ICD-10 Coding for Hypoxia Respiratory Failure(J96.01)
Complete ICD-10-CM coding and documentation guide for Hypoxia Respiratory Failure. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hypoxia Respiratory Failure
J96.0-J96.2Primary Range
Acute and chronic respiratory failure
This range includes codes for acute and chronic respiratory failure with hypoxia or hypercapnia.
Key Information: ICD-10 code for acute hypoxic respiratory failure
Essential facts and insights about Hypoxia Respiratory Failure
Primary ICD-10-CM Code for hypoxia respiratory failure
Decision Criteria
clinical Criteria
- Documented PaO2 <60 mmHg or SpO2 <90% on room air.
coding Criteria
- Primary code if hypoxia is the main reason for admission.
documentation Criteria
- Include ABG results and specific etiology.
Applicable To
- Acute hypoxic respiratory failure
Excludes
- Acute respiratory distress syndrome (ARDS) (J80)
Clinical Validation Requirements
- PaO2 <60 mmHg
- SpO2 <90% on room air
- ABG-confirmed hypoxia
Code-Specific Risks
- Risk of incorrect coding if hypoxia is not documented with ABG or SpO2 values.
Coding Notes
- Ensure documentation specifies acute hypoxia with ABG or SpO2 values.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
COPD with acute exacerbation
J44.1Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hypoxia 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 inadequate treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential loss of reimbursement due to incorrect DRG.
Mitigation Strategy
Educate clinicians on the importance of specific terminology., Use templates that prompt for specific documentation.
Impact
Reimbursement: May lead to lower DRG assignment and reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Query for specificity to use J96.01 if hypoxia criteria are met.
Impact
Risk of audits if hypoxia is not documented with ABG or SpO2 values.
Mitigation Strategy
Ensure all cases of hypoxia are supported by ABG results.
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 Hypoxia Respiratory Failure, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hypoxia Respiratory Failure
Use these documentation templates to ensure complete and accurate documentation for Hypoxia Respiratory Failure. These templates include all required elements for proper coding and billing.
Emergency Department Admission
Specialty: PulmonologyRequired Elements
- Acuity of respiratory failure
- ABG results
- SpO2 levels
- Underlying cause
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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