ICD-10 Coding for Acute Hypoxemic Respiratory Failure(J96.01)
Complete ICD-10-CM coding and documentation guide for Acute Hypoxemic Respiratory Failure. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Acute Hypoxemic Respiratory Failure
J96.0-J96.02Primary Range
Acute respiratory failure
This range includes codes for acute respiratory failure, specifying hypoxia or hypercapnia.
Acute respiratory distress syndrome (ARDS)
Used when ARDS is present, cannot be coded with J96.01 due to Excludes1 note.
Key Information: ICD-10 code for acute hypoxemic respiratory failure
Essential facts and insights about Acute Hypoxemic Respiratory Failure
Primary ICD-10-CM Code for acute hypoxemic resp failure
Decision Criteria
clinical Criteria
- Presence of acute hypoxemia with documented intervention
coding Criteria
- Do not code with J80 due to Excludes1 note
Applicable To
- Acute hypoxemic respiratory failure
Excludes
- Acute respiratory distress syndrome (J80)
Clinical Validation Requirements
- PaO2 <60 mmHg or SpO2 <91% on room air
- P/F ratio <300
- Acute intervention required (e.g., HFNC, mechanical ventilation)
Code-Specific Risks
- Incorrectly coding without acute intervention documentation
- Confusing with ARDS
Coding Notes
- Ensure documentation specifies 'acute hypoxemic respiratory failure' and includes necessary clinical validation.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
COVID-19
U07.1Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Acute Hypoxemic Respiratory Failure to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code J96.01.
Impact
Clinical: May lead to inappropriate treatment plans., Regulatory: Fails to meet coding specificity requirements., Financial: Results in lower reimbursement rates.
Mitigation Strategy
Train staff on documentation specificity., Use templates that prompt for required details.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Violates Excludes1 note, risking compliance issues., Data Quality: Compromises data accuracy for clinical reporting.
Mitigation Strategy
Use J80 only when ARDS criteria are met and exclude J96.01.
Impact
Using J96.01 with J80 violates Excludes1 note.
Mitigation Strategy
Educate coders on code exclusivity rules.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Acute Hypoxemic Respiratory Failure, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Acute Hypoxemic Respiratory Failure
Use these documentation templates to ensure complete and accurate documentation for Acute Hypoxemic Respiratory Failure. These templates include all required elements for proper coding and billing.
Emergency Department Admission
Specialty: PulmonologyRequired Elements
- SpO2 levels
- Intervention details
- Underlying cause
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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