronic, when the oxygen and carbon dioxide levels are unknown or not documented.This code should be used when more specific information is unavailable in the patient's medical record.Additional codes may be necessary to specify contributing factors, such as underlying conditions or environmental exposures.
Example 1: A 70-year-old patient with a history of COPD presents to the emergency department with acute shortness of breath.Oxygen saturation is 88% on room air.Arterial blood gas analysis is not available.The physician diagnoses acute respiratory failure, unspecified., A 65-year-old patient with cystic fibrosis is admitted for worsening respiratory symptoms.They have been experiencing chronic respiratory failure for years but are now acutely decompensating.The physician documents acute and chronic respiratory failure, unspecified., A 50-year-old post-operative patient experiences respiratory distress following abdominal surgery.Their oxygen saturation is low, and carbon dioxide levels are elevated, however, due to incomplete lab results, it is documented as respiratory failure, unspecified.
Complete and accurate documentation is critical for appropriate coding. This includes the acuity of the respiratory failure (acute, chronic, or both), the presence or absence of hypoxia and hypercapnia, any underlying respiratory or other conditions contributing to the failure, details of oxygen therapy, ventilation support, and other treatment modalities.Arterial blood gas values, pulse oximetry readings, and respiratory rate documentation are all very helpful.
** The utilization of J96.90 may be higher in specific patient populations with underlying chronic conditions affecting respiratory function.
- Payment Status: Active
- Specialties:Pulmonology, Critical Care Medicine, Internal Medicine, Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Emergency Room - Hospital, Skilled Nursing Facility, other