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ICD-10 Coding for Acute Hypoxic Hypercapnic Respiratory Failure(J96.01, J96.02)

Complete ICD-10-CM coding and documentation guide for Acute Hypoxic Hypercapnic Respiratory Failure. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Acute Respiratory Failure with Hypoxia and HypercapniaAcute Mixed Respiratory Failure

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Related ICD-10 Code Ranges

Complete code families applicable to Acute Hypoxic Hypercapnic Respiratory Failure

J96.0-J96.9Primary Range

Respiratory failure, not elsewhere classified

This range includes codes for various types of respiratory failure, including acute hypoxic and hypercapnic forms.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
J96.01Acute respiratory failure with hypoxiaUse when acute hypoxic respiratory failure is documented and validated by clinical findings.
  • pO2 <60 mmHg or SpO2 <91% on room air
  • P/F ratio <300
J96.02Acute respiratory failure with hypercapniaUse when acute hypercapnic respiratory failure is documented and validated by clinical findings.
  • pCO2 >50 mmHg with pH <7.35

Clinical Decision Support

Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.

Key Information: ICD-10 code for acute hypoxic hypercapnic respiratory failure

Essential facts and insights about Acute Hypoxic Hypercapnic Respiratory Failure

The ICD-10 codes for acute hypoxic hypercapnic respiratory failure are J96.01 and J96.02.

Primary ICD-10-CM Codes for acute hypoxic hypercapnic respiratory failure

J96.01
Acute respiratory failure with hypoxia
Billable Code

Decision Criteria

clinical Criteria

  • Presence of hypoxia as evidenced by ABG or pulse oximetry.

Applicable To

  • Acute hypoxic respiratory failure

Excludes

Clinical Validation Requirements

  • pO2 <60 mmHg or SpO2 <91% on room air
  • P/F ratio <300

Code-Specific Risks

  • Ensure hypoxia is specifically documented to avoid incorrect coding.

Coding Notes

  • Document specific hypoxic criteria to ensure proper coding.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

COPD with exacerbation

J44.1
Use when COPD exacerbation is the underlying cause of respiratory failure.

Pneumonia, unspecified organism

J18.9
Use when pneumonia is the underlying cause of respiratory failure.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Acute respiratory failure, unspecified

J96.00
Use J96.01 only when hypoxia is specifically documented.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Acute Hypoxic Hypercapnic 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: Leads to vague clinical records., Regulatory: Non-compliance with coding standards., Financial: Potential for reduced reimbursement.

Mitigation Strategy

Educate providers on the importance of specific documentation., Implement checklists for documentation completeness.

Impact

Reimbursement: Incorrect coding may lead to reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.

Mitigation Strategy

Ensure documentation specifies both hypoxic and hypercapnic components when present.

Impact

Lack of specificity in documenting respiratory failure types.

Mitigation Strategy

Implement training sessions on documentation standards.

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 Hypoxic Hypercapnic Respiratory Failure, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Acute Hypoxic Hypercapnic Respiratory Failure

Use these documentation templates to ensure complete and accurate documentation for Acute Hypoxic Hypercapnic Respiratory Failure. These templates include all required elements for proper coding and billing.

Acute respiratory failure in COPD exacerbation

Specialty: Pulmonology

Required Elements

  • Acuity of respiratory failure
  • Type: hypoxic, hypercapnic, or both
  • ABG results
  • Symptoms and clinical findings
  • Underlying etiology

Example Documentation

Patient presents with acute hypoxic and hypercapnic respiratory failure due to COPD exacerbation. ABG shows pO2 55 mmHg, pCO2 58 mmHg, pH 7.31.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Patient has acute respiratory failure.
Good Documentation Example
Acute hypoxic and hypercapnic respiratory failure secondary to COPD exacerbation, with ABG showing pO2 55 mmHg and pCO2 58 mmHg, pH 7.31.
Explanation
The good example provides specific details on the type of respiratory failure and supporting clinical data.

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