2025 ICD-10-CM code J96.91
(Valid) Effective Date: N/A Diseases of the respiratory system - Other diseases of the respiratory system 10 Feed
Respiratory failure, unspecified with hypoxia.
Medical necessity for this code is established by the presence of respiratory failure with documented hypoxia. The documentation must support the diagnosis and the need for medical intervention, including supplemental oxygen, mechanical ventilation, or other respiratory support.
It is crucial for physicians to accurately document the type of respiratory failure (acute, chronic, or acute and chronic), the presence of hypoxia or hypercapnia, and any underlying conditions contributing to the respiratory failure. This detailed documentation ensures proper coding and appropriate care management.
In simple words: This code indicates a problem with breathing where the body isn't getting enough oxygen, but the exact cause or timing isn't clear.
Respiratory failure, unspecified with hypoxia. This code is used when the patient is experiencing respiratory failure with insufficient oxygen levels in the blood, but it is not specified whether it is acute, chronic or post-procedural.
Example 1: A patient presents to the emergency department with shortness of breath and low oxygen saturation. The physician diagnoses respiratory failure with hypoxia, but further investigation is needed to determine if the condition is acute or chronic. The code J96.91 is used until a definitive diagnosis is made., A patient with a history of COPD experiences worsening shortness of breath and requires supplemental oxygen. Their oxygen levels remain low despite treatment. The physician documents chronic respiratory failure with hypoxia, but also notes an acute exacerbation. The combination code J96.21 (Acute and chronic respiratory failure with hypoxia) is used in this scenario, as it reflects both the chronic condition and the acute worsening., A patient undergoes a surgical procedure and develops difficulty breathing post-operatively. Their oxygen saturation drops, and they are diagnosed with post-procedural respiratory failure with hypoxia. The code J95.821 is used to capture the specific circumstance of respiratory failure following a procedure.
Documentation should clearly specify the acuity (acute, chronic, or acute and chronic), the presence of hypoxia, and any underlying medical conditions. Temporal parameters, complications, and contributing factors should also be documented where applicable. Note, the documentation for J96.91 does not specify whether hypoxia or hypercapnia is present. It is important to clearly document which is present, or the unspecified code should be used.
** Excludes certain conditions originating in the perinatal period (P04-P96), certain infectious and parasitic diseases (A00-B99), complications of pregnancy, childbirth, and the puerperium (O00-O9A), congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99), endocrine, nutritional, and metabolic diseases (E00-E88), injury, poisoning, and certain other consequences of external causes (S00-T88), neoplasms (C00-D49), smoke inhalation (T59.81-), and symptoms, signs, and abnormal clinical and laboratory findings not elsewhere classified (R00-R94).
- Payment Status: Active
- Specialties:Pulmonology, Critical Care Medicine, Internal Medicine, Emergency Medicine
- Place of Service:Inpatient Hospital, Emergency Room - Hospital, Office