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ICD-10 Coding for Chronic Hypoxic Respiratory Failure(J96.11)

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

Also known as:

Chronic Respiratory Failure with HypoxiaChronic Hypoxemic Respiratory Failure

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Related ICD-10 Code Ranges

Complete code families applicable to Chronic Hypoxic Respiratory Failure

J96.1-J96.12Primary Range

Chronic respiratory failure codes

This range includes codes for chronic respiratory failure with and without hypoxia.

Key Information: ICD-10 code for chronic hypoxic respiratory failure

Essential facts and insights about Chronic Hypoxic Respiratory Failure

The ICD-10 code for chronic hypoxic respiratory failure is J96.11, used when chronic hypoxia exists without acute exacerbation.

Primary ICD-10-CM Code for chronic hypoxic respiratory failure

J96.11
Chronic respiratory failure with hypoxia
Billable Code

Decision Criteria

clinical Criteria

  • ABG shows chronic hypoxemia without acute hypercapnia.

documentation Criteria

  • Document baseline PaO2 and O2 delivery method.

Applicable To

  • Chronic hypoxic respiratory failure

Excludes

  • Acute respiratory distress syndrome (J80)
  • Acute respiratory failure (J96.0-)

Clinical Validation Requirements

  • ABG shows PaO2 ≤55 mmHg on room air
  • SpO2 ≤88% for ≥5 mins without exertion
  • Requires daily supplemental O2

Code-Specific Risks

  • Mixing acute and chronic conditions
  • Not specifying hypoxia

Coding Notes

  • Ensure documentation specifies chronicity and excludes acute exacerbation.
View Full Code Details

Ancillary Codes

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

COPD with acute exacerbation

J44.1
Use when COPD exacerbation causes chronic hypoxic respiratory failure.

Differential Codes

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

Acute respiratory failure with hypoxia

J96.01
Use J96.01 for new-onset hypoxia (<48hrs).

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Chronic Hypoxic Respiratory Failure to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code J96.11.

Impact

Clinical: Leads to misinterpretation of patient's condition., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims due to insufficient documentation.

Mitigation Strategy

Use precise terminology in documentation., Educate staff on correct clinical terms.

Impact

Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.

Mitigation Strategy

Use J96.21 + J96.11 when acute component exists.

Impact

Failure to differentiate chronic from acute respiratory failure.

Mitigation Strategy

Implement documentation checks for chronicity indicators.

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

Documentation Templates for Chronic Hypoxic Respiratory Failure

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

Chronic hypoxic respiratory failure in COPD patient

Specialty: Pulmonology

Required Elements

  • O2 requirement
  • Baseline ABG
  • Exacerbation exclusion

Example Documentation

Chronic Hypoxic Respiratory Failure Status: O2 requirement: 2 L/min via NC. Baseline ABG: pH 7.38, PaO2 52 mmHg, PaCO2 42 mmHg. Exacerbation excluded by stable symptoms.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Patient has long-standing lung disease with low oxygen.
Good Documentation Example
Chronic hypoxic respiratory failure secondary to stage IV COPD, requiring continuous 2L O2 via NC. ABG on room air: pH 7.38, PaO2 52 mmHg, PaCO2 42 mmHg. No acute exacerbation.
Explanation
The good example specifies the chronicity, underlying condition, and excludes acute exacerbation.

Need help with ICD-10 coding for Chronic Hypoxic Respiratory Failure? Ask your questions below.

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