ICD-10 Coding for Acute Respiratory Distress(J80, J96.01)
Complete ICD-10-CM coding and documentation guide for Acute Respiratory Distress. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Acute Respiratory Distress
J80Primary Range
Acute respiratory distress syndrome
This code is used for cases of ARDS, characterized by acute onset, bilateral infiltrates, and hypoxemia not fully explained by cardiac failure or fluid overload.
Acute respiratory failure
These codes are used for acute respiratory failure, which can be a component of ARDS or occur independently.
Abnormalities of breathing
These codes cover symptoms like respiratory distress that may accompany ARDS but do not meet full criteria for ARDS or respiratory failure.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| J80 | Acute respiratory distress syndrome | Use when clinical criteria for ARDS are met, including bilateral infiltrates and hypoxemia. |
|
| J96.01 | Acute respiratory failure with hypoxia | Use when there is documented hypoxemia with clinical signs of respiratory distress. |
|
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 respiratory distress
Essential facts and insights about Acute Respiratory Distress
Primary ICD-10-CM Codes for acute respiratory distress
Decision Criteria
clinical Criteria
- Bilateral infiltrates on imaging and hypoxemia not due to cardiac failure.
Applicable To
- Acute respiratory distress syndrome (ARDS)
Excludes
- Neonatal respiratory distress syndrome (P22.0)
Clinical Validation Requirements
- Acute onset within 7 days
- Bilateral opacities on chest imaging
- PaO2/FiO2 ratio ≤ 300 mmHg
- Exclusion of cardiac failure or fluid overload
Code-Specific Risks
- Misclassification as cardiogenic pulmonary edema
- Inadequate documentation of exclusion of cardiac causes
Coding Notes
- Ensure documentation clearly differentiates ARDS from other causes of respiratory distress.
J96.01 - Acute respiratory failure with hypoxia
Use when there is documented hypoxemia with clinical signs of respiratory distress.
Applicable To
- Acute hypoxic respiratory failure
Excludes
- Chronic respiratory failure (J96.10)
Clinical Validation Requirements
- SpO2 ≤ 90% on room air
- PaO2 < 60 mmHg
- Tachypnea and use of accessory muscles
Coding Notes
Ensure hypoxemia is documented with objective measures.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Acute Respiratory Distress to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code J80.
Impact
Clinical: May lead to misdiagnosis of respiratory conditions., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Ensure ABG or pulse oximetry results are included in documentation.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Document exclusion of cardiac failure through clinical assessment and imaging.
Impact
Lack of detailed clinical documentation can lead to audit flags.
Mitigation Strategy
Implement standardized documentation templates and training.
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 Respiratory Distress, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Acute Respiratory Distress
Use these documentation templates to ensure complete and accurate documentation for Acute Respiratory Distress. These templates include all required elements for proper coding and billing.
Emergency Department presentation with ARDS
Specialty: Emergency MedicineRequired Elements
- Patient demographics
- Chief complaint
- Vital signs
- ABG results
- Chest imaging findings
- Exclusion of cardiac causes
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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